Overview
Pain across the bottom of the foot at any point between the heel and the ball of the foot is often referred to as "arch pain." Although this description is non-specific, most arch pain is due to strain or inflammation of the plantar fascia (a long ligament on the bottom of the foot). This condition is known as plantar fasciitis and is sometimes associated with a heel spur. In most cases, arch pain develops from overuse, unsupportive shoes, weight gain, or acute injury. If arch pain persists beyond a few days, see a foot and ankle surgeon for treatment to prevent this condition from becoming worse.
Causes
Over-stretching or tearing the arch pad causes the dull ache that is associated with arch pain. Pain is most keenly felt when weight is put onto the foot, or when pushing off the foot into the next stride. The pain of foot arch strain can be particularly acute after sitting for a long time, or when getting up in the morning. Those most susceptible to the condition are people with very high, rigid arches. The injury is also common in middle-aged people who have been inactive for a long period of time before suddenly increasing their physical activity. The injury is particularly common in runners and joggers.
Symptoms
Typically, the sufferer of plantar fasciitis experiences pain upon rising after sleep, particularly the first step out of bed. Such pain is tightly localized at the bony landmark on the anterior medial tubercle of the calcaneus. In some cases, pain may prevent the athlete from walking in a normal heel-toe gait, causing an irregular walk as means of compensation. Less common areas of pain include the forefoot, Achilles tendon, or subtalar joint. After a brief period of walking, the pain usually subsides, but returns again either with vigorous activity or prolonged standing or walking. On the field, an altered gait or abnormal stride pattern, along with pain during running or jumping activities are tell-tale signs of plantar fasciitis and should be given prompt attention. Further indications of the injury include poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc complex, (muscles of the calf). Crouching in a full squat position with the sole of the foot flat on the ground can be used as a test, as pain will preclude it for the athlete suffering from plantar fasciitis, causing an elevation of the heel due to tension in the gastroc complex.
Diagnosis
The doctor will take a brief history to determine how the injury occurred. If necessary, a thorough physical exam may be conducted to evaluate for any other injuries. Taking your workout shoes to the exam may also provide valuable information to the medical practitioner. Both feet will be physically and visually examined by the medical practitioner. The foot and arch will be touched and manipulated possibly with a lot of pressure and inspected to identify obvious deformities, tender spots, or any differences in the bones of the foot and arch.
Non Surgical Treatment
Once the severity and cause of arch and foot pain is determined, a course of corrective and rehabilitative actions can be started. Therapists may use machines and manual therapies to reduce pain and increase circulation to the area to promote healing. Maintenance of fitness levels via modification of activity may be prescribed. Substitute activities that may aggravate the pain and soreness with other activities; for instance, running causes the body to have multiple impacts with the ground, but the use of bicycling, elliptical trainers, step machines, swimming, or ski machines eliminates impact and allows you to continue to maintain and improve your fitness levels. Take medications to help reduce pain and inflammation. Follow up with your doctor until you are better.
Surgical Treatment
Tendon transfers: Too much pull of certain muscles and tendons is often the cause of the deformity related with a cavus foot. Moving one of these muscles or tendons may help the foot work better. In addition, patients with a cavus foot may have weakness in moving the foot up, which is sometimes called a foot drop. In these cases, a tendon from the back of the ankle may be moved to the top of the foot to help improve strength. Correcting the deformity of the foot may not be possible with soft tissue procedures alone. In these instances, one or more bone cuts (osteotomies) may be needed. Instead of a bone cut, a fusion (arthrodesis) procedure may be used. A fusion removes the joint between two bones so they grow together over time. During a fusion the bones may be held in place with plates or screws. Calcaneal osteotomy: This procedure is performed to bring the heel bone back under the leg. This is needed if correction of the deformity in the front of the foot does not also correct the back of the foot or ankle. A calcaneal osteotomy can be performed several ways and is often held in place with one or more screws. Sometimes patients have a deformity that has caused damage to the joints. In these cases, soft tissue procedures or bone cuts may not be enough, and it may be necessary to eliminate the joint. Clawed toes are a common problem with cavus foot deformity. This can be treated with tendon surgery, fusion or removal of part of the toe bones. Following surgery the toes are often temporarily held in place with pins.
