Ongoing ache on lateral portion of foot

by Kel
(Oregon)

I have had an ache in the on the outer portion of my right foot. It had a gradual onset, becoming more noticable over the period of a month (thru late April and May)and also more noticable after my long runs (yes, I am a recreational runner, mostly half marathons...oh, and I'm a 48 yr reasonably fit female). I have laid off of running for over two months but that seems to have no effect on the ache other than its not getting worse. The ache seems to have reached a plateau. Usually it's just an ongoing nonspecific ache centered around the knob of the 5th metatarsal on the side of my foot. Once in a great while, I feel a very mild burning pain sensation that seems to originate at the knob and move forward along the side of my foot, but not in association with any specific movement. Other than the ache, it is very tender, feeling like a bruise, if I press on the meaty area of my foot that stretches for about an inch just behind the knob toward the heel, right where the insertion of the peroneal tendon is. Other than that, I have no acute pain, nor can I recall any specific suspicious event that might have precipitated this (although I do run trails and rolled my foot in occasional misteps). The ache increases after any activity such as standing all day (as I do at my job), walking, biking, eliptical, and, most noticably, running, but I do not feel any pain during the activity, just the increased ache afterwards. The pain does not specifically intensify with any specific movements such as rolling my foot, calf stretching, toe pointing. I can sometimes feel a slight pulling when I step off on a stride (walking). There is no ankle discomfort. It seems to resolve overnight, except some initial stiffness when I first step out of bed, only to become a more intense ache as the day wears on. There is no swelling or redness. I only ever wear running tennis (1/2 size large so they accomodate swelling feet after long runs), usually with green superfeet inserts. The shoes don't seem to affect the ache other than the pressure against the tender knobby portion. I do have a history of ITBS & PF on the right foot. I have also been doing some PT exercises, mostly focusing on ankle strength, but they seem to have no effect.

So I'm thinking peroneal tendonitis or a stress fracture though I would've thought there would be more acute pain, especially during weight bearing activities, with a fracture. Am I wrong to think that? (I have an appointment to get in to a podiatrist and hopefully get an xray taken but that hasn't happened yet). Anyway, I just wanted to get your take on it...what is the most likely problem? What kind of treatment options are most likely? What time frame should I expect improvement(give or take...I realize there are a lot of factors to consider, but are we talking days, weeks, months)? How would I imobilize it better (since even a day of standing at work seems to agravate it)? Are there some PT exercises you would suggest? How much further damage am I risking by continuing as is or going back to running?

Thanks for any input...I realize that you are unable to say for sure without actually examining my foot but I am most frustrated. I tried to be as specific as possible. If there is anything I left out, please LMK!


Hi Kel,

You did a good job of describing your symptoms but at the end of the day the foot has to be examined and xrayed since the various causes of pain in that area will necessitate various treatments.
For example, if you actually fractured the fifth metatarsal base then there are real issues in terms of healing as typically that area is poorly vascularized and can take forever and then some to heal. Many times patients will opt for surgery to fix the fracture, requiring placement of a screw or other internal device. This will get you up and running a lot faster.
If it is peroneal tendonitis, then your shoes need to be examined as some people wear shoes that are too narrow in the mid portion of the foot and this creates the irritation on the tendon.
Running of course can also aggravate this problem and many times adjustments have to be made to the foot generally with the use of an orthotic to take pressure off that area.
Lastly, your doctor needs to rule out a subluxed cuboid as the source of your foot pain as many times this is overlooked.
The problem with foot problems (compared to similar problems on the hand for exeample) is that just the simple act of walking continually aggravates the injured area so it can take forever for the foot to stop hurting.
That is why I think your appointment with a podiatrist was a good idea. Find out exactly what is causing the problem and receive appropriate treatment so that you will be back to running as soon as possible.

Marc Mitnick DPM
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