Arch Pain (Foot Pain)

Trauma, sprains, strains, fractures, and arthritis are common causes of arch pain.

• Each foot contains 26 bones, which form two arches. The longitudinal arch runs the length of the foot, and the transverse arch runs the width.
• The bones of the arch are primarily held together by the shape with which they fit with each other and by fibrous tissues known as ligaments that serve to hold the bones to each other.
• The muscles of the foot, along with a tough, sinewy tissue known as the plantar fascia, provide secondary support to the foot.
• There are also fat pads in the foot to help with weight-bearing and absorbing impact.
• Arch pain can occur whenever something goes wrong with the function or interaction of any of these structures.

The arches are the primary structures of the body that absorb and return force to and from the body to the outside world when we are on our feet. When something happens to these structures, pain and injury may result.

There can be many causes of arch pain. Direct force trauma, ligament sprains, muscle strains, poor biomechanical alignment, stress fractures, overuse, inflammatory arthritis or the tightness or lack of tightness of the joints in the foot may all cause pain in the arch.

Injury to the plantar fascia is a common cause of arch pain. The plantar fascia is the thick, connective tissue which supports the arch on the bottom of the foot. It runs from the calcaneus (heel) forwards to the heads of the metatarsals. When the plantar fascia is damaged, the resulting inflammatory response may become a source of arch pain.

Sprains, strains, bruises, and fractures may be the result of a single stress or a combination of stresses to the foot. A blunt-force injury such as someone stepping on your foot may result not only in a bruise (contusion) but also in damage to the primary and secondary structures of the foot. Many of the muscles of the lower leg and foot attach on or near the arch. Injured or tight muscles may lead to incorrect biomechanics and in turn cause arch pain.

Injury to the bones of the foot can be caused by a single blow or twist to the arch or also by repetitive trauma, which can result in a stress fracture. A sprain of the arch occurs when the ligaments which hold the bones together are overstretched and the fibers tear. The muscles of the foot may be strained by overstretching, overuse, overloading, bruising, or being cut by stepping on a sharp object. Arthritis of the arch joints may also occur if the foot is subjected to repetitive movements that stress the arch.

Stress fractures, plantar fasciitis, and acute and chronic arthritis are most commonly the result of repetitive micro-trauma injuries. Micro-trauma injuries are caused when the structures of the body are stressed and re-stressed to the point that damage occurs in the tissues. Factors that commonly contribute to this injury can be running on uneven surfaces or surfaces that are too hard or too soft, shoes that have poor force-absorption qualities, or going too hard or too long during repeated exercise bouts.

Pain and tenderness associated with plantar fascia strains are usually felt on the bottom of the foot and may manifest either as a specific or general area of tenderness. Plantar fascia pain may be increased or decreased by stretching of the arch. Generally, in mild cases of plantar fasciitis, the pain will decrease as the soft tissues of the foot "warm up"; however, pain may increase as the use of the foot increases. In more severe cases of plantar fasciitis, pain may increase when the arch is stressed.

A more specific pain (point tenderness) is an indicator that something is wrong in that specific area. Pain with movement of the affected area is also an indicator of the particular body part affected.

Bones and ligaments work together to form joints, as bones are joined together by ligaments. Strains occur in ligaments. In the arch, there are ligaments that are located at the ends of each bone. These ligaments connect the bones to other bones on both ends and on the sides. Point tenderness and looseness of a joint are indicators of a sprain.

Fractures are indicated by point tenderness that may be severe over the area of bone that is affected. There may be a distinguishable lump or gap at the site of the fracture. A rotated toe or forefoot may also be a sign of a fracture.

The groups of muscles that support the arch can be divided into two groups. The muscles on the top of the arch start on the front lower leg and help to lift the arch, and the muscles that help pull the arch on the bottom of the foot are located the on back of the lower leg. Muscle injury may be indicated when pain is felt when the foot is fully extended, flexed, or turned in or out. Pain may also be felt when working the foot against resistance.

Bruises are the result of a direct-force injury to the body. A bruise can occur to the foot by a variety of causes, such as having your foot stepped on or by stepping on a rock. The tissues that compose the arch do not provide that area of the body much protection. Blows to the foot that result in pain, discoloration, swelling, and changes in how you walk may indicate more serious damage.

Arch pain may have a variety of different causes. Proper evaluation and diagnosis of arch pain are essential in planning treatment. A good general guideline is to compare the injured side to the uninjured side. The injury may present itself as a distinguishable lump, a gap felt at that location, or a "crunchy" feeling on that spot caused by inflammation. The type, causes, and severity of pain are also good indicators of the severity of the injury.

