Athletes and non-athletes alike can develop pain on the outside of the foot (lateral foot pain). Just like any foot pain, it’s important to get a proper diagnosis from a podiatrist. While, many different conditions can lead to lateral foot pain, many of them have similar causes.
Let’s take a look at these conditions, causes and risk factors, their symptoms, and treatment.
Stress fractures are tiny cracks in the bone caused by overuse during activities such as running, jumping, and even walking. While athletes are most at risk, non-athletes can also develop stress fractures. For example, weekend warriors who push themselves too hard without much training can develop this condition.
The pain typically comes on quickly with activity and subsides with rest. Along with pain you can experience swelling, redness, and bruising on the lateral side of the foot. When X-rays are taken, they are often negative during the first three weeks.
Treatment includes rest and can also include wearing a boot to prevent movement.
Depending on the cause, prevention can include use of custom orthotics (to prevent overpronation), replacement of athletics shoes (should occur every 500 miles), building up training slowly, and getting proper nutrition including plenty of Vitamin D (most important for underweight and post-menopausal women athletes).
When the peroneal tendons become inflamed, peroneal tendonitis develops. These two tendons are located side by side behind the outer ankle bone. Their job is to keep the foot stable and protect them from sprains.
Peroneal tendonitis can occur suddenly or develop over time. It’s most commonly found in athletes who engage in repeated ankle motion in sports such as running, soccer, football, and basketball. Other people at higher risk for this condition are those with high arches.
When this condition occurs pain, swelling, and warmth can be felt on the outside of the ankle and heel. It’s vital to get these symptoms checked out by a podiatrist, as they can lead to break down or tearing of the tendon without proper treatment.
Non-surgical treatment consists of oral anti-inflammatory medication or injection of PRP (platelet rich plasma), casting to prevent movement, physical therapy, and bracing to prevent extra motion during sports activities. Surgery may be required to repair the tendons or other foot structures.
While most bunions are found on the inside of the foot right next to the big toe, a tailor’s bunion develops on the outside of the foot. Like most bunions a tailor’s bunion is caused by abnormal foot structure. It can also get worse over time with high-heels, tight fitting, and pointy shoes playing a key role.
Symptoms of this condition can involve pain, redness, swelling, and numbness. Largely these occur when the bunion rubs against shoes.
Treatments are primarily non-surgical. They include orthotics to correct abnormal foot structure, padding or shoes that are wide enough to prevent the bunion from rubbing, icing, anti-inflammatory medications and steroid injections to reduce the swelling.
In addition to purchasing wider shoes, patients with this condition should avoid high-heels and tight, pointy shoes.
Foot and Ankle Arthritis
Osteoarthritis is the type of arthritis that most often causes pain on the outside of the foot and ankle. This condition is caused by the breakdown of cartilage and can lead to stiffness, pain and loss of joint movement. While osteoarthritis is more commonly found in the big toe joint, it can also affect the ankle and outer foot joints. Aging and overweight are more likely to bring on arthritis in the feet, but an injury to the joint can also be the culprit.
Symptoms of lateral foot and ankle arthritis can include pain, stiffness and swelling in the joint, and reduced ability to walk. Your podiatrist will likely do a gait analysis as part of the evaluation.
Most foot and ankle arthritis can be treated non-surgically and can include custom orthotics, weight reduction, braces to support the joints, physical therapy, anti-inflammatory medications and steroid injection to reduce pain and swelling.
The cuboid bone is found on the bottom, outside of the foot just in front heel bone. Cuboid syndrome occurs when the cuboid bone moves out of position with the heel bone. Most often dancers and other athletes develop this condition as a result sudden injury or overuse. However, even moderate activity can bring on this condition particularly when poorly fitting and unsupportive shoes are worn.
Symptoms can include pain on the outside of the foot, increased pain when weight is placed on the side of the foot or arch, and loss of movement in the foot or ankle.
Treatment includes application of a cuboid pad to offload the foot under the cuboid bone, stretching, and custom orthotics.
Sprained Ankle (inversion sprain)
Inversion sprains are common among athletes and the general population. These sprains affect one of three ligaments on the outside of the ankle. They occur when the ankle rolls outward as a result of great force such as a high jump or taking a wrong step off a stair. People and particularly athletes who’ve sprained their ankle before are at greater risk of another sprain.
Symptoms of this type of ankle sprain include pain, swelling, and redness.
The best initial treatment for a sprained ankle is the RICE protocol; rest, ice the sprained area, apply compression, and elevate your ankle above your heart. Physical therapy may be needed to help the injury heal.
It’s important to see your podiatrist to get an X-ray to ensure it’s not broken. Also keep in mind, when ankle sprains are not fully treated they can develop into Chronic Lateral Ankle Pain.
Fractures of the 5th Metatarsal
Fractures of the 5th metatarsal (the long bone just below the little toe) are common. Two types of fracture occur in this region. One is an Avulsion Fracture which often results from an injury when the foot rolls; it can occur while playing sports particularly tennis or by a misstep off a curb. A small piece of bone pulls away from the main bone by a tendon or ligament.
The other is a Jones Fracture. These fractures can occur over time through overuse or suddenly due to trauma. Because they occur in an area of the bone that gets little blood flow it can be difficult to heal.
Symptoms of a 5th metatarsal fracture can include:
- Pain and swelling
- Difficulty walking
Your podiatrist will examine the injury and order X-rays. Just like a sprain, the initial treatment should be use of the RICE protocol (see above under sprained ankle). Additional treatments include a boot to prevent the foot from moving and for the Jones fracture--treatment with surgery or a bone stimulator may be required.
Sinus Tarsi Syndrome
Another condition causing pain between the ankle and heel on the outside of the foot is Sinus Tarsi Syndrome. Painful swelling occurs on the subtalar joint.
- Athletes particularly dancers, volleyball players, and basketball players
- Flat feet and pronation cause two bones in the subtalar joint to pinch against each other
- Arthritis or instability in the subtalar joint
- Injury to that area of the foot particularly sprains
In addition to pain, patients can experience swelling between the ankle bone and heel. The swelling can become quite enlarged and can be mistaken for a cyst or tumor.
Treatment for this condition can include:
- Anti-inflammatory medication
- Orthotics to prevent pronation and pinching of the subtalar joint
- Stable shoes
- Bracing to prevent movement
- Physical therapy to help with balance and strength
- Surgery may be indicated if other treatments don’t work
If you're suffering from a sports injury on the outside of your ankle, call us today at 206-368-7000 or request an appointment online.