Pain in Arch of Foot: Causes and Treatments of Plantar Fasciitis
About the arch of the foot
The arch of the foot consists of the tarsal and metatarsal bones along with the surrounding ligaments and tendons.
The arch of the foot has many different roles and is responsible for several different functions in the foot. These include:
- Helps to weight-bear
- Helps stabilise movements
- Helps absorb shock
- Helps maintain balance
- Allows the foot to adapt to changes in terrain as the person walks or performs certain activities
A person may feel an injury directly to the arch, however is it also possible to feel pain and discomfort to other areas which interact with the foot including:
- Ball of foot
- Top of foot
- Lower back
Causes of pain in the arch of the foot include:
Overpronation is used to describe the way in which your foot moves when you walk, in this case, people who overpronate the outer edge of the heel hits the ground first and then the foot rolls inwards rapidly onto the arch. Over time, overpronation can damage muscles, tendons and ligaments which can in turn cause problems that lead to arch pain. You may also notice extra wear on the inside part of the sole of your shoe.
Plantar fasciitis is the most common cause of arch pain in the foot. It can affect the heel and/or arch. The plantar fascia is a thick, fibrous ligament on the bottom of your foot, It attaches to the heel, runs along the arch and then attaches at the ball of the foot. When the plantar fascia is under stress and becomes irritated and inflamed, the condition is called plantar fasciitis.
Symptoms of plantar fasciitis:
The symptoms of plantar fasciitis includes:
- Sharp pain in the inside part of the bottom of the heel
- Stabbing pain that usually occurs with the first few steps in the morning, then eases off.
- Stabbing pain after resting for long periods of time and then standing up.
- Pain is worse after exercise but not during exercise
- Mild swelling at the heel
Causes of plantar fasciitis:
With every single step that we take, we heel strike on the outside of the foot, then roll our foot in, in order to propel off our big toe. As the foot begins to weight bear, it flattens. This puts pressure on the plantar fascia which does not stretch a lot. For a foot that is more pronated (rolled in), there are increased ground reaction forces put into the plantar fascia. This can also happen with a more supinated (rolled out) foot type, where the foot is more rigid and has a tighter plantar fascia. Other causes of plantar fasciitis includes:
- A lack of arch support.
- A sudden injury.
- A tendency to roll your feet one way or another.
- An increase in activities such as running, basketball, tennis, soccer or gymnastics that involve repetitive pounding of foot.
- Being overweight.
- Having one leg that is shorter than the other. This causes the foot on the longer leg to carry the body’s entire weight longer than normal, stressing the fascia on that foot. Additionally, the foot of the shorter leg falls to the ground harder, putting more pressure on that foot.
- Poor flexibility in the calf muscle and/or ankle.
- Poor training for physical activities.
- Standing too long.
- Wearing shoes that don’t bend easily under the ball of the foot.
- Wearing shoes with too little cushioning.
How is plantar fasciitis diagnosed?
Like any other condition, a full biomechanical assessment is conducted based on the description of the symptoms. The range of motion of the joints in your feet, the strength of the muscles in your feet, your footwear, your exercises regime, the way you walk and your foot type is all assessed to determine if you have plantar fasciitis. Imaging may be needed to confirm the diagnosis and to also determine if anything else could be causing your heel pain.
Treatment of plantar fasciitis:
The treatment and management plan is all dependent on the results of the full biomechanical assessment. Some of the treatments for plantar fasciitis includes:
- Applying ice
- Strength and conditioning
- Manual massage
- Dry needling
A cavus foot is identified when the foot has a very high arch. This may be inherited or in more serious matters, could be caused by a neurological condition, for example, cerebral palsy, stroke or Charcot-Marie-Tooth disease. You may also develop hammer toes, clawed toes or callous that could cause pain. Ankle sprains are also very common in a high arched foot type due to the foot being unstable.
Posterior tibial tendon dysfunction
Posterior tibial tendon dysfunction, also known as adult-acquired flat foot, occurs when you have an injury or inflammation to the posterior tibial tendon, which results in flattening of the foot. The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot. The main function of the tendon is to hold up the arch and support the foot when walking.
Causes of posterior tibial tendon dysfunction:
Overuse of the posterior tibial tendon is often the cause of posterior tibial tendon dysfunction. Increased stress through any of these arch-related bones, ligaments and tendon is caused when the tendon is overused in activities such as running, walking, jumping, climbing or from ageing.
Symptoms of posterior tibial tendon dysfunction:
- Pain extending from the arch, inner ankle and back of the calf.
- Pain during activities/exercise
- Swelling of the ankle
- Flattening of the arch
In a foot, the tendons within that foot and your lower limb work together to form the arch. When these tendons do not work together, there is little or no arch which can potentially cause problems. Children are born with flat feet as the longitudinal arch is not yet developed. As children begin to stand on their toes, their muscles start to develop and an arch appears. This development continues throughout childhood and by adulthood, an arch has formed. However, sometimes this is not the case. Having flat feet can be painless in some people, however, others can experience pain in the heel or arch area making it difficult to stand on their toes or have swelling inside the ankle. They also may experience pain after long periods of standing or throughout exercise.
Causes of flat feet:
Adults can develop flat feet for a number of reasons including:
- Damage to the tendons that support the arch
- Damage or inflammation of the posterior tibial tendon
- Trauma involving broken bones in the foot
- Rheumatoid arthritis
- Nerve damage
Symptoms of flat feet:
- Feet tire easily
- The ankle, arch and heel have dull ache
- Swelling on the inside and bottom of your feet
- Back and lower limb pain
- Difficulty standing on your toes
Treatment for any of these conditions which cause your arch pain depends on the outcomes of the full biomechanical assessment conducted by a Podiatrist. In the meantime, there are a few things you can do to help ease the pain before you visit a Podiatrist for further assessment.
When you first notice the pain in your feet, rest your foot from activities that put stress on your feet or that may be causing the pain, for example, running or jumping.
There is a fair chance that your arch may be inflamed. Applying ice to your foot for 10-15 minutes twice a day will help with that inflammation.
Stretching and rolling:
There are a few stretches that will be able to help with your arch pain:
- Foot stretch:
- Place your ankle on your thigh and cradle your toes in one hand
- With your other hand, gently fold the foot in on itself by pushing down and in on the heel.
- Gently push down the toes towards the heel and hold for 3-5 minutes
- This can be performed once a day or whenever you are experiencing pain
- Calf stretch:
- Stand facing the wall and place your hands shoulder width apart
- Place your right foot behind your left
- Bend the front knee forward while keeping the back knee straight and the heel on the floor
- You should feel a stretch in your right calf, hold this for 30 seconds
- Repeat this 3 times on the right side and then switch legs
- Lacrosse ball:
- You can do this with any ball that is firm i.e. golf ball
- You can do this either sitting or standing
- Remove your shoes
- Place the ball underneath your foot
- Roll the ball all over your foot slowly, you can add some pressure if you feel it is needed
- Do this for 1 minute per foot
When to see a Podiatrist:
If pain persists or gets worse, seeing a Podiatrist for a full biomechanical assessment is the best way forward to help you with your arch pain. Once a full assessment is completed, your Podiatrist will create a management plan that will allow you to reach your goals and have you pain free in no time!
Call 03 9553 0044 or make an appointment HERE for your orthotic assessment with one of our team!