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Lateral Foot Pain

Lateral Foot Pain: How To Address It?

The recurring pain that runs along the outside edge of the foot (the little toe side of the foot) and ankle is known as lateral foot pain. Lateral foot pain can be demobilizing to some degree and described as a symptom rather than a diagnosis. This type of pain occurs before, during, and after activities, like exercising or running [1].

Lateral foot pain makes a person susceptible to ankle sprains and injuries. Severe cases make it difficult for an individual to stand on the affected side. Usually, it is advised to not diagnose the pain yourself because it can lead to more complications. Accurate diagnosis and quality treatment should be received by a trusted physician.

What Are The Symptoms Coinciding With Lateral Foot Pain?

It often often starts gradually as a result of many factors, including weight-bearing, poor footwear, and poor biomechanics. Below are some symptoms that often coincide with lateral foot pain:

  • Difficulty walking or doing activities, like weight-bearing.
  • Pain on the outside of the foot that remains for a moderate duration.
  • Swelling and tenderness in the foot.
  • Inability to stand properly on foot.
  • Susceptibility to ankle sprains.

What Are The Causes Of Lateral Foot Pain?

Lateral foot pain arises from conditions that have been left unchecked. Some common causes include:

1. Stress Fracture: 

Repetitive pressure on the feet during weight-bearing activities, like jumping, pivoting, or running, results in a stress fracture. Feet are more prone to tiny cracks and stress fractures because they can sustain high levels of loading. Typically, stress fractures developing on the outer edge of the foot occur in the metatarsal head or 5th metatarsal, resulting in sudden pain that worsens over time [2]. People with flat feet or higher foot arch also tend to suffer more from foot problems.

Pain is felt as deep, achy pain that worsens every time a person lifts heavy objects or wears tight shoes.

2. Bunions:

Bunions are bone defects that cause the large toe of the foot to rotate inwards and point towards the smaller toes. Bunions occur within the bone as a result of wearing tight shoes for prolonged periods. This causes a person to walk in a way that increases stress on the lateral side of the foot instead of the big toe joint, resulting in severe lateral foot pain because of unequal distribution of weight [3]. By evenly distributing your weight, they can also help you address corns, calluses, calcaneus, and bunions.

3. Peroneus Brevis Tendon Injury:

Injury of the peroneus brevis tendon that runs from the outer lower leg also causes lateral foot pain. Peroneus Brevis tendon injury is more common in people who have their peroneal tendons under repetitive stress through occupational or habitual activities (wearing high heels, repeat squatting). Peroneus Brevis tendon injury causes lateral foot pain accompanied by warmth and weakness at the insertion site, weakness, and a popping sound [4].

4. Tarsal Coalition:

One of the rare causes of lateral foot pain that affects one in 100 people is the tarsal coalition, which occurs when an excess bar of bone connects two or more foot bones. Symptoms often cause fatigue, foot cramps, and lateral foot pain that interfere with the walking ability [5].

5. Cuboid Syndrome:

Cuboid syndrome occurs as a result of the partial dislocation of the cuboid bone or injury of ligaments within the foot. The cuboid bone, located in the middle of the outer side of the foot, connects the foot to the ankle and provides ankle stability. Overuse is the main cause of the cuboid syndrome. Lack of recovery time between exercises, excessive physical activity, being obese, and wearing tight shoes are some causes of cuboid syndrome that cause lateral foot pain and discomfort [6].

6. Ankle Sprains:

It is common in 85% of people who have recently twisted their ankle that is resulting in an ankle or inversion sprain. It can occur due to ankle sprains radiating up towards the ankle rather than the foot [7].

7. Midtarsal Joint Sprain:

The injury of ligaments that are connected to the midtarsal joint causes the sprain, known as the midtarsal joint sprain. The midtarsal joint sprain causes lateral foot pain that runs from the outside to the middle of the foot.

How Is Lateral Foot Pain Diagnosed?

A physical examination of the foot is the first option to diagnose the condition, during which the doctor evaluates and examines the stability and mobility of the foot. The doctor will also assess symptoms of pain, foot deformities or injuries, and swollen areas.

