Lateral Foot Pain

Well then, why does this young man have pain on the outside of this foot, near his little toe, when walking for long periods of time, along with cramping of the feet. He recently undertook a “bussing tables” job at a local restaurant and is (suddenly) on his feet for 8-10 hours daily for 7-8 days at a stretch?

Take a good look at the top few photos. What do you see?

You should see:

  • windswept biomechanics of the legs (i.e. internal tibial torsion on the left and relative external tibial torsion on the right). missed out on torsions? click here
Internal tibial torsion often places extra force on the lateral aspect of the foot. You (often) rotate the extremity internally to maintain the knee in the saggital plane.  
  • he has inverted feet bilaterally with (most likely) and forefoot varus (the forefoot is inverted with respect to the rear foot). This is easier to see with exam, as it looks like he may have a forefoot valgus in the picture
for what we hope are obvious reasons, when a person has an uncompensated (cannot form an adequate foot tripod) forefoot varus, this will place extra force on the outside of the foot. 
  • he has a left short leg (functional or anatomical)

folks will often (but not always) pronate through the mid foot more on the longer leg side (in an attempt to shorten the leg) and supinate (remember: plantar flexion, inversion and adduction) on the shorter leg side in an attempt to lengthen the limb. 

Now can you see why he has lateral foot pain?

What about the cramping?

Hmmmm. going from almost zero to 8-10 ours daily of standing on hard floors. think the intrinsic muscles of the foot might be called to task? And this is exactly what is happening. Those muscles, which have little endurance capacity, are going through glycolytic pathways to function, this the cramping.

So what do we do?

  • for starters, we valgus posted the insoles of his shoes L »R to try and push him off the lateral aspect of his foot and toward the head of the 1st metatarsal (see pics)
  • we gave him a temporary 3mm lift in the L side (a full sole lift). A heel lift only puts the foot in plantarflexion, lift the whole foot.
  • we gave him the tripod standing, lift toes, spread toes and reach “shuffle walk” exercises (you can search the blog under “exercise” or “tripod” to see these posts again: 3 sets, 10 reps, 3X daily
  • we advised him to stay out of motion control shoes (which would push his L knee too far laterally and outside the saggital plane
  • we manipulated his feet to insure his mechanics were biomechanically appropriate
  • we did manual stimulation of the tibialis anterior, extensor digitorum longus, interossei, extensor hallucis brevis and tibialis posterior followed by multiangle isometric resistance 

We will see how he does and may need to consider a custom crafted orthotic with intrinsic valgus posting if he does not respond well to therapy. we may need to consider dry needling and/or acupuncture as a supportive modality as well.

We hope you followed our reasoning in this case. If not, maybe search through our blog and youtube channel and catch up on some of this cool stuff!

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