Causes (and Relief) for Lateral Foot Pain

Your feet deserve more credit than they probably get. Each foot boasts 26 bones, 33 joints, and more than 100 muscles, tendons, and ligaments which work together to provide the balance and support your body needs to stand, walk, run, and jump. But these small, interconnected parts can be prone to injury, which sometimes results in lateral foot pain.

“The lateral aspect of the foot is on the outside, from the little toe to the heel,” explains Jason Gold, D.P.M., a podiatrist in Boca Raton, FL. For such a small piece of real estate, pain can be significant. Dr. Gold says common symptoms of lateral foot pain include:

• Burning, numbness, or tingling that can shoot towards the toes or up towards the back

• Swelling

• Tenderness with walking or after activity

The severity and type of pain you experience could be intense and sharp, or mild and throbbing, based on the culprit. “Symptoms of lateral foot pain vary depending on what’s causing it,” says Dr. Gold. Let’s take a look at some possible causes of lateral foot pain.

With so many tiny bones and ligaments coming together while bearing the full load of a person’s weight, it’s no wonder that injuries can happen. These are some of the common ones.

Stress Fracture

A stress fracture stems from overuse or repetitive movements, leading to tiny cracks in the bone. This differs from a regular fracture, which is caused by one specific injury. “Stress fractures can lead to constant pain on the outside of the foot,” if they’re in certain areas, says Dr. Gold. Fractures in the following bones are particularly unrelenting, he says:

• Fifth metatarsal base: he long bone on the outside of the foot that connects to the small toe)

• Cuboid: a bone on the outer edge of the foot in front of the heel

• Calcaneus: the heel bone

If you have a stress fracture in your foot, you’ll have pain from bearing any weight, and even from tapping on the bone in question, says James Higgins D.P.T., a physical therapist at Integrative Physical Therapy in New York City. “An X-ray is the gold standard for diagnosing this problem,” he adds.

Most stress fractures heal on their own within six to eight weeks with RICE (rest, ice, compression, elevation) and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling, per the Cleveland Clinic. Crutches or a brace can help you get around without applying pressure.

Cuboid Syndrome

This develops when the cuboid bone on the outer back edge of your foot moves out of alignment with its neighboring bones, says Dr. Gold. It may be caused by a sudden trauma to the area or repetitive “microtrauma” from certain activities, like dancing or jumping. It’s easy to misdiagnose cuboid syndrome, Dr. Gold adds. There are no definitive diagnostic tests for this condition, but if your doctor presses firmly on the cuboid bone, you’ll definitely know if that’s the source of your pain.

The most effective treatments for cuboid syndrome are RICE, wearing supportive shoes and/or inserts, says Dr. Gold. In some cases, a doctor carries out a technique called the “cuboid whip” to try to pop the cuboid bone back in place, he adds. You lie on your back with the knee of your injured foot bent, and the doctor holds the injured foot while you quickly straighten your leg, keeping the foot flexed. At the same time, the doctor pushes firmly on the cuboid bone, popping it back in place.

Peroneal Tendonitis

Peroneal tendonitis is common and causes pain and swelling on the outside of the midfoot, says Dr. Gold. In this condition, the tendon is inflamed but not torn. “It can occur through overuse of the tendon from too much walking barefoot or in unsupportive shoes, like sandals,” Dr. Gold says. “Another possible cause is a sudden injury that causes trauma to the area.”

A thorough physical exam is key to diagnosing peroneal tendonitis. A person with peroneal tendonitis will feel pain when their therapist moves their foot into inversion (moves the sole towards the midline of the body) and eversion (moves the sole away from the midline of the body), says Higgins. If the pain is severe, magnetic resonance imaging (MRI) can help determine the extent of the injury.

Treatment for peroneal tendonitis begins with RICE, wearing more supportive shoes, NSAIDs for pain relief, and inserts or orthotics (prescribed medical devices worn inside the shoes). If these measures don’t work, your doctor may recommend bracing or physical therapy, Dr. Gold adds.

