What causes foot arch pain?

Pain in the arch of your foot can really hurt. Like, really hurt. And when your feet hurt, it can be hard to think about anything else.

“Not having a strong foundation of support can affect everything,” says Steven Hawley, DPM, a podiatrist at UPMC Williamsport.

The good news, however, is that 90% to 95% of people with foot arch pain can improve their symptoms with conservative treatments.

As a podiatrist board certified in foot and ankle reconstructive surgery, Dr. Hawley treats a range of foot problems.

“Many patients present to specialists after attempting some conservative treatments that have failed to eliminate their pain,” Dr. Hawley says. “Not all patients will require surgery, but there is a subset of patients who exhaust conservative treatments that could benefit from this type of intervention.”

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Common Causes of Foot Arch Pain

A lot of different things can contribute to foot and arch pain, says Dr. Hawley. For some it’s their foot structure or perhaps the way they walk. For others, it’s an injury related to overuse or not wearing the right shoes.

“It’s our job to get answers for people,” Dr. Hawley says. “We look at the symptoms they have and then try to pinpoint the cause.”

Plantar Fasciitis

According to Dr. Hawley, plantar fasciitis is one of the most common reasons for foot arch pain and heel pain. The plantar fascia is the band of fibrous tissue that runs along the bottom of your foot. It extends from the heel of your foot to your toes.

When you push off the ball of your foot to walk or run, it puts tension on the plantar fascia. This same motion over and over can make the tendon start to become less flexible and elastic.

When the fascia doesn’t stretch as easily, it gets irritated and inflamed, causing pain. “With plantar fasciitis, the pain can be sharp or shooting,” Dr. Hawley says. “It often starts at the heel and goes into the arch.”

Plantar fasciitis can be common among runners and walkers, especially those who exercise on hard surfaces. It can affect people of all ages. “We see it in younger people who play sports, as well as older adults who remain active,” he says.

Posterior Tibial Tendonitis

Plantar fasciitis isn’t the only problem that can affect the arches of your feet. “There are tendons that support your arch that can get inflamed,” he says.

The posterior tibial tendon is the big one that causes problems, especially for runners. This tendon connects the inner part of your foot to the lower leg. When it gets inflamed, it often hurts around the inner ankle and into the arch.

As with plantar fasciitis, posterior tibial tendonitis usually needs rest and some anti-inflammatory medicine. Supportive shoe gear or inserts can be beneficial to provide additional structural support to this tendon as well as the arch of the foot.

Tarsal Tunnel Syndrome (TTS)

Tarsal tunnel syndrome (TTS) is a nerve compression problem, like carpal tunnel — but in your feet. It affects the posterior tibial nerve and can cause arch pain or foot numbness and tingling.

Having flat feet can increase a person’s risk of developing TTS. Another is swelling from an injury — or from arthritis or diabetes — because the swelling pushes against the nerve. Anti-inflammatory medicine can help, and surgery to release the nerve is a last option.

Fallen Arches

Flat feet, also called fallen arches, can lead to arch pain all on its own.

“Not everyone with flat feet has pain,” Dr. Hawley says. “But it can affect gait, which affects other things.” PT and orthotics can help treat fallen arches.

Achilles Tendonitis

Having a tight or inflamed Achilles tendon can cause pain in the midfoot and heel. Sometimes Achilles tendonitis happens along with plantar fasciitis, and it’s hard for patients to know where the pain is coming from. “It’s often more than one thing causing arch pain,” Dr. Hawley says.

Preventing Foot Arch Pain

Regular stretching of the foot and calf is one way to prevent arch pain, Dr. Hawley says. The problem is, most people don’t think to stretch or do other foot exercises until they have pain.

The biggest preventive measure Dr. Hawley suggests is wearing the right footwear.

First, this means replacing worn shoes. “You need structural support,” Dr. Hawley says. Once that wears away, you start to put yourself at risk for injury.

While a great pair of dress shoes may last years, athletic shoes wear out much quicker. You can often tell if you look at the bottom and note the wear on the soles and around the heels.

Also, wear shoes fitted to your foot type. “Don’t just pick the color or style you like,” he says. “Pick based on the functional benefit.”

There is no “standard” running or walking shoe or brand he recommends. There are dozens of options. “You need the right arch support, but also, length and width matter,” Dr. Hawley says.

Treating Foot Arch Pain

To relieve foot arch pain, rest and stretching are often key. For plantar fasciitis, it’s important to stretch:

  • The plantar fascia itself.
  • The calf muscles.
  • The muscles around the foot and ankle joint.

Dr. Hawley will often refer people to a physical therapist to work with them on stretches that target these areas. “A lot of arch pain can be reversed by the right exercises,” he says.

He may recommend using orthotics, or shoe inserts, as these can make a big difference, too.

Taking anti-inflammatory medicine can also help. “Some people may also be a candidate for pain relieving injections,” Dr. Hawley says. “For plantar fasciitis, there is an area where we can inject that helps some people.”

If conservative treatments have not improved your pain, more advanced imaging may be recommended. “An MRI can find those soft tissue tears or soft tissue masses pushing on the bottom of the foot,” Dr. Hawley says.

If needed, surgery may be an option. One option is a plantar fascia release, which involves making a small incision through a scope. “It can help significantly,” Dr. Hawley says, “but it’s a last resort.”

“Don’t wait until pain gets the better of you,” he says. Learn more about foot and ankle care in North Central Pa.

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