Arch pain is the term used to describe symptoms that occur under the arch of the foot. When a patient has arch pain they usually have inflammation of the soft-tissues within the midfoot. The arch of the foot is formed by a tight band of tissue that connects the heel bone to the toes called the plantar fascia.
This band of tissue is important in proper foot mechanics and transfer of weight from the heel to the toes. When the tissue of the arch of the foot becomes irritated and inflamed, even simple movements can be quite painful.
Causes Plantar Fasciitis: The most common cause of arch pain is plantar fasciitis.1 Plantar fasciitis is the name that describes inflammation of the fibrous band of tissue that connects the heel to the toes. Symptoms of plantar fasciitis include pain early in the morning and pain with long walks or prolonged standing. Arch pain early in the morning is due to the plantar fascia becoming contracted and tight as you sleep through the night. When awakening and walking in the morning, the fascia is still tight and prone to irritation when stretched. When walking or standing for long periods, the plantar fascia becomes inflamed and painful. Treatment of plantar fasciitis is best accomplished with some simple stretching exercises, anti-inflammatory medications, and inserts for your shoes.2
Stress Fractures: The bones that are in the midfoot (including the navicular, cuboid, and cuneiform bone) and the metatarsal bones can all be damaged by overuse. When this occurs, a stress fracture is a possible injury to the bone. Stress fractures occur not as the result of a single injury, but rather repetitive overuse that eventually leads to a crack forming in the bone.3 Stress fractures typically cause pain that worsens with increased activity. Unlike plantar fasciitis that can loosen with some activity, the pain associated with a stress fracture typically worsens as activity levels increase. When a stress fracture occurs the bone needs rest. In some situations, a walking boot can lead to effective relief, whereas in other situations all weight must be relieved from the bone requiring crutches.
Sprains of Ligaments: There are 26 bones in each foot, all of which are connected by an intricate web of ligaments. These ligaments can be injured by twisting or landing awkwardly while walking or running. Ligament injuries typically occur after an unusual foot movement and cause immediate pain. Swelling may also occur. Most ligament sprains will improve with rest. Sometimes immobilizing the foot can help with treatment. In some rare situations, surgery may be needed for treatment. One such ligament injury is called a Lisfranc sprain of the midfoot.4
Tendonitis: Inflammation of the tendons that pass along the foot can also cause pain in the arch.5 The two most commonly injured tendons that cause arch pain are the tibialis posterior and the peroneal tendons. These tendons start in the leg, course behind the ankle, and then to the underside of the foot. Both tendons are important at controlling movements of the foot and ankle.
When to See a Doctor
Most often arch pain is not a serious medical problem, but there are times that evaluation by a medical professional is necessary. Some of the signs that you should see a doctor include:
Inability to bear weight on the extremity
Worsening symptoms that do not respond to simple treatment
Signs of infection (fever, chills, redness around the arch)
Diagnosis of arch pain can typically be made with a careful examination of the foot.3 Evaluating the alignment of the foot, structure, and ligamentous support can all be performed by medical examination. If there are concerns about the structure or stability of the foot, special tests may be performed for further evaluation. X-rays can give a useful assessment of the alignment of the bones of the foot. Other tests including CAT scans and MRIs may also be necessary for further evaluation.
Treatment and Prevention
Treatment of arch pain generally consists of relieving pressure from the irritated area on the bottom of the foot, and efforts to control swelling and inflammation. Some of the simple steps that you can begin with include:2
Rest: Resting the affected extremity is critical in order to reduce inflammation within the arch of the foot. This may require changes in activities, or even the use of crutches.
Ice application: Applying ice to the affected area can be a helpful way to control inflammation and also reduce pain. Many people find ice massage an effective method to apply cold treatment to this area.
Anti-inflammatory medications: Nonsteroidal anti-inflammatory medications are effective medications to relieve discomfort associated with inflammation. Make sure you check with your doctor before beginning any new medication.
Footwear modifications: Changes in footwear with more arch support, better cushioning, or other changes can often be helpful. Wearing supportive footwear is essential when managing arch pain.
Once the symptoms of arch pain have been effectively controlled, it is also important to ensure they do not return as soon as the treatment is completed. Ensuring proper fitting footwear with good support can be one helpful step. In addition, gradual resumption of activity should be carried out in the early stages following an episode of arch pain.
A Word From Verywell
Arch pain is a frequent complaint and typically from one of a few common conditions. Fortunately, most people with arch pain can find effective relief of symptoms with a few simple steps. If these are not effective, seeing your medical provider can help to ensure there is not a more serious problem that is causing your symptoms. Once people have arch pain, they should take steps to prevent the recurrence of this problem.