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Foot Bone or Joint Injury

Outer Foot Pain: What are the causes?

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Posted 2 years ago


Last updated: 14/11/2023


by James McCormack

James McCormack
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Pain on the outer side of the foot is a very common source of foot pain. In this article, we discuss the most common conditions that cause pain on the foot’s outer side, their symptoms, and how they are managed.

Outer Foot Pain: Differential Diagnosis

5th Metatarsal Stress Fracture

The 5th Metatarsal is also known as the baby toe. It sits on the foot’s outer side and can be injured when excess pressure or force is applied. This is common in running or jumping activities but may occur from trauma such as a heavy object falling on it. If a small hairline fracture appears, this is known as a 5th Metatarsal Stress Fracture.

5th Metatarsal Stress Fracture Symptoms include sharp pain on weight-bearing, swelling, redness, and there may be some bruising. It is typically painful to walk and tender to touch. It is diagnosed through an x-ray in the initial instance. In some cases, there can be 5th metatarsal pain with no fracture. In this instance, it is regarded as a bone stress response, and we still manage it similarly to fracture. 

Treatment involves a period in a Walker Boot, typically 4-6 weeks. This is followed by 4-6 weeks of Physical Therapy.

Related Article: What exercise can I do with a 5th Metatarsal Fracture?

Peroneal Tendonitis

Three Peroneus muscles run along the outer shin and wrap around the lateral ankle, with 2 of the three attaching to the 5th Metatarsal bone.

Overuse or overload of these muscles can lead to Peroneal Tendonitis. When overload occurs on the tendon closest to its attachment on the 5th Metatarsal, it is often referred to as a Peroneal Enthesopathy (outer metatarsal pain). It can often be confused as a 5th Metatarsal Stress Fracture.

Symptoms include pain and stiffness in the morning and pain with activity that may ease as the tendon warms up.

Treatment usually is conservative under the guidance of a Physical Therapist. Treatment includes strengthening exercises, taping, insoles and gait analysis.

Cuboid Syndrome

The cuboid bone is a small bone on the outside of the foot. Its name derives from its cube-like shape, and it can become painful if excess repetitive pressure is placed through it or as the result of a sudden twist or turn.

This can lead to a slight movement or subluxation of the cuboid bone, which is referred to as cuboid syndrome.

It is often tender to touch the Cuboid bone and painful to do a heel raise or rotate the midfoot. It is an uncommon injury and, therefore, often misdiagnosed.

Symptoms can self-resolve with relative rest. If this is not the case, seeing a Podiatrist, Physical Therapist or Osteopath is recommended. Treatment includes massage, manipulation, mobilisation, taping, and custom insoles.

Mortons Neuroma

Between each toe in the foot, a webspace holds the interdigital nerve. Compression to any of these nerves can lead to pain and swelling of the nerve, commonly between the 2nd and 3rd metatarsals, but can occur between the 4th and 5th metatarsals (Iselins Neuroma).

Poor biomechanics, poorly fitted footwear and foot deformity can lead to compression of the interdigital nerve and the formation of Morton’s Neuroma.

Symptoms include burning-type pain, pins and needles, numbness, and the feeling of a pebble in one’s shoe when walking. You can diagnose Morton’s Neuroma through an ultrasound scan or an MRI.

Treatment from a Podiatrist or root specialist Physical Therapist can include mobilisations, stretching, stability exercises, and custom insoles. If this fails, it may be necessary to have an ultrasound-guided steroid injection or surgery.

Sinus Tarsi Syndrome

The Sinus Tarsi is a small tunnel that runs outside the ankle joint. It hosts an array of ligaments, tendons, blood vessels, and nerve endings. The sinus tarsi can become irritated by abnormal foot structure, flat foot deformity, lateral ankle sprains, or systemic conditions.

When the Sinus Tarsi is irritated, it is called Sinus Tarsi Syndrome, and it can lead to pain, tingling, and burning along the lateral ankle and lateral foot.

Treatment includes ice, anti-inflammatories, Physical Therapy, and custom insoles typically. Sinus Tarsi Syndrome can require an ultrasound-guided steroid injection for irritable cases.

Related Article: Best Shoes for Sinus Tarsi Syndrome

Lateral Foot Coalition

This rare condition involves the coalition of two bones outside the foot. This normal congenital condition is usually not noticed until the second generation or later in a person’s life.

It can cause pain and stiffness outside the foot, especially in sports or wearing unsupportive footwear. It may promote an abnormal gait pattern.

Treatment often includes custom insoles and footwear advice. Failing this, you may require surgery.

Physiotherapy with James McCormack

This article is written by James McCormack, a Lower Limb Specialist who is an expert in treating Foot Pain.

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack if you are experiencing any of the symptoms discussed in this article. James offers Online Physiotherapy Appointments weekly and face-to-face appointments in his London clinic.

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