Four grades can be used to describe arch pain:

• Pain during activity only
• Pain before and after activity, and not affecting performance
• Pain before, during, and after athletic activity affecting performance
• Pain so severe that performance is impossible

When the pain begins to interfere with activities of daily living or if you cannot perform your desired activities without pain, you should consider seeking medical attention. Other indicators that you should seek medical care are if the area looks deformed, becomes exquisitely tender to the touch, or is causing you to move differently.

The doctor will take a brief history to determine how the injury occurred. If necessary, a thorough physical exam may be conducted to evaluate for any other injuries. Taking your workout shoes to the exam may also provide valuable information to the medical practitioner.

• Both feet will be examined by the medical practitioner. The foot and arch will be touched and manipulated possibly with a lot of pressure and inspected to identify obvious deformities, tender spots, or any differences in the bones of the foot and arch.
• The medical professional will examine how the muscles of your foot function. These tests may involve holding or moving your foot and ankle against resistance; you may also be asked to stand, walk, or even run. Pain caused by movements may indicate the cause of the pain.
• The nerves in the foot will be tested to make sure no injury has occurred there.
• An x-ray, MRI, or bone scan of the foot and arch may be taken to determine if there are changes in the makeup of the bone.

Once the severity and cause of arch and foot pain are determined, a course of corrective and rehabilitative actions can be started.

• Therapists may use machines and/or manual therapies to reduce pain and increase circulation to the area to promote healing.
• Maintenance of fitness levels via modification of activity may be prescribed.

• Substitute activities that may aggravate the pain and soreness with other activities; for instance, running causes the body to have multiple impacts with the ground, but the use of bicycling, elliptical trainers, step machines, swimming, or ski machines eliminates impact and allows you to continue to maintain and improve your fitness levels.

• Use corrective prophylactic measures.
  • Purchase new shoes or replace the insoles of your current shoes.
  • Athletic shoes lose the elastic properties of the soles through usage and age. A good rule of thumb is to replace your shoes every six months, more often if there is heavier usage. The use of after-market insoles can increase energy absorption and add support to the foot.
  • Custom fabricated orthotics or off-the-shelf orthotics may also improve the biomechanics of the foot.
• Focus on muscle strengthening and flexibility.

• You may be given exercises to increase the strength and stability of the affected area and to correct muscles that may not be balanced.
• Exercises to increase flexibility will maintain or improve the length of a muscle. Flexibility helps to make a stronger muscle that is less likely to be injured.

• Take medications to help reduce pain and inflammation.
• Follow up with your doctor until you are better.

When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain.

Rest will allow the tissues to heal themselves by preventing any further stress to the affected area.

Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold.

Compression and elevation will help prevent any swelling of the affected tissues.

There are two types of over-the-counter medication that may help with the pain and swelling of arch pain. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will also help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and dosage should not exceed the labeled directions. Special care should be taken and a physician consulted if you have a history of stomach ulcers. Those who have chronic medical conditions or who are taking other medications should consult with their doctor regarding the most appropriate type of pain and/or anti-inflammatory medications. Commercial over-the-counter arch supports or orthotics may also help to ease the arch pain.

In cases where abnormal findings were seen in the initial scans or X-rays, follow-up scans or X-rays may be indicated. A plan for a gradual return to play should be started once the pain is reduced and muscle strength and flexibility are restored.

Biomechanical studies of how the body interacts with the world around it may reveal the underlying causes of arch pain.

Returning to participation in sports and other activities and prevention of arch and foot pain are governed by the same factors. Arch pain may be often caused by doing too much of a particular activity too fast. Arch pain can be seen at the beginning of a conditioning or a sports season. A sudden increase in activity may also cause arch pain during the middle or end of a season or a conditioning program.

A good workout program begins with a physical exam by a physician, then gradual and consistent workouts. For example

• Warm-up: Walk two to three minutes, then jog for 30 seconds, and walk for 30 seconds.
• Repeat three times.
• Main set: Jog for a minute, then walk for a minute for 20 to 40 repetitions. As you become more comfortable with alternating jogging and walking, increase your jogging time until you can run continuously for 40 minutes. Working out on good surfaces and using proper equipment in your workout will help to lower the risk of arch pain.

Components of a good exercise program should include core strengthening, muscle strengthening, and flexibility training that are specific to the goals of the workout program or the sport.

If the pain is encountered when working out, try decreasing the intensity of the workout. If the pain persists or sharpens, then you should immediately stop and seek medical advice to discover the source of the pain. Pushing through pain most often results in injury.