Pain on left lateral area of my left foot , just below my pinky toe

by Rita
(Basking Ridge, NJ)

I have noticed for the last 2 weeks or so a sensitivity area of my left foot just below my pinky bone. It seems to be worse after wearing my sandals as they tend to not give much support to my feet. The pain today is much worse and when I palpate the area it is tender over the bone. I have also noticed a slight redness to the skin but it might be because I have been touching it a lot . I have iced it and it does feel better however as soon as I stopped the pain came back. I am a nurse so most of the week my feet our in nursing shoes which are pretty supportive. My husband is a chiropractor ...maybe he needs to do something? Please advise me. Thank you...

RESPONSE

Hi Rita,

You could have your husband x-ray the foot to make sure you do not have any kind of bone spur, particularly a bone spur on the metatarsal bone.

If the x-ray is negative for a bone spur as well as osteoarthritis in the fifth metatatarsal joint then you are left with two common possibilities (and of course a number of remote possibilities)

I should mention I do not suspect a stress fracture because they usually do not occur on the distal head of the metatarsal bone, but that should be looked for as well.

Because of the slight redness and tenderness in the painful area, my first guess would be a bursitis either on the bottom of the metatarsal head or on the lateral side. This is the most common cause of non-traumatic pain occurring in this area of the foot.

The reason it may hurt more in your sandals are two fold. One is the fact that if the sandals have thin soles and no cushioning, this will increase the pressure on the metatarsal heads. In addition the fifth metatarsal head is more subject to torsional forces on it when you walk, so the combination of the two could cause a bursitis to form.

Secondly, if you sandals are very flimsy, meaning the easily bend at the level of the ball of your foot, then that also creates excessive pressure on the heads of the metatarsal bones and this could also be a contributing factor as well.

The next most common cause for pain and perhaps redness in that area of the foot would be a capsulitis of the fifth metatarsal-phalangeal joint. This is essentially an over-stretching of the soft tissues of the joint on the bottom portion of your foot. This condition can also occur from flimsy shoes such as sandals.

Icing it will help for as long as the ice is applied but that does nothing for long term care. Both a bursitis and capsulitis can be treated with physical therapy modalities of which I am sure your husband has many.

Additionally, you would have to change the shoes (sandals) that are causing the problem, otherwise any other treatment is self defeating.

If physical therapy does not do it for you, then you might consider a round of oral anti-inflammatory medication or even a cortisone injection.

I would first eliminate the shoes that are aggravating the problem, including walking around barefoot, and try some therapy. You can supplement that with nsaids and always consider a cortisone injection at a later date.

One last caveat. If you cannot resolve the pain, then you might consider an MRI simply because sometimes there is a tear in the capsular ligament and that of course will not be seen on an x-ray.

Marc Mitnick DPM
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