Prevention
People who run regularly should replace shoes every six months, more frequently if an avid runner. Avoid running or stepping on uneven surfaces. Try to be careful on rocky terrain or hills with loose gravel. Holes, tree stumps and roots are problems if you are trail running. If you have problems with the lower legs, a dirt road is softer than asphalt, which is softer than concrete. Try to pick a good surface if possible. However, if you're racing, be sure to train on the surface you'll eventually run on. Be careful running too many hills. Running uphill is a great workout, but make sure you gradually build this up to avoid injuries. Be careful when running downhill too fast, which can often lead to more injuries than running uphills. Prevent recurrent injuries. Athletes who have experienced ankle injuries previously may benefit from using a brace or tape to prevent recurrent ankle injuries.
Stretching Exercises
Calf Raises. Strengthens the tendons in your heels and calf muscles, which support your arch. Raise up on the balls of your feet as high as possible. Slowly lower down. Do three sets of 10 reps. Progress to doing the raises on stairs (with heels hanging off), and then to single-leg raises. Step Stretch. Improves flexibility in your Achilles tendon and calf-when these areas become tight, the arch gets painfully overloaded. Stand at the edge of a step, toes on step, heels hanging off. Lower your heels down, past the step, then raise back up to the start position. Do three sets of 10 reps. Doming. Works the arch muscles and the tibialis posterior (in the calf and foot) to control excess pronation. While standing, press your toes downward into the ground while keeping the heel planted, so that your foot forms an arch (or dome). Release, and do three sets of 10 reps on each foot. Toe Spread and Squeeze. Targets the interossei muscles of the foot, which support the arch. While sitting, loop a small resistance band around your toes. Spread toes; release. Then place a toe separator (used at nail salons) in between toes. Squeeze toes in; release. Do three sets of 10 reps of each exercise on both feet. Towel Curls. Works the toe-flexor muscles that run along your arch to increase overall foot strength. Lay a small hand towel on the floor, and place one foot on the towel. Using just your toes, scrunch the towel toward you, hold, then slowly push the towel away from you back to start position. Do three sets of 10 reps on each foot.
Pain across the bottom of the foot at any point between the heel and the ball of the foot is often referred to as "arch pain." Although this description is non-specific, most arch pain is due to strain or inflammation of the plantar fascia (a long ligament on the bottom of the foot). This condition is known as plantar fasciitis and is sometimes associated with a heel spur. In most cases, arch pain develops from overuse, unsupportive shoes, weight gain, or acute injury. If arch pain persists beyond a few days, see a foot and ankle surgeon for treatment to prevent this condition from becoming worse.
Causes
Over-stretching or tearing the arch pad causes the dull ache that is associated with arch pain. Pain is most keenly felt when weight is put onto the foot, or when pushing off the foot into the next stride. The pain of foot arch strain can be particularly acute after sitting for a long time, or when getting up in the morning. Those most susceptible to the condition are people with very high, rigid arches. The injury is also common in middle-aged people who have been inactive for a long period of time before suddenly increasing their physical activity. The injury is particularly common in runners and joggers.
Symptoms
Typically, the sufferer of plantar fasciitis experiences pain upon rising after sleep, particularly the first step out of bed. Such pain is tightly localized at the bony landmark on the anterior medial tubercle of the calcaneus. In some cases, pain may prevent the athlete from walking in a normal heel-toe gait, causing an irregular walk as means of compensation. Less common areas of pain include the forefoot, Achilles tendon, or subtalar joint. After a brief period of walking, the pain usually subsides, but returns again either with vigorous activity or prolonged standing or walking. On the field, an altered gait or abnormal stride pattern, along with pain during running or jumping activities are tell-tale signs of plantar fasciitis and should be given prompt attention. Further indications of the injury include poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc complex, (muscles of the calf). Crouching in a full squat position with the sole of the foot flat on the ground can be used as a test, as pain will preclude it for the athlete suffering from plantar fasciitis, causing an elevation of the heel due to tension in the gastroc complex.
