July 30, 2021
Why does my foot hurt here? You may be asking yourself this common question whether you have had an injury or simply developed pain. Pain can be common on the outside of the foot in this location. There are several reasons pain can manifest along the lateral border of your foot. Common foot problems seen in this area tend to be Jones fractures and related stress fractures, peroneal tendonitis, and bursitis. Let’s dive deeper into each of these pathologies.
Jones fractures are a common fracture often brought on by injury and falling on the outside of the foot. This was named after the physician Dr. Robert Jones who described the injury in the 1900’s after sustaining one himself. The fracture occurs at the base of the fifth metatarsal. Sometimes these problems begin with a mild soreness before more significant pain develops. This is because they can be associated with stress to the foot. This area tends to have a paucity of blood supply causing these injuries to not heal very readily and sometimes not heal at all. These fractures will usually present with pain that comes on with walking traditionally, increased activity, or there truly is a twist of the foot and ankle onto the outside of the foot. Commonly, people will have pain and swelling, but in some cases, its pain and no swelling. Experiencing any ongoing pain in this area is worth an evaluation given the problems with healing.
These fifth metatarsal fractures, known as Jones Fractures, often need close attention and a follow up with an x-ray. Surgical intervention may be needed if it
is predicted that it won’t heal or will heal very slowly. Whether it be a person trying to get back to work or an athlete back to the field, intervening in this type of fracture may be crucial to a speedy recovery. Other recovery methods, depending on the results of the x-ray, might include wearing a boot for immobilization and instruction to be non-weightbearing. Surgery often involves either a screw or even a plate and screws depending on the severity of the injury.
At the same exact location as a Jones Fracture, there is a tendon on the fifth metatarsal that moves the foot outwards. Tendons are similar to ropes. They connect muscle to bone and allow the foot and leg to move in certain directions. This tendon moves the foot from side to side and is called the peroneal brevis tendon. Because there could be injury to the tendon but not the
bone, there can still be pain but a completely normal X-ray. Often these problems will occur with no injury and come on over time with increased activity. Patients tend to feel pain and swelling on the outside of the foot. This pain may travel along the course of the tendon: the outside of the foot towards the heel.
People with a high arch are more prone to tendonitis because they put more of their body weight on the outside of their foot. This predisposes the tendon to having to work harder, therefore potentially having inflammation or even maybe a tear. To figure out what issue is going on with a perfectly clean x-ray, patients are given a trial of immobilization with a brace or a boot. Depending on the case, patients can also get imaging and MRI to delineate if it is a fracture or a tendon tear. If a boot or brace doesn’t help in the recovery process, physical therapy and/or anti-inflammatories can sometimes be used to alleviate pain and recover. In some cases, recalcitrant pain associated with the peroneal brevis tendon can signal a tear. This may require surgery for the pain to improve.
Sometimes patients will come in with generalized pain in the same area as tendonitis and Jones fracture due to overload on the side of their foot. This can be focal on the base of the fifth metatarsal, similar to a Jones fracture. However, it can also be more diffuse along the outside border of the foot. This pain is called bursitis because there is inflammation in the local tissue. Often over activity or constant pressure on the outside of the foot over time may cause this issue. Again the shape of the foot is a high arch in most patients. These patients put more pressure on the outside of the foot. These is often swelling or even callus formation on the bottom of the foot along the outside border. Usually pain is more along the bottom of the foot that the top.
With these types of patients, there is an attempt to rebalance their foot. A properly fitted insert for a shoe may successfully offload the outside of the foot thereby reducing pressure and pain from the bursitis. Stretching of the ankle and calf is crucial to reduce undo pressure along the bottom of the foot. Anti-inflammatories are helpful when able to be taken safely. If pain continues, then it is important to follow up for a formal evaluation with imaging to make sure you obtain proper treatment.
We Are Here to Help
Do you have high arched feet? Are you experiencing any of these pains on the outside of your foot? Don’t wait, get an evaluation today! Dr. Miller is available at several locations around the Cincinnati area with Beacon Orthopaedics. Contact us today for more information! Click here to learn more and schedule an appointment with Dr. Miller for foot and ankle injuries.