Ever had pain on the outside of your foot or ankle for no known reason? This is not one of the more common complaints for foot pain, however we will try to help eliminate the mystery of why your foot is hurting in that area. There are many problems that arise on the outside of your foot, but before we dive into the specific issue that you may have, let’s teach you some basics about your foot anatomy.
The Basics of Your Foot
The foot is composed of 26 bones and the anatomy is complex. One basic principle is that the inner half of the foot is built to take more stress than the outer half of the foot. The midfoot area is composed of multiple small bones called tarsal bones, and these are then connected to the long bones that extend out that form the ball of your foot. The first metatarsal bone that forms the great toe joint along with the 2nd and 3rd bones form the inner arch. The 4th and 5th metatarsals that connect the largest metatarsal bone called the cuboid bone form the lateral arch.
The cuboid bone is also connected to the heel bone. A very basic principle of lateral heel pain is that if you have pain along the inner part of your foot. For example, the big toe joint, by favoring the great toe joint, you tend to throw your weight on the outside of your foot, therefore causing lateral foot pain. The same may be true with plantar fasciitis. This presents itself with pain beneath your heel bone, and by rolling your weight on the outside of your foot, it tends to make the heel pain feel better. Lateral foot pain treatment may involve a combination of therapies, including adjusting foot posture.
Common Problems That Cause Lateral Foot Pain
Ankle Sprains
When you sprain your ankle, it is common to injure the ligaments of the outer ankle that connect the leg bone, called the fibula, to the foot bones. An ankle sprain is usually an obvious injury; however, pain can persist in this area for an extended period of time. It is also one of the most common ankle injuries in the foot and ankle. In cases like this, lateral foot pain treatment can often include rest and physical therapy.
Fractures
Traumatic Fractures
- Jones Fracture – A Jones fracture occurs when you land on the outside of your foot, putting a significant amount of your body weight on the 5th metatarsal bone. This causes a fracture which may go through the entire 5th metatarsal bone close to the midfoot area.
- Fracture of the 5th Metatarsal Base – This usually occurs from an ankle sprain. The peroneus brevis tendon, which helps support your foot from moving side to side, attaches to the 5th metatarsal base. When you twist your ankle, this tendon may pull so hard on the bone that it will create a fracture called fracture of the 5th metatarsal base.
- Stress Fracture of the Cuboid Bone – Stress fractures along the lateral aspect of your foot are not as common as those along the medial portion. However, the most common may be a fracture through the cuboid bone, which is the large bone in the middle part of the lateral arch that attaches your 4th and 5th metatarsal bones to your heel bone (the calcaneus).
Tendinitis
There are two tendons that start as muscles on the outer part of your legs and extend to the lateral part of your ankle and into your foot. One is called the peroneus longus, and the other is peroneus brevis. Both function to stabilize your foot and ankle. Tendinitis or tendon tears may occur in these tendons due to overuse or compensating for pain elsewhere in the foot, where these tendons may be overworked.
Sural Nerve Pain
The sural nerve is a nerve branch that originates in the leg and runs down on the side of the foot to the 5th. It can get inflame from trauma and possibly from peroneal tendinitis because of the swelling that takes place in the tendons and the nerve passes over these tendons. Lateral foot pain treatment for this condition may involve anti-inflammatory medications or nerve-blocking injections.
Cuboid Syndrome
Cuboid Syndrome would cause pain in the mid portion of the outer part of your foot, usually where the cuboid bone connects to the heel bone. Because of rolling your foot to the outside in favoring, compensating, or from trauma, the joint from the calcaneus and cuboid may be out of alignment. Correcting the alignment is a key part of lateral foot pain treatment.
Sinus Tarsi Syndrome
The sinus tarsi is a small depression just below the ankle on the outer part of your foot. This depression leads to the subtalar joint, which is the joint between the ankle bone, the talus, and the heel bone, the calcaneus. The subtalar joint is a complex joint that allows your foot to move like a universal joint on a car. There are two ligaments on that joint that become inflamed from overuse or trauma and will cause pain in this location.
How Will the Foot and Ankle Specialist Diagnose My Problem?
Physical Examination and History
From your medical history, the doctor may be able to discover an area of pain that caused you to favor your foot and thereby this compensation led to pain on the lateral portion of your foot. Based upon where the location is note, there may be pain and swelling noted on the area, and the following tests may be done:
- X-rays – X-rays may be use to rule out fractures or stress fractures, which are small cracks in the bones.
- MRI – MRI is a useful tool to evaluate for stress fractures or tendon tears or specifically peroneal tendinitis.
- Diagnostic Ultrasound – Diagnostic Ultrasound may also be useful in assessing the tendons.
Treatments
Depending on the diagnosis, physical therapy may be recommend along with the use of anti-inflammatory medications and reduction of activities to get you back to full physical activity. In cases of lateral foot pain, treatments can vary from conservative to surgical approaches.
Immobilization
If a fracture is note, using a CAM walker for a period of weeks may be recommend by your foot and ankle specialist.
Orthotics
Custom-made arch supports are very useful for many conditions such as cuboid pain, tendinitis, and sinus tarsi syndrome.
Cortisone Injections
Cortisone injections may be useful for treatment of nerve conditions on the lateral aspect of the foot (sural nerve pain) and also sinus tarsi syndrome.
Regenerative Medicine/Human Cellular Tissue Products
This treatment can be helpful for arthritic joints or for peroneal tendon tears, which occur on the lateral aspect of the foot. This treatment is often refere to as stem cell treatment.
Surgery
In the case of a Jones fracture, this typically is a slow-healing fracture, possibly because of lack of blood flow to this area, and surgery may be necessary to ensure that the bones heal properly and are in proper anatomical position.
Finally, if you are finding you have pain on the outer edge of the foot and the attempts that you have made, including resting the area and anti-inflammatories, it may be time for you to schedule an appointment with a foot and ankle specialist so that they may eliminate the mystery of this problem.
