Plantar fasciitis is the most common problem to affect the heel and arch. This is an inflammation of the plantar fascia, which, unlike the name suggests, is not primarily an inflammatory condition but is more likely to be a degenerative one. This does not mean that it will not go away if you leave it alone. It can quite easily become a chronic, long-standing painful condition because the plantar fascia is not given much of a chance to rest, as we are always on our feet using it.
Sometimes the pain will subside as soon as the day has gone, either first thing in the morning or after a period of walking. However, the body may try to protect the sore area by limping, which can help to cause further problems in other parts of the body such as the back or knees.
Heel pain is one of the most common complaints that people have, and it is often the most disabling since you spend so much time on your feet and the heel is the first part of the foot to contact the ground. It is often felt on the bottom of the foot directly below the heel bone, specifically under the plantar fascia – a fibrous band of tissue that connects the heel bone to the base of the toes.
What is foot arch pain?
Foot arch is the curved part of the bottom of the foot, and it is formed by the shape of the bones, ligaments, and tendons in the foot. The foot arch is what allows the foot to support the weight of the body and is important in helping us to spring off during walking and running. Pain in the foot arch can occur due to a number of reasons, and current statistics indicate that more than 80% of the population will experience foot arch pain during their lifetime. The symptoms of foot arch pain can include the following. Initially, there may be some inflammation which causes the area to get very hot and warm to touch. In the case of a sudden injury, a patient may feel a tearing sensation which is usually followed by a sharp pain. Pain is commonly felt when the injury is weight-bearing. Due to the nature of the foot, some patients with foot pain near arch can notice a change in their foot shape as the pain progresses and the arch falls. This condition is more commonly known as flat feet.
Common causes of foot arch pain
One common cause of foot arch pain is a condition known as overpronation. This is when the arches collapse and the feet roll excessively inwards. This inwards rolling of the feet can cause the plantar fascia to be excessively stretched and cause plantar fasciitis. Sometimes a biomechanical malalignment and/or weakness can cause the foot to overpronate. This can be assessed by podiatrists with a biomechanical examination and the use of gait analysis equipment. Overpronation can be a hereditary condition and it can also increase with age. In cases of overpronation that lead to plantar fasciitis, a functional orthotic can be prescribed to correct the overpronation and therefore prevent the condition from recurring. An abnormally high or low arched foot can lead to muscle imbalances in the feet and can also lead to excessive loading on the plantar fascia. The high arched foot is a rigid foot type and often an insufficiency of a shock absorbing mechanism can often lead to a transfer of too much load to the plantar fascia to absorb. This can be caused with supination of the foot, which is when the foot does not roll inwards enough. A functional orthotic with a deep heel cup and the use of shock absorbing materials can often comfort this condition.
The importance of early treatment
In the initial stages, self-management of the condition should be followed. The PRICE regime for acute injuries should be employed. This involves protection of the affected area to prevent further damage, rest from any activity that may exacerbate the symptoms, application of ice or a cold therapy pack to reduce pain and inflammation, compression using bandages or strapping to support the affected area and ease pain and inflammation, and elevation of the foot to reduce swelling. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be taken to relieve pain and reduce inflammation. Corticosteroid injections are sometimes used to reduce severe pain and inflammation. This is an effective treatment, but it is essential to exercise caution to prevent the weakening of tendons which can lead to rupture or further deformity of the foot.
Early treatment of foot arch pain is imperative if a swift recovery is to be achieved. Without the correct rehabilitation, the condition may become severe and cause further problems. The severity of the condition can lead to abnormal stress on the knee and hip joints resulting in muscle and joint pain. Ignoring the symptoms can also lead to the development of secondary conditions such as fallen arches or plantar fasciitis. It is also common for individuals with foot arch pain to walk in a different manner to alleviate the pressure on the affected foot. This compensation for pain can result in other MSK conditions such as ankle sprains, shin splints, and knee pain.
Treatment Options for Foot Arch Pain
Rest is of course the best and is often enough to relieve the pain. Do so as much as possible with your feet up. Try to keep going with non-weight-bearing activities such as swimming. Consider using crutches to keep weight off your feet. Apply an ice pack (or bag of frozen peas wrapped in a tea towel) to the painful area for around 20 minutes, 2 to 3 times a day. This will help to reduce the inflammation and pain. Complementary treatments such as taping and acupuncture can also be very helpful. Prolonged use of NSAIDs (non-steroidal anti-inflammatory drugs) or corticosteroid injections are best avoided, as they can weaken the soft tissues in your feet and may lead to chronic problems. High-arched feet may have a tendency to clawing of the toes and a high pressure spot on the ball of the foot – use of cushioning metatarsal pads may help with these problems. If your foot arch pain is of biomechanical origin or unresponsive to simple treatments, a full biomechanical analysis is recommended to identify possible causes. This can be performed by a suitably qualified physiotherapist, podiatrist, chiropodist, or a biomechanics coach.
