At a glance:
- The arch of the foot helps the foot absorb impact, as well as helping you bear weight, keep balance, move on uneven terrain, propel you forward, and more.
- The arch is made up of the metatarsal and tarsal bones as well as a number of muscles, tendons and ligaments.
- A number of different conditions, ranging from high arches to flat feet, inflammation of tendons or ligaments and even the way you walk may lead to arch pain.
What is a Foot Arch?
In simple terms, the arch is the curve of the sole of the foot. In a typical foot with a healthy arch, weight is distributed across the ball of the foot and the heel, and the inside middle aspect of the foot is raised in an arch.
The arches of the foot are made up of two groups of bones called the tarsals and metatarsals as well as the tendons and ligaments of the foot. Each foot has three arches - the medial, lateral and transverse arches - that add flex and curve to the foot .
The five metatarsals connect your toes to the middle of the foot, and are instrumental in helping you stand, walk, run and balance. Connecting them and the heel are the seven tarsals. Together with muscles, ligaments and tendons, these 12 bones give shape to the lateral and medial arches (the higher and lower arches that run the length of your foot).
These arches function in a similar way to a spring, allowing the foot to absorb impact without damage. Arches also help you bear weight, balance, adapt to uneven terrain and more. One of the primary ways the arch accomplishes this is with the help of the posterior tibialis tendon.
This tendon is joined to the bottom of the calf at the back of the shin bone, runs through the middle of the ankle and joins to several tarsal bones in the arch. The posterior tibialis tendon is essential for maintaining a healthy and responsive arch.
What Causes Arch Pain?
Any damage to the bones, tendons, ligaments or muscles of the arch through injury or strain may lead to pain. Structural problems with the feet, whether genetic or through injury may also lead to problems with arches and pain. Older people and those who are overweight or obese have a higher risk of developing conditions that cause arch pain.
There are a number of common causes of arch pain, including:
Cavus Foot
A condition typified by a very high arch, cavus foot causes excessive pressure to be placed on the ball and heel during everyday activity. The condition may lead to a number of symptoms, including ball and heel pain, arch pain, hammer or claw toes, calluses on the ball, pain on the lateral border (outside) of the foot and instability when walking.
Cavus foot may be caused by a number of different factors, including neurological conditions and other diseases, including cerebral palsy, spina bifida, stroke, muscular dystrophy or Charcot-Marie-Tooth disease. Cavus foot may also be the result of genetic inheritance.
While the overall symptoms of cavus foot are the same for genetic cavus foot and cavus foot caused by disease there is one significant difference between the two. Cavus foot caused by disease is frequently progressive with the shape of the foot continuing to change and worsen throughout life. In most cases, genetic cavus foot rarely changes or progresses.
Schedule an appointment to see a podiatrist or see a physiotherapist to get the foot care you need.
Flat Feet (Fallen Arches)
At the opposite end of the curvature spectrum are fallen arches or flat feet. People with flat feet have lower than normal arches, making the foot appear flat on the ground. For some people, flat feet cause no problems, but for others, the condition may lead to pain in the arch, ball, heel, leg or back.
Flat feet may be developmental or may be caused by medical conditions. Children’s feet develop as they age. Babies and toddlers typically have flat looking feet due to deposits of fat that hide the arches, but typically arches begin to show when they start to exhibit the ability to stand on their toes.
In some people, the arches never develop past the low arches they had as children. As a person ages, a regular, healthy arch may also flatten, leading to fallen arches. This lowering of the arch may also be caused by trauma or wear. During pregnancy, the laxity of ligaments, combined with increased weight, can also lead to flat feet.
A number of medical conditions may also lead to fallen arches, with Ehlers-Danlos syndromes , cerebral palsy, muscular dystrophy, rheumatoid arthritis , diabetes and obesity all either causing or increasing the risk of developing flat feet.
