Chronic Lateral Side Foot Pain

by RF
(NYC)

Dear Dr. Mitnick,

I'm a now ex-runner with chronic pain on the lateral side of my right foot. After my second marathon (mostly on uneven roads) I gave myself a week off and then went for a light run. This run was a disaster as I landed badly and expierienced severe pain in the mid area of the foot. The first podiatrist I saw took an x-ray to rule out fracture and gave me a walking boot and a perscription for anti-inflammatories. This failed to eliminate the pain so she followed up with a steroid injection in the general area and some Powerstep Orthotics. After more time of no relief I tried somebody else. The new Dr. performed the cuboid whip also ordered an MRI.

The MRI showed no fracture, but lots of fluid and inflammation behind the pinky toe. He gave me another injection and the same general advice on warm baths and icing.
Fast forward to now, I’m now stuck at three months with no relief. The pain is tolerable throughout the day but I can’t run more than five minutes without having to stop. I feel this is a little long to be dealing with a tendonitis and I’m confused and frustrated. Is there anything I could be missing here?

I would take a picture but there is no obvious redness or anything like that. Pain is diffuse on the foot but mostly centered right above the 5th metatarsal under the pinky toe. I live in a city and have to walk to get around.

I would be so grateful for any advice. Thank you in advance.

RESPONSE

Hi RF,

Your narrative is a little confusing to me because initially it sounds like your pain was further back in your foot as a subluxed cuboid would certainly be further back in the foot.
Having said that, if your pain is just behind the pinky toe on the bottom of the foot then it sounds like we are talking about pain under the fifth metatarsal head. Is that the spot that hurts?
In any event, the most common cause of pain in that area, assuming no stress fracture, would be an inferior metatarsal bursitis. A bursitis is a sac filled with fluid that the body initially forms to "cushion" an area. However, some times the bursal sac itself becomes inflamed and thus is called a bursitis.
Typically, the more you walk (run) on this, the worse it will get. When it is very painful the area will be somewhat spongy and may even be slightly red in color. So, when it does hurt I would suggest you actually examine the foot and see if that is the case.
There are a couple of ways to approach this problem. One would be the use of an orthotic with a cutout directly under the fifth metatarsal head which attempts to reduce pressure on the bone and the bursal sac.
A cortisone injection directly into the bursal sac can also be very helpful. In addition, some physical therapy such as ultrasound directly over the bursal sac may also help to quiet it down.
Assuming this is your problem and your hopes are to resume running, then you will probably need some kind of orthotic in an effort to keep pressure off the inflamed sac.

Marc Mitnick DPM
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