SYDNEY HEEL PAIN CLINIC

What is arch pain?

Arch pain is one of the most common foot complaints. The foot arch is the area that runs underneath the foot, from the base of the toes to the heel bone. The arch functions to distribute the forces from walking correctly through the foot, function as a shock absorber, and create balance and stability in the foot and lower leg, especially with changes in terrain. Arch pain is a common complaint for runners and physically active people, but it is not uncommon for people not engaged in physical activity to suffer with arch pain as well.

Arch pain can be sudden in onset (for example, following a sporting event or a day of lots of walking), or progressively over a period of time (such as with wearing inappropriate footwear). Patients with arch pain often report that their pain is worse when they walk barefoot or when wearing unsupportive footwear such as flip-flops or ballet flats.

What conditions cause arch pain?

There are a number of conditions that may be present in the foot to cause arch pain. Quite often, an affected patient is suffering with more than one condition at the one time. Generally, arch pain is most commonly caused by plantar fasciitis, peroneal tendonitis or tibialis posterior tendonitis.

Arch pain caused by plantar fasciitis

Plantar fasciitis is the most common condition that causes arch pain in patients. It is the condition that develops when the plantar fascia ligament become inflamed or injured. The plantar fascia is located along the base of the foot. It connects the heel bone to the base of the toes. Inflammation can occur as a result of injury or overuse. Patients that have plantar fasciitis usually report that their arch pain is worst in the morning when they take their first steps as they rise out of bed. The pain often subsides after a period of walking. The arch pain caused by plantar fasciitis is described by patients as burning, tearing, pulling, or tightness in the bottom of the foot.

Arch pain caused by peroneal tendonitis

Peroneal tendonitis occurs when the peroneal tendons become inflamed, causing arch pain. Each leg has two peroneal tendons. They extend parallel to each other, vertically down the lower leg, and behind the bony lump on the outside of the foot. One tendon attaches on the outside of the foot at the base of the little toe, and the other on the inside of the arch. The functions of the peroneal tendons are to provide stability for the ankle when the foot is weight bearing, and help in turning the foot outwards and stabilize the arch as the person walks. Patients suffering from peroneal tendonitis usually have pain when turning the foot in or out, and ankle instability. It is a condition that often affects runners, as they are constantly trying to roll their feet outwards as they run.

Arch pain caused by tibialis posterior tendonitis

Also referred to as posterior tibial tendon dysfunction (PTTD), tibialis posterior tendonitis is a relatively common problem causing arch pain. This particular tendon connects one of the shin muscles to the bones on the inside of the foot, acting to hold up the foot arch and support the foot during walking. PTTS occurs when the tendon becomes torn or inflamed through injury or overuse. When the tendon becomes injured and is not allowed time to heal, the arch collapses over a period of time. Patients experience pain along the inside of the foot and around the inside of the heel and ankle, sometimes making it difficult to walk, or even stand for extended periods of time. PTTD is often a problem in people who play high impact sports such as tennis, basketball or soccer. Also common in the elderly when the muscle / tendon fails.

How is the cause of arch pain diagnosed?

Arch pain is a very common foot complaint, and as such, your sports podiatrist will have had a lot of experience in diagnosing the conditions that cause arch pain. To begin with, your podiatrist will collect a through medical history from you. They will ask questions about the type of pain you have and when it occurs. Some other information your sports podiatrist may seek from you might include:

• Your age, sex and regular occupation
• Your past history and current level of participation in sports or other physical activity
• A description of the pain sensation you are experiencing
• Whether particular activities or movements make it better or worse
• History of any injuries to the leg or foot
• Whether you are currently on any medication.

Your sports podiatrist will continue by conducting a physical examination of your feet. They will palpate (physically feel) your ankle and foot for any structural abnormalities and apply pressure at certain points to establish what causes your arch pain. If you only have arch pain in one foot, your sports podiatrist will compare the sore and healthy foot for any structural or physical differences.

Your sports podiatrist may find it beneficial to order an xray or ultrasound. In some cases, these types of medical imaging can help to rule out certain conditions with symptoms that may be very similar, aiding in the diagnosis of your arch pain.

Biomechanical assessment in diagnosing arch pain

Your sports podiatrist is likely to conduct a biomechanical assessment and gait analysis as part of their examination of your arch pain. Biomechanical assessment is an invaluable diagnostic tool, which gives your sports podiatrist a clear view of the biomechanics of your lower leg and foot. Any imbalances or malalignment of the foot can be viewed. Using this analysis, your sports podiatrist can ascertain which parts of the foot are under the most stress as you walk or run.

To conduct the analysis, removable markers are placed on particular points of your lower leg and foot. Specialized software is used to capture images from a camera, which then provides a motion analysis while you walk or run on the treadmill. Your sports podiatrist can then view the images of the alignment of your lower leg structures as your feet land and push off the treadmills surface.

How is arch pain treated?

The treatment of choice largely depends on the cause of the arch pain. It is important that you consult with a qualified sports podiatrist so that they may conduct a thorough assessment and diagnosis before commencing any treatments. Your sports podiatrist will devise an appropriate treatment plan for you based on the cause of your arch pain, your symptoms, and your activity level.

Some of the treatments commonly used for patients with arch pain include:

• Strapping: strapping tape applied in the correct way can help to support the arch of the foot whilst allowing the injured or inflamed tissues to heal, providing you relief from arch pain
• Changing footwear: your sports podiatrist will be able to recommend which shoes are most appropriate for your foot, to help reduce arch pain both immediately and in the longer term
• Rest: your sports podiatrist may recommend that you change your current physical activity level to something less strenuous, or you may even need to rest completely for a period of time to allow damaged tissues to heal
• Losing excess weight: managing a healthy weight and losing any excess weight is beneficial when treating arch pain, as a lower body mass puts less pressure and strain on the structures of the foot
• Ice packs: you can use a cold compress or ice pack on the sore arch for 15-20 minutes at a time regularly during the day to reduce inflammation and relieve pain
• Shoe inserts and orthotics: your sports podiatrist might recommend tailor-made orthotics or shoe inserts if they are appropriate for you. These can help to support the arch of the foot correctly and provide stability for the foot and ankle
• Extracorporeal shockwave therapy (ESWT): a hand-del probe is used to direct high-frequency sound waves can be into the affected area. This process accelerates healing by stimulating blood flow, helping to break down any scar tissue and relieving pain.
• Stretching and strengthening: your sports podiatrist can recommend and demonstrate for you the types of exercises that are appropriate for your arch pain. Stretching and strengthening the lower limb, ankle and foot helps with pain management in the long term and prevention of future recurrence. You must closely follow the exercise program that your sports podiatrist prescribes for you. Not doing so may exacerbate your condition
• Medication: NSAIDs (non-steroidal anti-inflammatory drugs) may be recommended as a last resort in cases where the pain is severe and not able to be managed with other treatment methods. NSAIDs have some side effects, so whilst they provide pain relief in the short term, they are not a long-term solution to arch pain.

Please note that the information provided in the article above in relation to arch pain is for educational purposes only, and should not be taken as medical advice. If you are suffering with arch pain, you should consult with a qualified sports podiatrist to discuss your condition. Appointments can be made online at sydneyheelpain.com.au or by calling 02 93883322.

Karl Lockett – sports podiatrist.