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Severe lateral foot pain

by Jocelyn
(Alberta, Canada)

Hi there,


I'm at a bit of a loss so hopefully I can get some answers here.

In about November 2009 I was playing women's league basketball and started to develop foot pain which was diagnosed as plantar fasciitis in both feet. Throughout the season, I started doing recommended stretches (in the morning, before/after games or practices, and any other time needed) and the plantar fasciitis seemed to improve. However, I started to develop sharp pain in the outside of my feet (from what I can tell, right where 5th metatarsal meets proximal phalanx and cuboid bones). Now, a year and a half later, while I rarely ever have plantar fasciitis pain, this lateral foot pain is often so sharp I limp, struggle to get up & down stairs, and gasp if my foot is bumped the wrong way. The pain is worst if I squeeze my foot sideways or if I put pressure just below baby toe joint (closer to ankle).

I've been to see a podiatrist numerous times and had expensive custom orthotics formed which I wear regularly. I'm currently trying to get pregnant so can't take anti-inflammatories (although Naproxen, ibuprofen, acetominophen, and topical creams have been ineffective anyways). I've stopped wearing flip-flops and heels, but nothing seems to help. I'm concerned that extra weight during pregnancy will exacerbate symptoms and as I'm only 30, I'd like to hope that I'm not doomed to chronic foot pain as a lifelong prognosis.

Please shed any light you can on the situation so I can follow up with my family physician.

Thank you,

Jocelyn

Hi Jocelyn,
If I understand your description properly you are having pain in two places on the foot; one where the fifth toe meets the metatarsal bone and secondly where the other end of the metatarsal bone meets the cuboid bone.
If that is correct, the first thing that comes to mind is your pain is probably due to a pair(s) of shoes that are too narrow.
Most times the pain near the toe is due to an inflamed bursal sac (bursitis) that is caused by narrow shoes. The pain further back is generally either a bone bruise of the fifth metatarsal base (where the bone flares outward) or possibly irritation of the peroneus longus muscle as it passes down the side of the foot and quickly cuts under the foot at the level of the cuboid bone. Lastly, there is a condition known as cuboid syndrome where the bone is actually displaced, causing pain (read my section on cuboid syndrome).
In any event, as I stated earlier the common denominator is usually due to shoes that are too narrow, especially in cases where patients have pain in both locations. BTW, I rarely see people with pain in both locations at the same time.
Now, to further complicate things you have to consider the orthotics as part of the problem rather than the solution. I am not sure of the time line, but did you get the orthotics for the plantar fasciitis or did you get them for the other problems?
The problem with orthotics is that they take up space in the shoes and thus will take a normal fitting shoe and turn it into a shoe that is too narrow.
Since you are not yet pregnant I do not think that is a causative factor but you will have to contend with that aspect as you gain weight and undergo hormonal changes.
You need to have a face to face talk with your podiatrist and let he or she evaluate your feet when they are in your shoes with the orthotics to make sure there is enough width from side to side.
Over the years I have had a lot of success with these problems by just having my patient wear a slightly wider shoe made out of soft material (patten leather shoes are the types of shoes you would avoid as they have no "give" to them.)
As a side note, I am assuming at some point you had an xray to make sure there was nothing more serious going on.

Marc Mitnick DPM
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