Medical information foot arch pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Arch pain can be extremely annoying and painful. Here’s some inportant information you need to know about it.

There are two arches in the foot. The longitudinal arch runs lengthwise and the transverse arch runs widthwise. The arches consist of ligaments, which stabilize the bones of the feet. Arch pain occurs most commonly in the longitudinal arch.

Arch pain usually occurs as a result of overuse with activities such as running, walking, and jumping. People who have flat feet, or people whose feet flatten and roll inward when walking (over-pronation) are more likely to develop arch pain. Arch pain usually comes on slowly. However, it can occur suddenly if the ligaments are stretched or torn during a forceful activity such as sudden sprinting or jumping.

The symptom is pain in the arch of the foot.

For acute pain, ice packs should be place on the arch for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain subsides. Anti-inflammatory medicine may also be used.

The arch will require extra support. Taping the arch or using an extra arch support (orthotics) in the shoe may help. Orthotics can be purchased at an athletic shoe store or they can be custom-made by a podiatrist.

The following exercises should only be done after checking with your doctor or physical therapist first

Exercising the muscles of the foot can be initiated with a towel stretch.

•Towel stretch: Sit on a hard surface with the injured leg stretched out in front. Loop a towel around the ball of the foot and pull the towel toward the body keeping the knee straight. Hold this position for 15 to 30 seconds then relax. Repeat 3 times.

•Once the towel stretch is "mastered", the standing calf stretch can be started. Facing a wall, place the hands against the wall at about eye level. Keep the injured leg back, the uninjured leg forward, and the heel of the injured leg on the floor. Turn the injured foot slightly inward ("pigeon-toed") and slowly lean into the wall until a stretch in the back of your calf is felt. Hold for 15 to 30 seconds. Repeat 3 times. Do this exercise several times each day.

•Next is the plantar fascia stretch. Stand with the ball of the injured foot on a step. Reach for the lower step with the heel until a stretch in the arch of the foot occurs. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times.

Another stretch... place a chair next to the non-injured leg and stand upright. Stand on the injured foot. Try to raise the arch of the foot while keeping the toes on the floor. Try to maintain this position and balance on the injured side for 30 seconds.

•Towel pickup. With the heel on the ground, pick up a towel with the toes. Release. Repeat 10 to 20 times.

•Frozen can roll. Roll the bare injured foot back and forth from the heel to the mid portion of the arch over a frozen juice can. Repeat for 3 to 5 minutes.

•Resisted dorsiflexion. Sit with the injured leg out straight and the foot facing a doorway. Tie a loop in one end of a section of rubber tubing. Put the foot through the loop so that the tubing goes around the arch of the foot. Tie a knot in the other end of the tubing and shut the knot in the door. Move backward until there is tension in the tubing. Keeping the knee

straight, pull the foot toward the body, stretching the tubing. Slowly return to the starting position. Do 3 sets of 10.

•Resisted plantar flexion. Sit with the leg extended and loop the middle section of the tubing around the ball of the foot. Hold the ends of the tubing in both hands. Gently press the ball of the foot down and point the toes, stretching the tubing. Return to the starting position. Do 3 sets of 10.
•Resisted inversion. Sit with legs extended and cross the uninjured leg over the injured foot. Wrap the tubing around the ball of the injured foot and then loop it around the uninjured foot. Hold the other end of the tubing in one hand. Turn the injured foot inward and upward. This will stretch the tubing. Return to the starting position. Do 3 sets of 10.
•Resisted eversion: Sit with both legs extended in front with the feet about a shoulder's width apart. Tie a loop in one end of the tubing. Put the injured foot through the loop so that the tubing goes around the arch of that foot and wraps around the outside of the uninjured foot. Hold onto the other end of the tubing with a hand. Turn the injured foot up and out. Return to the starting position. Do 3 sets of 10.

Arch pain can be prevented by wearing shoes that fit properly and have proper arch support. Stretching the arches before activity will also help prevent this injury. Some people will need to wear orthotics all the time and others only during sporting activities.

Here are a couple of special conditions that predispose to arch pain.

Pes planus (flatfoot) is a condition where the arch or instep of the foot collapses and comes in contact with the ground. In some individuals, this arch never develops.

Flat feet are a common condition.

Painful flat feet in children may be caused by a condition called tarsal coalition. In tarsal coalition, two or more of the bones in the foot fuse together, limiting motion and often leading to a flat foot.

Foot pain, ankle pain, or lower leg pain (especially in children) may be a result of flat feet and should be evaluated by a physician.


• absence of longitudinal arch of foot when standing
• foot pain
• heel tilts away from the midline of the body more than usual

If a tarsal coalition is suspected, a CT scan is often ordered. If a posterior tibial tendon injury is suspected, your doctor may recommend an MRI.

If pain due to flat feet occurs, an orthotic (arch supporting insert in the shoe) can bring relief. Many running shoe stores carry shoes for normal feet and pronated feet. The shoes designed for pronated feet make long distance running easier and less tiring as they correct for the positional abnormality.

For tarsal coalition, treatment starts with rest and possibly casting.

If this fails to improve the pain, surgery may be necessary to either resect the fused bone or fuse several bones in a corrected position. For problems with the posterior tibial tendon, treatment may start with rest, anti-inflammatory medications, and shoe inserts or ankle braces.

Percutaneous needle tenotomy using ultrasound guidance followed by injection of platelet-rich plasma is curative for most posterior tibial tendon problems.

In more advanced cases, surgery may be necessary.

High arch, or pes cavus, is an excessively elevated toe-to-heel arch of the foot.

High arch is the opposite of flat feet. Highly arched feet are much less common than flat feet and more likely to be associated with an abnormal orthopedic or neurological condition. Neuromuscular diseases that cause changes in muscle tone may be associated with the development of high arches.

Unlike flat feet, highly arched feet tend to be painful because more stress is placed on the arch. Highly arched feet generally make it difficult to fit shoes. In addition, pes cavus generally requires foot support, and may cause significant disability.

Corrective shoes may help to relieve pain and can improve walking. This includes orthopedic modifications to the shoes, such as an arch insert and a support insole.

People with highly arched feet should be evaluated for underlying neurological and orthopedic conditions. Identifying these other conditions may help prevent arch problems.

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