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5th Metatarsal / Peroneal Tendon Pain?
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I’ve been having a problem with my 5th metatarsal and/or peroneal tendons. Pain is essentially on the side and bottom of the 5th metatarsal base and gets tender at times.

No acute injury to cause this issue. Developed when I was in PT for a hip injury from a dog bite.

X-rays and an MRI ruled out any fractures and no real problems were visualized with the distal peroneal tendons.

Podiatrist put me in a boot x 6 weeks which did not do much. If I tried to make the boot tight it became painful, whereas if I loosened the straps it was more comfortable. I only got about 1.5 - 2 weeks of pain free time in the boot and much weaker lower extremity. No PT was ordered and was told to just walk to strengthen it. (That was about a year ago).

Saw a orthopedic md a little while later who ordered the MRI suspecting a fracture, but that came back with nothing helpful and not much to go on.

I’ve noticed that I get pain in the spot in athletic shoes more than anything else. Tighter fitting athletic shoes (ie Nike Pegasus) are more troubling than keeping the shoes tied loosely. Hiking boots , ski boots and being bare foot don’t seem to cause any issues.

In addition, I’ve been doing some PT which is showing some slight improvement.

In addition to mostly core strength, I’ve been using the rowing machine for cardio.

Anyone with a similar experience?
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Re: 5th Metatarsal / Peroneal Tendon Pain? [rpb556] [ In reply to ]
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i've had pain on the side of my foot from cycling shoes that were too tight. maybe you need wider running shoes and/or cycling shoes? Also if you ar getting pain in the same are with cycling shoes, a shim/wedge under the medial foot might help too.

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Re: 5th Metatarsal / Peroneal Tendon Pain? [tristorm] [ In reply to ]
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The injured foot usually measures on the border of narrow/medium and my other food measures medium. When I try wide shoes, my feet slide around quite a bit.

Currently doing New Balance 880’s. I sized up by half size and while they are big, it gets me through the work day.

The shim idea is interesting. Is there a way I can make one to test out?
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Re: 5th Metatarsal / Peroneal Tendon Pain? [rpb556] [ In reply to ]
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I had it in 2015 in a bad way from running on slushy icy roads in my neighbourhood because there was no where else to run. Had to take 2 weeks off running altogether. It hurt so much I couldn't even run a few metres. Pushing off the wall in the pool hurt. Bilateral pain. I then did Ironman Puerto Rico in my best half ironman time. Then I had to take a few more weeks off and slowly rebuild. I don't have an answer other than taking time off. I doubt a cast or boot would help other than preventing you from exercising.

They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

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Re: 5th Metatarsal / Peroneal Tendon Pain? [rpb556] [ In reply to ]
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I had something similar, thought it was a broken foot, and my ortho looked at clean x-rays and sent me to a massage therapist. He told me to tell her to work on my abductor digiti minimi (also known as the abductor quinti digiti, I think). The massage work was quite painful, but it worked.


<The Dew Abides>
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Re: 5th Metatarsal / Peroneal Tendon Pain? [spockwaslen] [ In reply to ]
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spockwaslen wrote:
I had it in 2015 in a bad way from running on slushy icy roads in my neighbourhood because there was no where else to run. Had to take 2 weeks off running altogether. It hurt so much I couldn't even run a few metres. Pushing off the wall in the pool hurt. Bilateral pain. I then did Ironman Puerto Rico in my best half ironman time. Then I had to take a few more weeks off and slowly rebuild. I don't have an answer other than taking time off. I doubt a cast or boot would help other than preventing you from exercising.

Luckily, I only have the issue on one foot, but I feel for you. Unfortunately, I've tried the time off as well and that really did not seem to help much. Luckily, I was able to snag an appointment with another podiatrist last this week to maybe get some more answers.
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Re: 5th Metatarsal / Peroneal Tendon Pain? [dewman] [ In reply to ]
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dewman wrote:
I had something similar, thought it was a broken foot, and my ortho looked at clean x-rays and sent me to a massage therapist. He told me to tell her to work on my abductor digiti minimi (also known as the abductor quinti digiti, I think). The massage work was quite painful, but it worked.

I also thought I had a stress fracture but everything was clean. I have actually questioned this muscle in my mind. Along with pain near the 5th met base, I do experience some on the bottom side. Were was your pain?
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Re: 5th Metatarsal / Peroneal Tendon Pain? [rpb556] [ In reply to ]
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rpb556 wrote:
I also thought I had a stress fracture but everything was clean. I have actually questioned this muscle in my mind. Along with pain near the 5th met base, I do experience some on the bottom side. Were was your pain?

It was about 1 to 2 inches toward the heel from the base of the small toe, on the bottom of the foot, about 1/4 to 1/2 inch from the side of the foot. It did not feel anything like a muscle injury. It was sharp, came on suddenly about 30-60 minutes after a half-marathon, and it was localized to an area the size of a dime. It only hurt when bearing weight, so I was certain it was a broken bone, but a massage therapist can't fix a broken bone in five painful minutes.

When the MT worked on it, it was tender almost everywhere she worked, but especially at the painful spot underneath and on the side of the foot. It's a surprisingly large muscle considering it abducts the smallest toe.


<The Dew Abides>
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Re: 5th Metatarsal / Peroneal Tendon Pain? [rpb556] [ In reply to ]
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I've had issues with cycling shoes hurting me in that area all my life (30 years of biking so far).

One thing I've come to realize after trying countless off the shelf shoes is that it was -not- directly related to width.
Under/beside the 5th metatarsal base, which my podiatrist also referred to as the styloid (I thought those were only on wrists!).

The podiatrist said that some folks are just bothered in that area from the slight curve that you have in cycling shoes at that point in the shoe, and the one thing he did to give me some relief was he took my insole and added a lift under the heel, guessing about 5 - 7mm, to effectively flatten the shoe out for me from the heel to the styloid.
Last edited by: SBRcanuck: Mar 31, 21 10:38
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