Diagnosis
The doctor will take a brief history to determine how the injury occurred. If necessary, a thorough physical exam may be conducted to evaluate for any other injuries. Taking your workout shoes to the exam may also provide valuable information to the medical practitioner. Both feet will be physically and visually examined by the medical practitioner. The foot and arch will be touched and manipulated possibly with a lot of pressure and inspected to identify obvious deformities, tender spots, or any differences in the bones of the foot and arch.
Non Surgical Treatment
Once the severity and cause of arch and foot pain is determined, a course of corrective and rehabilitative actions can be started. Therapists may use machines and manual therapies to reduce pain and increase circulation to the area to promote healing. Maintenance of fitness levels via modification of activity may be prescribed. Substitute activities that may aggravate the pain and soreness with other activities; for instance, running causes the body to have multiple impacts with the ground, but the use of bicycling, elliptical trainers, step machines, swimming, or ski machines eliminates impact and allows you to continue to maintain and improve your fitness levels. Take medications to help reduce pain and inflammation. Follow up with your doctor until you are better.
Surgical Treatment
Tendon transfers: Too much pull of certain muscles and tendons is often the cause of the deformity related with a cavus foot. Moving one of these muscles or tendons may help the foot work better. In addition, patients with a cavus foot may have weakness in moving the foot up, which is sometimes called a foot drop. In these cases, a tendon from the back of the ankle may be moved to the top of the foot to help improve strength. Correcting the deformity of the foot may not be possible with soft tissue procedures alone. In these instances, one or more bone cuts (osteotomies) may be needed. Instead of a bone cut, a fusion (arthrodesis) procedure may be used. A fusion removes the joint between two bones so they grow together over time. During a fusion the bones may be held in place with plates or screws. Calcaneal osteotomy: This procedure is performed to bring the heel bone back under the leg. This is needed if correction of the deformity in the front of the foot does not also correct the back of the foot or ankle. A calcaneal osteotomy can be performed several ways and is often held in place with one or more screws. Sometimes patients have a deformity that has caused damage to the joints. In these cases, soft tissue procedures or bone cuts may not be enough, and it may be necessary to eliminate the joint. Clawed toes are a common problem with cavus foot deformity. This can be treated with tendon surgery, fusion or removal of part of the toe bones. Following surgery the toes are often temporarily held in place with pins.
Prevention
People who run regularly should replace shoes every six months, more frequently if an avid runner. Avoid running or stepping on uneven surfaces. Try to be careful on rocky terrain or hills with loose gravel. Holes, tree stumps and roots are problems if you are trail running. If you have problems with the lower legs, a dirt road is softer than asphalt, which is softer than concrete. Try to pick a good surface if possible. However, if you're racing, be sure to train on the surface you'll eventually run on. Be careful running too many hills. Running uphill is a great workout, but make sure you gradually build this up to avoid injuries. Be careful when running downhill too fast, which can often lead to more injuries than running uphills. Prevent recurrent injuries. Athletes who have experienced ankle injuries previously may benefit from using a brace or tape to prevent recurrent ankle injuries.
Stretching Exercises
Calf Raises. Strengthens the tendons in your heels and calf muscles, which support your arch. Raise up on the balls of your feet as high as possible. Slowly lower down. Do three sets of 10 reps. Progress to doing the raises on stairs (with heels hanging off), and then to single-leg raises. Step Stretch. Improves flexibility in your Achilles tendon and calf-when these areas become tight, the arch gets painfully overloaded. Stand at the edge of a step, toes on step, heels hanging off. Lower your heels down, past the step, then raise back up to the start position. Do three sets of 10 reps. Doming. Works the arch muscles and the tibialis posterior (in the calf and foot) to control excess pronation. While standing, press your toes downward into the ground while keeping the heel planted, so that your foot forms an arch (or dome). Release, and do three sets of 10 reps on each foot. Toe Spread and Squeeze. Targets the interossei muscles of the foot, which support the arch. While sitting, loop a small resistance band around your toes. Spread toes; release. Then place a toe separator (used at nail salons) in between toes. Squeeze toes in; release. Do three sets of 10 reps of each exercise on both feet. Towel Curls. Works the toe-flexor muscles that run along your arch to increase overall foot strength. Lay a small hand towel on the floor, and place one foot on the towel. Using just your toes, scrunch the towel toward you, hold, then slowly push the towel away from you back to start position. Do three sets of 10 reps on each foot.