Pain on the outside of the foot refers to any pain or injury on the outside of the forefoot, middle of the foot, or heel.
On this page:
- When should I see a doctor?
- Peroneus brevis tendon strain
- Cuboid syndrome
- Midtarsal joint sprain
- Sinus tarsi syndrome
- Peroneal tendonitis
When should I see a doctor?
When should you see a doctor with your foot pain? If you have severe pain, severe swelling, are unable to complete normal daily tasks three days after injury, or have a change in sensation in the foot, such as numbness or pins and needles then seek medical advice. If you have rested and applied the PRICE principles (protection, rest, ice, compression, elevation) and still have pain or weakness for two weeks or more then also seek professional advice.
Peroneus Brevis Tendon Injury
The Peroneus Brevis tendon inserts into the 5th metatarsal bone (the long bones in the foot) on the outside of the forefoot. A strain or rupture of the tendon can occur at the point it attaches to the bone and normally occurs after a sudden violent movement of the ankle or foot. Symptoms include, pain over the prominent bony part on the outside of the ball of the foot, with possible swelling or bruising. The foot will be painful to walk on. Pain will be made worse by putting the tendon under stress, which is done by attempting to turn the sole of the foot outwards (evert the foot), particularly against resistance.
Treatment involves rest and applying ice or cold therapy to reduce pain and inflammation. Once symptoms have subsided a full rehabilitation program of stretching, strengthening and proprioception exercises is important.
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Cuboid syndrome occurs when the peroneus longus muscle in the lower leg applies excess traction (pulling) on the cuboid bone, causing it to partially dislocate. The injury often occurs in conjunction with peroneal tendonitis, or if the patient overpronates (foot rolls in and flattens). Symptoms of cuboid syndrome are very similar to a sprained ankle and include pain on the outside of the foot, especially when weight bearing.
The Cuboid bone is one of 8 tarsal bones in the rear and mid-foot and is located on the outside of the foot, just in front of the ankle. Cuboid syndrome usually occurs after an ankle sprain, although it can happen in isolation with no other related injury.
Treatment involves physically manipulating the Cuboid bone back into position by a doctor or surgeon (known as reduction). Once the Cuboid bone is back in position it can be kept in place with the help of taping and padding. Any biomechanical problems of the foot can be corrected with Orthotic insoles which help support the arch of the foot.
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Midtarsal Joint Sprain
A midtarsal joint sprain is an injury to the ligaments holding the midtarsal joints together, causing pain in the outside, middle part of the foot. There are eight tarsal bones in the foot. The exact location of the pain will depend on which of the many ligaments has sprained (torn). Pain will be felt on the outside midfoot area and there may be swelling on the outside or top of the joint. Pain will be felt on certain movements of the foot but again, which specific movements are painful will depend on which of the injured ligaments are affected. The two most commonly injured ligaments are the calcaneocuboid ligament on the top of the foot (connects the Calcaneus and the Cuboid), and the Bifurcate ligament (a Y shaped ligament).
Treatment for most Midtarsal joint sprains is rest, cold therapy, and a full rehabilitation program once pain allows, but for a Bifurcate ligament the foot is immobilized and may need to be put in a cast for four weeks. Surgery may be considered if the injury is severe and bones have been displaced.
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Jones fracture is a fracture of the 5th metatarsal bone on the outside of the foot, at the ‘proximal’ end of the bone (nearest the ankle). It is most likely to be caused following an ankle sprain or forceful impact to the outside of the foot, but it may occur through overuse, particularly repetitive strain or impact to the outside of the foot. The main symptom is pain on the outside of the foot with the patient having difficulty weight-bearing.
If you suspect a fracture then seek medical help immediately. An x-ray will be needed to diagnose the injury and the foot will need to be immobilized in a cast for 6-8 weeks. Often Surgeons prefer to operate and place a screw in the bones to hold them in place whilst they heal as recovery and return to sport is likely to be faster. The time taken to return to full fitness after a surgical fixation is around 8 weeks, although it is recommended for full healing to be seen on a radiographic image before full training is resumed.
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Sinus Tarsi Syndrome
The sinus tarsi is a small bony canal which runs into the ankle under the talus ankle bone. Damage to the sinus tarsi can be caused by repetitive strain from overuse, or from an ankle sprain. Symptoms typically include pain just in front of the lateral malleolus (bony bit on the outside of the ankle), which may sometimes be difficult to pinpoint. Symptoms are often exacerbated by running round a curve as in track running.Tenderness will be felt at the opening of the sinus tarsi which is located on the outside of the ankle.
The aims of treatment and rehabilitation are to reduce pain and inflammation, correct biomechanical dysfuncion in the foot, mobility, stretching and strengthening exercises with a gradual return to full fitness.
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Peroneal tendonitis is inflammation of the peroneal tendons which run behind the lateral malleolus (bony bit on the outside of the ankle) causing pain and swelling on the outer ankle and foot. Pain is often worse during activity but gets better with rest. Pressing in under the malleolus on the outside of the ankle will be tender. Athletes who do a lot of running or repetitive activites and have tight calf muscles and peroneal muscles at the back of the lower leg are more likely to suffer peroneal tendonitis.
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