Pain on the outside of the foot

Where exactly the side of your foot hurts, and how it started, usually points to the cause. We see patients with outer foot pain at our offices in Lyndhurst, Paramus and Millburn, NJ. For other areas, see our foot pain guide. For pain along the inner side of the foot, see arch pain.

Where it hurts is the first clue

Where it hurts	What it often feels like	Common cause
Behind or just below the outer ankle bone	Aching with activity, sometimes snapping	Peroneal tendons
The bony bump halfway along the outer edge	Sudden pain after a roll, or pain built up with sport	Fifth metatarsal fracture
The middle of the outer foot	Pain with walking, sometimes after a sprain	Cuboid syndrome
The base of the little toe	A bump that rubs in shoes	Tailor’s bunion
Along the outer edge, on the skin	Numbness, tingling or burning	Sural nerve

This is a starting point, not a diagnosis.

Peroneal tendonitis

Two peroneal tendons run behind the outer ankle bone. One attaches to the base of the fifth metatarsal on the outer edge of the foot.^[1] Tendonitis comes from overuse or an injury such as a sprain and causes pain, swelling and warmth. It is most common in sports with repetitive ankle motion, and high arches raise the risk.^[7] These tendon problems can be hard to tell apart from a sprained ankle ligament.^[8] Snapping behind the ankle bone can mean the tendons are slipping out of place; get it checked soon, because a tendon that keeps slipping is more likely to tear.^[7] See peroneal tendon problems.

A broken fifth metatarsal, including a Jones fracture

The fifth metatarsal is the long bone on the outside of the foot that leads to the little toe. Two breaks are common:^[2]

• Avulsion fracture. A tendon or ligament pulls a small piece off the bone when the ankle rolls. It is often overlooked alongside a sprain.
• Jones fracture. A break, sudden or from stress, in a small area that gets less blood, so it is more prone to healing problems.

Both cause pain, swelling and tenderness on the outside of the foot, bruising and difficulty walking. A Jones fracture sometimes doesn’t show on the first X-ray.^[2] The exact location guides treatment, because poor blood supply in the Jones area contributes to its high rate of not healing.^[9] Treatment ranges from a stiff-soled shoe or boot to a cast with crutches; surgery is considered when the bone is out of place, broken in more than one place, or not healing.^[2] See foot and ankle fractures.

Stress fractures

A stress fracture is a small crack from repeated loading. It is less common in the fourth and fifth metatarsals than in the middle of the foot, but there it causes pain on the outside of the foot. The pain builds gradually, is worse on your feet, eases with rest, and is tender right over the bone. The usual trigger is a sudden jump in activity, such as a new training plan, a walking vacation or new shoes.^[6]

They often don’t show on X-rays for the first few weeks. One at the base of the fifth metatarsal heals slowly, typically needing at least six weeks in a cast or boot without bearing weight, and sometimes surgery.^[6] See stress fractures in runners.

Cuboid pain (cuboid syndrome)

The cuboid is a cube-shaped bone in the middle of the outer foot, in front of the heel bone. Cuboid syndrome is thought to come from a subtle disturbance of the joint between the two, and to be a common source of outer midfoot pain in athletes.^[3] It may follow an ankle sprain in which the foot turns under with the toes pointed down, the usual way an ankle gets rolled.^[10] It feels like a sprain and has no definitive test, so diagnosis rests on the examination. In case reports, manipulation of the cuboid, support for the foot, or both often helped, but evidence-based guidelines are lacking.^[3]

Tailor’s bunion: a bump near the little toe

A tailor’s bunion (bunionette) is a bump at the base of the little toe where the fifth metatarsal sticks out, often from an inherited foot structure and sometimes from a bone spur. Narrow shoes rub on it and cause redness, swelling and pain. Treatment starts with wide toe-box shoes, a pad, anti-inflammatory medicine and ice, and sometimes an injection or custom orthotics. Surgery is considered when pain continues.^[4] If hard skin builds up over it, see corns and calluses.

After rolling your ankle

A bad sprain of the outer ankle ligaments can cause as much pain, bruising and swelling as a fracture.^[11] Outer foot pain after a roll can also be an avulsion fracture of the fifth metatarsal,^[2] an irritated or slipping peroneal tendon,^[7] or cuboid syndrome.^[10]

Among other checks, the Ottawa ankle rules call for an X-ray when you can’t take four steps or the base of the fifth metatarsal is tender, and when a clinician applies them they are very accurate at ruling fractures out (see sprain or fracture?).^[5] Pain lasting over four to six weeks may be a chronic sprain and needs a fresh look.^[11] See ankle sprains.

Numbness or burning: the sural nerve

The sural nerve supplies feeling to the outer side of the foot, heel and ankle.^[12] Injury, surgery or pressure on it can cause anything from numbness to severe nerve pain.^[13] Numbness, tingling or burning, rather than an ache, suggests a nerve may be involved.

How we evaluate it

We press on specific spots, test the tendons against resistance, check the ankle ligaments and look at your foot shape.^[8] In a high-arched foot whose heel tilts inward, the outer border is overloaded, which can lead to peroneal tendonitis and stress fractures.^[14] See high-arched feet. X-rays at the practice usually come first; ultrasound shows the tendons, and MRI helps when a stress fracture is likely but the X-ray is normal.^[8,6]

How we treat it

• Protection and pain relief: a stiff-soled shoe, boot or cast for a fracture; a splint or brace for a short time for an irritated tendon; ice and anti-inflammatory medicine if they suit you.^[2,7]
• Rebuilding: exercises for strength, range of motion and balance, and a brace for sport if needed.^[7]
• Shoes, padding and orthotics that take pressure off a tailor’s bunion.^[4] See custom orthotics.
• Finding the cause of a stress fracture, such as a jump in training or worn-out shoes, and checking bone strength when a fracture happened with light activity.^[6]
• Surgery when a tendon is damaged, a fracture is out of place or not healing, or a bunionette stays painful.^[7,2,4]

Common questions

Why does the outside of my foot hurt when I walk?

Possible reasons include irritated peroneal tendons, cuboid syndrome (thought to be common in athletes) and, less often, a stress fracture of the fourth or fifth metatarsal.^[1,3,6] Pain that worsens as you walk, eases with rest and is tender over one spot should be checked for a stress fracture.^[6]

Can I walk on a broken fifth metatarsal?

Being able to walk doesn’t rule out a break. Difficulty walking is common, but tenderness right over the base of the fifth metatarsal calls for an X-ray even if you can walk.^[2,5] Walking on a fracture may cause further injury, so stay off the foot until it is checked.^[2]

What kind of doctor treats pain on the outside of the foot?

Dr. Ozturk is a Foot and Ankle Surgeon and podiatrist, double board certified (DABPM, FAPWH), who treats pain on the outside of the foot with and without surgery. A podiatrist, or doctor of podiatric medicine (DPM), is a physician and surgeon for the foot, the ankle and the related parts of the leg.^[15] Orthopedic surgeons who focus on the foot and ankle also treat these problems; see podiatrist or orthopedic surgeon?

When to seek care

Book an evaluation for outer foot pain that lasts more than a couple of weeks or keeps coming back.