Overview
The most common cause of arch and heel pain is a condition called plantar fasciitis. This is an inflammation of a thick band of tissue that runs along the arch of your feet from your heel to your toes, and aids in the stabilization of your arch during walking and running. Symptoms involve two areas-the arch, and more commonly, the inside heel area. Severe pain can be present, especially in the morning on arising.
Causes
A person with flat feet has greater load placed on the posterior tibial tendon which is the main tendon unit supporting up the arch of the foot. Throughout life, aging leads to decreased strength of muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow. Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation and degeneration of the tendon. Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside. The deformity can progress until the foot literally dislocates outward from under the ankle joint.
Symptoms
Pain in arch of foot is really the only symptom of this condition. It is unlikely to see any swelling or bruising and instead there will be a deep tender spot near the heel. Occasionally the pain may radiate further down the foot. With this condition, pain will usually be felt first thing in the morning or after periods of sitting. This is because the plantar fascia tightens and shortens slightly when there is no weight on it and by standing on it it suddenly stretches and becomes painful. After a few steps it starts to loosen off and the pain may subside. If this is the same pattern of pain you experience it is quite likely you have plantar fasciits. Pain may also be felt when walking up stairs or standing on tip-toes (anything that stretches the fascia).
Diagnosis
Magnetic Resonance Imaging (MRI) can show tendon injury and inflammation but cannot be relied on with 100% accuracy and confidence. The technique and skill of the radiologist in properly positioning the foot with the MRI beam are critical in demonstrating the sometimes obscure findings of tendon injury around the ankle. Magnetic Resonance Imaging (MRI) is expensive and is not necessary in most cases to diagnose posterior tibial tendon injury. Ultrasound has also been used in some cases to diagnose tendon injury, but this test again is usually not required to make the initial diagnosis.
Non Surgical Treatment
Initial treatment of the tear will focus on symptom relief. This may involve the use of anti-inflammatory medications, strapping of the toe, off-loading padding, altered footwear and activity modification. Following this treatment will focus on the underlying causes of the problem, such as flat feet, bunions and hammer toes. Your podiatrist will perform a thorough biomechanical assessment to determine the best course of action to offload the forefoot and decrease the mechanical stress on the area. This injury usually occurs gradually and is best treated in the early stages. Often a customised soft full length orthotic and footwear modifications can prevent the problem from progressing. Occasionally surgery needs to be performed, either frank repair of the plantar plate or in chronic cases a resection osteotomy may be suggested.
Surgical Treatment
Surgical advances have dramatically improved the ability to alleviate the pain and decreased function that millions of Americans experience due to flat feet. Nevertheless, many patients and even some physicians remain unaware of the new procedures, which are best performed by a foot and ankle specialist who has the applicable training and experience.
Prevention
Early in the treatment of arch pain, consideration needs to be given to the cause and strategies put in place to prevent it happening again. Advice should be sought on the adequacy of footwear. Stretching exercises should be continued long after the symptoms are gone. Foot orthoses should be used if structural imbalances are present. Activity levels and types of activities (occupational and sporting) need to be considered and modified accordingly.
Stretching Exercises
Flexibility is important in preventing injuries. With a simple stretching exercise, you can rehabilitate the muscles of your foot to relieve arch pain and prevent future injuries. This simple exercise by Tammy White and Phyllis Clapis for Relay Health is a good way to strengthen your foot muscles and stretch your plantar fascia. Sit in a chair and cross one foot over your other knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat three times. When you can stand comfortably on your injured foot, you can begin standing to stretch the plantar fascia at the bottom of your foot.
The most common cause of arch and heel pain is a condition called plantar fasciitis. This is an inflammation of a thick band of tissue that runs along the arch of your feet from your heel to your toes, and aids in the stabilization of your arch during walking and running. Symptoms involve two areas-the arch, and more commonly, the inside heel area. Severe pain can be present, especially in the morning on arising.
Causes
A person with flat feet has greater load placed on the posterior tibial tendon which is the main tendon unit supporting up the arch of the foot. Throughout life, aging leads to decreased strength of muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow. Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation and degeneration of the tendon. Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside. The deformity can progress until the foot literally dislocates outward from under the ankle joint.
Symptoms
Pain in arch of foot is really the only symptom of this condition. It is unlikely to see any swelling or bruising and instead there will be a deep tender spot near the heel. Occasionally the pain may radiate further down the foot. With this condition, pain will usually be felt first thing in the morning or after periods of sitting. This is because the plantar fascia tightens and shortens slightly when there is no weight on it and by standing on it it suddenly stretches and becomes painful. After a few steps it starts to loosen off and the pain may subside. If this is the same pattern of pain you experience it is quite likely you have plantar fasciits. Pain may also be felt when walking up stairs or standing on tip-toes (anything that stretches the fascia).
Diagnosis
Magnetic Resonance Imaging (MRI) can show tendon injury and inflammation but cannot be relied on with 100% accuracy and confidence. The technique and skill of the radiologist in properly positioning the foot with the MRI beam are critical in demonstrating the sometimes obscure findings of tendon injury around the ankle. Magnetic Resonance Imaging (MRI) is expensive and is not necessary in most cases to diagnose posterior tibial tendon injury. Ultrasound has also been used in some cases to diagnose tendon injury, but this test again is usually not required to make the initial diagnosis.
Non Surgical Treatment
Initial treatment of the tear will focus on symptom relief. This may involve the use of anti-inflammatory medications, strapping of the toe, off-loading padding, altered footwear and activity modification. Following this treatment will focus on the underlying causes of the problem, such as flat feet, bunions and hammer toes. Your podiatrist will perform a thorough biomechanical assessment to determine the best course of action to offload the forefoot and decrease the mechanical stress on the area. This injury usually occurs gradually and is best treated in the early stages. Often a customised soft full length orthotic and footwear modifications can prevent the problem from progressing. Occasionally surgery needs to be performed, either frank repair of the plantar plate or in chronic cases a resection osteotomy may be suggested.
Surgical Treatment
Surgical advances have dramatically improved the ability to alleviate the pain and decreased function that millions of Americans experience due to flat feet. Nevertheless, many patients and even some physicians remain unaware of the new procedures, which are best performed by a foot and ankle specialist who has the applicable training and experience.
Prevention
Early in the treatment of arch pain, consideration needs to be given to the cause and strategies put in place to prevent it happening again. Advice should be sought on the adequacy of footwear. Stretching exercises should be continued long after the symptoms are gone. Foot orthoses should be used if structural imbalances are present. Activity levels and types of activities (occupational and sporting) need to be considered and modified accordingly.
Stretching Exercises
Flexibility is important in preventing injuries. With a simple stretching exercise, you can rehabilitate the muscles of your foot to relieve arch pain and prevent future injuries. This simple exercise by Tammy White and Phyllis Clapis for Relay Health is a good way to strengthen your foot muscles and stretch your plantar fascia. Sit in a chair and cross one foot over your other knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat three times. When you can stand comfortably on your injured foot, you can begin standing to stretch the plantar fascia at the bottom of your foot.