Some diagnostic exams can also help determine the underlying cause of the condition. These tests include magnetic resonance imaging (MRI), x-rays, bone scans, and CT scans.

X-ray of lateral foot pain

How Lateral Foot Pain Can Be Treated?

If it lingers for a long time, the patient should seek medical attention. Over-the-counter pain medications, physical therapy, and RICE protocol are some options for treating pain. Pain can be caused by inflammation of the Achilles tendon (tendinitis), plantar fasciitis, and stress fractures – they can directly benefit from wearing textured insoles. The following are different treatment options for different causes of lateral foot pain:

1. Stress Fractures:

Usually, stress fractures heal independently, but some fractures require surgery. After surgery, it is recommended to completely rest your feet and not put pressure on the foot. Shoes inserts and crutches can also be used to avoid pressure.

2. Peroneus Brevis Tendon Injury:

Lateral foot pain due to peroneus brevis tendon injury is often treated with non-steroidal anti-inflammatory drugs (NSAIDs). If the peroneal tendons are completely torn, surgery may be required. Physical therapy can also strengthen the foot’s range of motion and peroneal muscles.

3. Tarsal Coalition: 

Lateral foot pain due to tarsal coalition can be alleviated by:

  • NSAIDs or steroid injections
  • Temporary boots and casts for stabilizing the foot
  • Physical therapy
  • Shoe inserts to support the tarsal bones

4. Cuboid Syndrome:

Physical therapy is a suitable option for managing lateral foot pain associated with the cuboid syndrome. Stretching the feet and legs before exercising may also prevent the cuboid syndrome. Custom shoe inserts also help support the cuboid bone.

5. Ankle Sprains:

Physical therapy is recommended to strengthen the ankles to avoid further ankle injuries. Your healthcare professional may recommend NSAIDs to relieve the pain [8]. Typically, plenty of rest, ice, custom foot orthotics, compression with an elastic bandage, and particular strengthening exercises can help with lateral foot pain.

Conclusion:

Lateral foot pain is more frequent in people who play sports, perform repetitive activities, and work out a lot. If a person experiences lateral foot pain, resting for five to six days is advised. But if the pain persists, scheduling an appointment with the doctor is important. NSAIDs, physical therapy, and rest are some excellent treatment options to manage lateral foot pain. It is recommended to consult an orthopedic / foot doctor (podiatrist) for professional medical advice.

References:

  1. Sanal HT, Chen L. Lateral foot pain. Skeletal Radiol 2015;44:1705. https://doi.org/10.1007/s00256-015-2181-x.
  2. Kaiser PB, Guss D, DiGiovanni CW. Stress Fractures of the Foot and Ankle in Athletes. Foot Ankle Orthop 2018;3:247301141879007. https://doi.org/10.1177/2473011418790078.
  3. Aebischer AS, Duff S. Bunions: A review of management. Aust J Gen Pract 2021. https://doi.org/10.3316/informit.553827823333931.
  4. Keles-Celik N, Kose O, Sekerci R, Aytac G, Turan A, Güler F. Accessory Ossicles of the Foot and Ankle: Disorders and a Review of the Literature. Cureus 2017;9:e1881–e1881. https://doi.org/10.7759/cureus.1881.
  5. Addar A, Marwan Y, Algarni N, Algarni N, Berry GK, Benaroch T. Tarsal coalition: Systematic review of arthroscopic management. Foot 2021;49:101864. https://doi.org/https://doi.org/10.1016/j.foot.2021.101864.
  6. Pountos I, Panteli M, Giannoudis P V. Cuboid Injuries. Indian J Orthop 2018;52:297–303. https://doi.org/10.4103/ortho.IJOrtho_610_17.
  7. Delahunt E, Remus A. Risk factors for lateral ankle sprains and chronic ankle instability. J Athl Train 2019;54:611–6. https://doi.org/10.4085/1062-6050-44-18.
  8. Lau BC, Moore LK, Thuillier DU. Evaluation and Management of Lateral Ankle Pain Following Injury. JBJS Rev 2018;6.

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