Arch pain is characterized as a burning sensation under the long arch of the foot. The arch, essential to proper biomechanics, tightens and relaxes during the different phases of gait.
Your foot is composed of 3 arches; the transverse arch, the lateral longitudinal arch and the medial longitudinal arch. Your arches are supported and maintained by the interlocking tarsal and metatarsal bones, the ligaments of the plantar fascia, and the extrinsic muscles of the foot and its tendons. The arches complex network of small joints, tendons, ligaments and muscles are reinforced by the fascia ligament that connects to the heel bone and extends to the toes. This makes the arch extremely vulnerable to stress and damage. The most common causes of arch pain is either structural imbalances within the foot or a direct injury. The arch is crucial in proper foot mechanics as the smooth transfer of weight from the heel to the toes is essential to posture, gait and movement.
Arch pain is extremely common as approximately 2,300,000 Americans suffer from the condition annually. Causes of arch pain include; an excessive stretch, bend, twist, jerk or plantarflexion, or dorsiflexion to any of the muscles or ligaments that support the arch. Pain in the arch area is characterized by overuse or over compensation and caused by poor foot alignment and function. There are three main diagnoses for arch pain; plantar fasciitis the most common derivative, posterior tibial tendonitis and flexor dysfunction.
The plantar fascia is a soft fibrous tissue structure that extends from heel to toe and runs under the arch providing support. With each step taken the fascia is called into action. Overuse of this vital ligament causes inflammation and typically occurs in the heel and or arch of the foot. Fasciitis can be extremely painful and debilitating with significant pain after long periods of rest or sleep.
The Flexor Brevis, Halluces and Longus muscles allow your big toe to bend downward. Overuse of any of these structures will likely cause pain. Excessive pronation of the tendons due to overstretching will cause your big toe to over work itself and its supporting muscles to help stabilize your foot.
Posterior tibial tendonitis is the primary structure that supports the arch. Weakness in this muscle will lead to excessive pulling and stretching of the tendon and subsequent pain. Pain can also occur on the inside ankle and shin with this injury and can range from a simple strain to a complete dysfunction. Often, tarsal tunnel syndrome or posterior tibial tendonitis can be confused and misdiagnosed with plantar fasciitis. Tarsal tunnel syndrome is a pinching of the tibial nerve which runs through the ankle as it passes through the flexor retinaculum, the supportive band that surrounds the ankle joint. The symptoms of tarsal tunnel syndrome are often limited to the ankle, but since the nerve passes through the entire foot it can cause arch pain.
Arch pain is caused by a variety of conditions; abnormal anatomy or position of the foot like excessive pronation where the ankle rolls inward, structural imbalances, arthritis, obesity, lack of physical exercise, non-supportive or inadequate footwear such as high heels and tight tendons or muscles such as the Achilles and calf respectively. Additional problems may result from standing, walking or being on your feet all day, excessive physical training or improper exercise techniques.
Symptoms that occur within the arch are usually due to inflammation of the tissues within the mid foot, which can create imbalance in the normal mechanics and function of the arch. When even small movements become painful, the body will compensate to offset this pain and discomfort with changes to gait and posture, further creating additional problems.
Treatment of arch pain will include rest, ice or cold therapy and nonsteroidal anti-inflammatory medications or NSAIDs. If allergic to anti-inflammatory medications or concerned about the longterm effects all natural topical analgesics are an excellent substitute for pain relief without the added health risks or burdens. Reducing physical activity and changing your daily exercise or training routine is essential as is wearing properly fitted footwear. Consider swimming or cycling as alternative exercises to maintain training during your recovery period. Both activities take pressure off of your foot and arch and will allow your midsole tissue to begin healing while still engaged in exercise. Once symptoms have improved or are completely resolved individuals may begin slowly returning to normal activities. Non-invasive medical appliances like a foot brace that provides compression and can secure your arch muscles and ligaments in place so they do not move as you do will help speed recovery exponentially.
Corticosteroids injections, while they may reduce pain and inflammation, are not recommended as they are extremely painful and degrade already inflamed and weakened tissue. Ultrasound therapy is also unlikely to be helpful, but is less invasive and may be considered as an alternative therapy in the unlikely event traditional treatment fails.
Insoles and orthotics will provide some cushioning and additional support to the arch, but full resolution is unlikely. Only 1 in 10 people will fully heal when using an OTC insole or even custom prescribed orthotic. These non-invasive medical appliances fail to secure the fascia ligament and secondary muscles that support the arch as you walk or move. Failure to secure the supporting structures of the arch is failure to treat the problem.
People with arch pain may continue to have flare-ups of pain. Proper stretching should be applied during treatment and after pain has subsided to ensure there is no reoccurrence. If the condition is not successfully treated or you suffer from chronic pain seek medical attention as your practitioner will want to evaluate your condition through imaging technology; likes X-rays and an MRI, to determine the scope of the problem. If you do not apply or seek proper treatment you may become physically inactive and will likely require more invasive therapy and or surgery to resolve your condition.