Overpronation
Overpronation describes the particular way the foot rolls as a person walks if they place the outer edge of the heel on the ground first. Pronation is required for normal propulsion, however if this is exaggerated, over time, this constant stressing of the arch may lead to a flattening of the foot and arch pain. People who over pronate may also develop calluses and corns, hammer toes, and problems with the knees, hips or back.
Peroneal Tendonitis
The peroneal tendons are two tendons that run down either side of the lower leg bone (fibula) and around the ankle. One tendon connects to the fifth metatarsal (the bone connected to the little toe) while the other connects to the centre of the arch. These tendons help turn the foot out and stabilise the arch while walking as well as add stability to the ankle.
When one or both of these tendons become injured or inflamed due to trauma or wear, this may lead to arch or ankle pain.
Plantar Fasciopathy
The plantar fascia is a thick band of connective tissue that joins the heel bone and the ball of the foot, giving shape to the arch. The plantar fascia supports the arch of your foot and aids you with walking by giving stability and spring to the foot.
When this fascia becomes damaged or inflamed, the condition is referred to as plantar fasciopathy. It’s one of the most common causes of pain in the feet and may be caused by a number of different factors.
The pain of plantar fasciopathy may centre around the heel, the ball of the foot or the mid arch depending on the site of irritation and may be dull and throbbing or sharp and sudden. The pain associated with plantar fasciopathy typically develops slowly over time as wear and tear continues to damage or aggravate the ligament.
The pain may often be worse in the mornings or after you’ve been off your feet for a while as the damaged fascia may have begun to tighten while not bearing any weight. Pain may flare and become severe after prolonged physical activity but people with plantar fasciopathy typically don’t experience pain until after the activity has ceased.
Both cavus foot and fallen arches may lead to the development of plantar fasciopathy. Being overweight or obese may also increase your chances of developing the condition due to the extra strain placed on the ligament. Active people between the ages of 40 and 70 are the most likely to develop plantar fasciitis, with men being slightly more likely to develop the condition than women.
Posterior Tibial Tendon Dysfunction (PTTD)
When the posterior tibialis tendon becomes damaged or inflamed it may no longer be able to support the arch of the foot. PTTD is sometimes known as adult-acquired flat foot syndrome. The lack of support for the arch may lead to arch pain. Other symptoms of PTTD include pain or inflammation of the ankle or pain around the calf.
PTTD is typically caused by overuse of the posterior tibialis tendon. This overuse may be due to overpronation, an increase in activities that use the tendon such as running, stair climbing or playing a number of sports, weight gain, or wearing poorly fitted or cushioned shoes.
Posterior tibial tendon dysfunction is typically a progressive condition, meaning that without treatment it will continue to worsen. The condition usually progresses through three distinct stages - strain, degeneration and rupture. Discovering and treating the underlying cause of the dysfunction is vital.
Treatment for Arch Pain?
How arch pain is treated depends on the underlying cause of the pain. In some cases, home remedies such as rest, ice packs and gentle stretching may be enough to relieve arch pain, but in others specialised care may be needed.
A trip to a podiatrist, physiotherapist, or both, may be required to diagnose the underlying cause of your pain and come up with a treatment plan. A number of options may be used, including:
- Orthoses - prescribed shoe inserts, supportive insoles or support shoes may be used to support feet with structural abnormalities such as cavus or fallen arches, or may be utilised to correct problems with the way the foot falls, such as overpronation.
- Physical Therapy - exercises and stretches may help strengthen muscles or loosen tightness that may be leading to problems with ligaments or tendons, such as PTTD.
- Surgery - in some cases surgery may be required to fix a structural abnormality or to repair damage that is causing the pain.
- Medication - pain relieving medication such as NSAIDS (non-steroidal anti inflammatory drugs) or corticosteroid injections may be used to help relieve pain and inflammation.
If you have pain in your feet, don’t ignore it. Foot pain is not something you should put up with and in many cases, if you ignore it it may worsen over time. The fastest and easiest way to find and book the healthcare you need, when you need it, is to search and book online with MyHealth1st.