Here we explain the common causes of pain along the outside of the foot including forefoot, midfoot and heel area.
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. Symptoms include:
- Pain over the prominent bony part on the outside of the ball of the foot.
- Possible swelling or bruising.
- The foot will be painful to walk on.
- Pain will be made worse when attempting to turn the sole of the foot outwards against resistance.
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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. Symptoms of cuboid syndrome are very similar to a sprained ankle and include:
- Pain on the outside of the foot.
- Pain is worse when weight bearing.
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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.
- 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).
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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. However, it may occur through overuse, particularly repetitive strain or impact to the outside of the foot. The main symptoms are:
- Pain on the outside of the foot.
- 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.
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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.
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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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When should I see a doctor?
- 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.