Arthritis

Arthritis (inflammation in the tissues in your joints) can affect any of the joints in your feet, including those along the outer edges. The two most common types of arthritis are:

• Osteoarthritis (OA). This condition is caused by cartilage damage from injury or older age.

• Rheumatoid arthritis (RA). This is an autoimmune disease where the immune system malfunctions and causes inflammation in the joints.

If you have arthritis in the joints of your foot, it will be uncomfortable when pressure is applied to the joint, per the American Academy of Orthopaedic Surgeons (AAOS). You may experience:

• Pain

• Redness

• Stiffness

• Swelling

• Tenderness

Unsurprisingly, any of these symptoms can make it difficult to walk. Talking to your doctor about your symptoms is the first step towards a diagnosis, followed by imaging tests like X-rays, CT scans, ultrasounds, or MRIs.

Treatment options for both OA and RA include corticosteroid injections to help relieve pain and swelling near the affected joint and NSAIDs to help reduce inflammation. If you also have stiffness in your foot that makes movement difficult, physical therapy may help.

Twisted Ankle

An ankle sprain, caused when you twist or turn your ankle in an awkward way and stretch or tear the lateral ankle ligaments, can also lead to consistent foot pain, says Dr. Gold. Symptoms of an ankle sprain depend on the severity of the injury, but typically include:

• Bruising

• Pain (especially when putting weight on the injured foot)

• Restricted range of motion

• Swelling

• Tenderness when you touch your ankle

You might also have felt or heard a distinctive “popping” sensation at the time of the injury.

Treatment starts with a few days of RICE, says the Mayo Clinic. Take NSAIDs if you need pain relief (these will help bring any swelling down too). Your doc may recommend stabilizing your ankle with an elastic bandage, ankle support, or sports tape while it heals.

Tarsal Coalition

Tarsal coalition occurs when the seven tarsal bones near the back of your feet aren’t connected properly. It’s something you’re born with, but symptoms don’t usually appear until your teenage years. These symptoms include:

• Flat feet

• Limping after prolonged periods of exercise

• Stiffness and pain in your feet, especially near the back and sides, that gets worse after a lot of physical activity.

Generally, imaging tests like X-ray, CT scan, and MRI are needed to make a diagnosis of tarsal coalition, says the AAOS. Although some cases require surgical treatment, most can be managed with physical therapy to strengthen the foot, shoe inserts designed to support the tarsal bones, and NSAIDs or corticosteroid injections to relieve pain. Temporary casts or boots may be recommended to stabilize the foot.

Some people are more likely to experience lateral foot pain than others. According to Higgins, the following are risk factors for this type of pain:

• Balance impairments

• History of lower extremity impairment

• Older age

• Wearing constricting shoes

Because your feet take so much of the burden of your weight, being overweight or obese can also increase your risk for injuries that may lead to lateral foot pain. According to an article published in Arthritis Care & Research, a higher body mass index (BMI) is strongly associated with foot pain and disability. A BMI greater than or equal to 25 is considered overweight; greater than or equal to 30 means the person is obese.

To keep foot injuries at bay, start with your shoes. Make sure they provide enough support, especially if you have flat feet, says Dr. Gold. It’s particularly important that the sneakers you wear for exercising are supportive but not too tight. If you have flat feet or a history of foot injuries, ask your doctor about shoes with arches or corrective inserts, which reduce the stress on your joints and tendons by placing the foot in the correct position, Dr. Gold explains. Keeping your BMI in the healthy range (between 18.5 and 24.9) reduces unnecessary stress on your feet, he adds.

If you’ve had lateral foot pain before, Higgins suggests following a strengthening and balancing program for the ankle and foot (under the guidance of a pro) to reduce the risk for future falls and accidents.

Daily activities we take for granted, like standing and walking, can be painful when you have lateral foot pain. Start to RICE at the first sign of an issue, and if your symptoms don’t ease in a couple of days, make a doctor appointment. Even mild injuries and conditions that cause lateral foot pain can quickly get worse if they’re not addressed, but with so many treatment options, you’re sure to find a solution that can bring relief.