Unexplained pain on side of foot

by Bea
(Oregon)

The outside "edge" of my left foot hurts (in the general vicinity of the cuboid). There is no visible wound, no trauma, it does not hurt to touch it, and it doesn't hurt when I'm walking; only when I'm sitting or standing. It feels like the skin (or more accurately, just under the skin) is being stretched or torn. And it is very uncomfortable. I saw a podiatrist who couldn't figure it out. He took X-rays that showed no problem. I have tried wrapping the foot, putting cushions on it, massaging it, I even smeared some lidocaine on it but nothing seems to help. It did quit hurting for a while for a couple months but I think that was because I'd had some surgery and was on pain meds for that. It hurts with shoes and without shoes. It does seem to subside somewhat if I wear tennis shoes all the time, but after two weeks even that hasn't resolved it and as soon as I take off the tennis shoe the pain returns. It doesn't hurt when I wake up in the morning, and if I put on tennis shoes immediately and leave them on all day the pain stays away but I still don't know what the problem is.

RESPONSE

Hi Bea,

You do not mention what, if any, treatment you had. You went to a podiatrist, who took an x-ray, found nothing and then just let you go? There are plenty of times I take an x-ray, find nothing, but that does not mean there isn't a problem.

Two possible things come to mind, the only variable being the fact that the foot hurts when you are sitting; that seems a little odd to me.

In any event, my first thought would be an irritation of the peroneus longus tendon as it passes through what is known as the cuboid groove. This tendon passes down the outside of the foot and at the level of the cuboid bone makes an abrupt turn and goes underneath the foot, all the way to the other side of the foot.

Where it passes through the cuboid groove, it is subject to irritation just from everyday walking. It can be aggravated by shoes that are too narrow is that section of the foot.

Nothing would show up on x-ray regarding this problem and more than likely would feel better in sneakers, as they are wider in that part of the foot and they are cushioned on the bottom. I just do not know why it would hurt when you are seated.

A second possibility would be a subluxed cuboid, where the cuboid bone actually displaces slightly and thus causes pain. It can "pop" back into place and sublux again. This condition would also feel better in sneakers, but again I do not know why it hurts when seated.

If you are in enough pain to warrant it, a ct scan mri might be worth your while in a effort to get a better picture of what is going on in that section of your foot.

Prior to having imaging studies done, why not have some treatment? Assuming there are no contraindications, as I know nothing about your health status, you might consider either a round of oral anti-inflammatory medication or even a cortisone injection into the area.

Physical therapy would be another option to consider as well.

Speak to your doctor about some of these options and see if he is in agreement.

Marc Mitnick DPM
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