Arch Pain

Arch pain is often felt as a burning sensation under the long arch of the foot. There are a number of causes of this, but the most common is plantar fasciitis, but can also be due to the strain of any structure in the arch of the foot.

Causes of arch pain

There are a number of possible causes for arch pain, but the most common are structural imbalances of the foot, such a pronated foot (rolls inward at the ankles). This is often not enough in isolation to cause the problem, but in combination with other factors arch pain may develop. These other factors are usually associated with overuse – running, walking, hard surfaces and/or OFAD (on feet all day), usually combined with inadequate or non-supportive footwear.

The more common specific causes of arch pain can be:

* plantar fasciitis (strain of the plantar fascia – a strong ligament that supports the arch)
* tarsal tunnel syndrome (a pinched nerve at the ankle that refers pain to the arch)
* foot strain from a pronated foot or flat foot
* there can be osteoarthritis of the joints in the midfoot that can cause arch pain

Self management of arch pain

The initial treatment for arch pain, especially if it is of sudden onset is the use of ice to reduce the swelling. Later heat and anti-inflammatory gels can be a big help.

Activity should be modified – if you stand a lot at work, see if you can using seating more; if you run a lot, consider swimming or cycling for a while.

Use footwear that is supportive in the midfoot and heel area.

Arch pain management

An accurate diagnosis from a health professional is important early in the management of arch pain.

If the symptoms are mild, management will generally just consist of advice about fitting footwear, stretching exercises for the calf muscles and arch and if indicated, the use of foot orthotics.

If the symptoms are more severe, tape can be used to restrict motion and support the arch; anti-inflammatory medication can be used to give some relief. Orthotics are usually indicated.

If there is no initial response to treatment, further investigations may be necessary to check for conditions such as arthritis or a pinched nerve.

Prevention of arch pain

Early in the treatment of arch pain, consideration needs to be given to the cause and strategies put in place to prevent it happening again. Advice should be sought on the adequacy of footwear. Stretching exercises should be continued long after the symptoms are gone. Foot orthoses should be used if structural imbalances are present. Activity levels and types of activities (occupational and sporting) need to be considered and modified accordingly.

 

Plantar Fasciitis

What is plantar fasciitis?

Plantar fasciitis (say “PLAN-ter fash-ee-EYE-tus”) is the most common cause of heel pain. The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk.

What causes plantar fasciitis?

Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if:

Your feet roll inward too much when you walk (excessive pronation).
You have high arches or flat feet.
You walk, stand, or run for long periods of time, especially on hard surfaces.
You are overweight.
You wear shoes that don’t fit well or are worn out.
You have tight Achilles tendons or calf muscles.

What are the symptoms?

Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.

If you have foot pain at night, you may have a different problem, such as arthritis, or a nerve problem such as tarsal tunnel syndrome.

How is plantar fasciitis diagnosed?

Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about:

Your past health, including what illnesses or injuries you have had.
Your symptoms, such as where the pain is and what time of day your foot hurts most.
How active you are and what types of physical activity you do.

Your doctor may take an X-ray of your foot if he or she suspects a problem with the bones of your foot, such as a stress fracture.

How is it treated?

No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better:

Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces.
To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin), naproxen (such as Aleve), or aspirin.
Do toe stretches, calf stretches and towel stretches several times a day, especially when you first get up in the morning.
Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts (orthotics). Use them in both shoes, even if only one foot hurts.

 

Flatfoot (Pes Planus)

 

What is flatfoot?

Flatfoot (pes planus) is a condition in which the longitudinal arch in the foot, which runs lengthwise along the sole of the foot, has not developed normally and is lowered or flattened out. One foot or both feet may be affected.

What causes flatfoot?

Flatfoot may be an inherited condition or may be caused by an injury or condition such as rheumatoid arthritis, stroke, or diabetes.

Who is affected by flatfoot?

Children as well as adults may be flat-footed. Most children are flat-footed until they are between the ages of 3 and 5 when their longitudinal arch develops normally.

What are the symptoms?

People who have flat feet rarely have symptoms or problems. Some people may have pain because of:

Changes in work environment.
Minor injury.
Sudden weight gain.
Excessive standing, walking, jumping, or running.
Poorly fitted footwear.

Children sometimes have foot discomfort and leg aches associated with flat-footedness.

How is it treated?

Treatment in adults generally consists of wearing spacious, comfortable shoes with good arch support. Your doctor may recommend padding for the heel (heel cup) or orthotic shoe devices, which are molded pieces of rubber, leather, metal, plastic, or other synthetic material that are inserted into a shoe. They balance the foot in a neutral position and cushion the foot from excessive pounding.

For children, treatment using corrective shoes or inserts is rarely needed, as the arch usually develops normally by age 5.

Surgery is rarely needed.

You may be able to relieve heel pain by stretching tight calf muscles.

Stand about 1 ft (30 cm) from a wall and place the palms of both hands against the wall at chest level.
Step back with one foot, keeping that leg straight at the knee, and both feet flat on the floor. Your feet should point directly at the wall or slightly in toward the center of your body. Keep the knee of the leg nearest the wall centered over the ankle.
Bend your other (front) leg at the knee, and press the wall with both hands until you feel a gentle stretch on your back leg (calf muscle).
Hold for a count of 10 (increasing the count to 30 or longer as you continue over several weeks). Switch legs and repeat. Do this 2 to 4 times a day.

Foot-strengthening exercises done with a towel and weights.

Place a towel on the floor, and sit down in a chair in front of it with both feet resting flat on the towel at one end.
Grip the towel with the toes of one foot (keep your heel on the floor and use your other foot to anchor the towel). Curl your toes to pull the towel toward you.
Repeat with the other foot. To increase strength, later use 3 lb (1.5 kg) to 5 lb (2.5 kg) weights (such as a large can of fruit or vegetables) on the other end of the towel.