Dr. Young Talks About Lateral Column Pain and Lateral Overload

This is a subject that I have talked about previously. I wanted to revisit this and summarize this problem and condition. The lateral column of the foot encompasses the fourth and fifth metatarsals. This is the outside of the foot that includes the fifth toe and the fifth metatarsal phalangeal joint. It also includes the fifth metatarsal base which is the insertion point for the peroneal brevis tendon. Finally it also includes the cuboid bone and some patients with this may be diagnosed with "cuboid syndrome".

This is a common condition that I see in our clinic. It is frustrating for our patients because often this is not something that comes with a real nice clear diagnosis like let's say a bunion. But what happens is the patient will present to our clinic and say that they have pain on the outside of their foot (lateral column). Often times the patient will have a high arch foot or they will have compensated for another problem such that the weight is shifted to the outside of the foot. The lateral column is not designed for significant weightbearing. This is primarily the function and job for the great toe joint and the medial column. Therefore all it takes is a small change in weightbearing or the pattern of gait and the extra load going through the outside of the foot causes pain and symptoms. It is very rare to have a stress fracture in this location but that can happen. What can happen as there is just fatigue and pain on the lateral column and the stress load is such that it is short of that needed to cause a stress fracture. So stress fracture rarely occurs in this location. It is possible to develop pain at the insertion of the peroneal tendon of the fifth metatarsal base. It's also possible to have a tailor's bunion and have that pain flareup.

Our patients will have an x-ray to make certain there is no other pathology in this location. This condition responds very well to prescription orthotics tuned to shift the pressure off the lateral column of the foot, especially if it is a chronic condition. Some athletic shoes are better than others for this also. If there is a component of peroneal tendon symptoms, and there is a special ankle brace that may be helpful also.

These are some the conditions that may be associated with lateral column pain:

-Tailor's bunion or pain affecting the fifth MTP joint

-Stress fracture of the fourth or fifth metatarsal (rare)

-Stress reaction of bone of the fourth and fifth metatarsal (rare)

-Nonspecific Bone "fatigue and pain" of the fourth and fifth metatarsal (common)

-Insertional peroneal brevis tendinitis

-Cuboid area pain "cuboid syndrome"

If you have foot pain and need evaluation, please see myself Dr. Timothy Young, or my partner Dr. Brendon Nelson. Give us a call at 425-391-866 or make an appointment online.