Ask the podiatrist: Pain on the outside of feet

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Michelle says: I'm getting pain along the outer sides of my feet both during and after running. I have properly fitted shoes and doing a half marathon in three weeks so grateful for any advice!

Hi Michelle, this is indeed a common complaint amongst runners and can have limiting effects on your performance. Pain along the outer sides of the feet has a large number of causes; diagnosis and subsequent treatment is assisted, in part, by knowledge of the precise pain location and onset history. The most common cause (particularly amongst mid-foot and forefoot runners) is tendinopathy of muscle peroneus brevis and/or muscle peroneus longus (small muscles in the back of your calf which are connected to the outside of the foot). This is probably what you are suffering with. However, other causes can be as follows.

·       Lateral heel fat pad atrophy (degeneration of the fatty pad underneath the outside of your heel) – repeated heel impact during rearfoot running in damaged or older, less shock absorbing running shoes. The fat pad also extends along the outside (and inside) of the foot and is subject to damage and potential pain.

·       Subluxation (partial dislocation) of the cuboid bone, also known as cuboid syndrome – risk factors include, following a lateral ankle sprain, sub-talar joint pronation beyond the mid-stance phase during walking and running (excessive pronation) and running extensively on uneven terrain, although the exact cause of the subluxation remains unclear.

·       Calcaneo-cuboid joint arthritis or 5th and 4th metatarso-cuboid joint arthritis  – high arched feet are at greater risk of placing greater compressive forces through these joints during running creating bony degeneration or generally in all foot types, following direct traumatic injury.

·       Fracture of the 5th metatarsal – this can take the form of an avulsion fracture, commonly following a lateral ankle sprain, where the tendon of muscle peroneus brevis or a joint ligament actually pulls the bone apart rather than becoming detached itself, or a Jones fracture through direct trauma or repetitive stress at the base of the 5th metatarsal or through the shaft or neck of the metatarsal for similar reasons. Fractures are usually accompanied though by pain, swelling and bruising.

·       Compression from footwear – compression of the base of the 5th metatarsal or the head, particularly if there is a Tailor’s bunion (a bunion on the little toe joint), can cause pain. In addition, friction can create painful blisters over these areas.

There are other causes and it is important, therefore, that you seek a correct diagnosis of your pain to stop what might appear a small injury becoming a major one and receive the appropriate therapy. This may be minimal and quick e.g. rest, stretching and massage, or it might need to be more involved.

Given your time frame and the event that you are about to undertake, you should consult with your GP as soon as possible and seek an early referral to a podiatrist or physiotherapist who specialises in sport-related injuries. If this is not possible through the NHS then a series of private appointments will probably be necessary. The clinician(s) will seek to accurately diagnose the cause of your pain via orthopaedic assessment, muscle testing and possible imaging such as MRI. They will seek to control any inflammation, either locally and/or systemically, provide tailored activity modification advice, potentially prescribe specialised removable footwear and/or bracing, foot orthoses or insoles to give functional rest to the area. They may also prescribe stretching, strengthening and proprioceptive (position awareness) restorative exercises, provide deep tissue massage to lessen scar tissue adhesions, restore (if possible) any loss in the range of motion at local joints and offer activity rehabilitation advice.

Michael Ratcliffe is a podiatrist and advisor for Carnation Footcare.