Rest and ice therapy
Rest and ice therapy is usually combined with anti-inflammatory medication. Rest is to some extent relative, and depends on the specific injury and individual. One must stop any activity that creates pain until the pain and swelling subside. Inactivity does not mean total immobilization; even with an ankle sprain, you can still exercise the uninjured leg and do other activities to prevent deconditioning, but it is important not to “overdo it.” If the injury is severe, an athlete may need to use crutches to help prevent further stress on the injury. A physician will be able to recommend the appropriate duration of rest based on the severity of the injury. Step two in the R.I.C.E. regimen is icing, which reduces blood flow, thereby reducing inflammation and pain. Apply ice as soon as possible following the injury. 20 minutes of ice followed by 40 minutes without ice is the guideline, and this can be repeated several times a day. Commercial ice packs, bags of frozen peas, or ice massage are effective means to achieve an icing effect. Be careful not to use excessive icing, as this can cause tissue damage related to frostbite. Step three is compression. This is the application of pressure to the injured area, which helps reduce swelling, and is usually accomplished using a specially designed elastic bandage. With compression, it is important not to wrap the area too tightly, as this may cause additional swelling below the wrapped area. The bandage should be snug, but still allow for good blood flow. Last is elevation. Often called the most important part of the R.I.C.E. regimen, elevation involves raising the injured area above the level of the heart to reduce swelling. Lying on the couch with the injury propped up on pillows is an effective way to elevate an injury. Elevation should be done as often as possible during the waking hours, and is a very easy way to speed up the healing process.
Stretching and strengthening exercises
Strengthening the foot intrinsics and extrinsics is also an important activity for prevention and rehabilitation of arch pain. Small muscles and tendons that run from the foot and ankle to the toes to control toe movement are usually underdeveloped and deconditioned in people with arch pain, and strengthening these muscles can provide support to the arch. Exercises for the posterior tibial tendon and peroneal muscles can also provide the added support of controlling overpronation and supination of the foot that can cause arch pain.
Stretching the plantar fascia is almost always required with this being a painful condition. To stretch the tight plantar fascia may exacerbate the symptoms, however, flexibility is important, and a tight fascia is always the case in people with plantar fasciitis. A stretch for the arch of the foot is to grab the toes with one hand and the heel with the other and gently pull to stretch the bottom of the foot and heel cord. This should be done in the morning before getting out of bed and several times throughout the day.
Multiple options are available for treating arch pain according to its cause. Options are usually guided at relieving stress on the inflamed soft tissues. The most successful way to relieve the symptoms of arch pain involves avoiding excessive loading on the area by weight loss, switching to non weight-bearing forms of exercises, and corrective taping to support the foot. This taping technique can provide the sole of the foot with arch support by using a stirrup-shaped piece of tape to take stress off the plantar fascia and allow it to heal.
Orthotic devices and shoe modifications
When helping people with high arches or fallen arches, footwear plays a key role. Orthotic devices can be used to provide support and cushioning. Custom-made orthotics are made from a cast of the foot and contour to the foot, providing the best support. Prefabricated orthotics are mass-produced and come in a variety of styles and can be fitted by using trial and error. People who need minimal support can be fitted with a neutral insert or an arch cushion. Insoles are made of a variety of materials, including foam, leather, plastic, and fiber, all serving different functions. It may be helpful to consult a podiatrist on how to select the most suitable shoe. Shoes that have a firm heel counter, torsional stability, and proper arch support are the ideal starting point. It is important that the shoe is fitted with the insert and is comfortable. Laced shoes or shoes with Velcro fasteners are ideal for securing the insert in place and preventing it from moving around. Step-in shoes and slip-ons are less accommodating and may not be ideal for an orthotic insert. Many shoe modifications can be made to improve comfort once orthotic inserts are being used. Examples include stretching the shoe upper to relieve pressure over bunions or hammer toes, adding a lift to the heel of the shoe, fitting a soling to correct leg length discrepancies, and enlarging the shoe to reduce pressure over prominent areas of the foot.
Physical therapy and massage
Physical therapy and exercises may be an effective treatment option for reducing pain and improving function caused by foot arch pain. A systematic review of the literature found evidence to support the use of low dye taping, combined with exercise, mobilization and orthoses, for plantar pain. “There is strong evidence to support the use of low-dye taping with a medial arch support pad for immediate relief of plantar fasciitis,” says Dr. Michael P. Wearing of La Trobe University in Melbourne, Australia. Wearing was the lead on the study and the research appears in the August 2006 issue of the Journal of Bone and Joint Surgery. “This method is best used as a short-term treatment to allow the patient time for the long-term photogenic and strength-based rehabilitative approach. Combining arch support with the pad enhances the support to the fascia,” he says. Exercises to extend the big toe and ankle which strengthen the global foot musculature have been shown to reduce pain and improve foot function in adults diagnosed with painful pes planus. There are currently no published studies on the effects of mobilization using sustained or impulse forces in any direction to the joints in the foot in adults with painful flat foot. Massage has also been found to alleviate symptoms of foot arch pain treatment and improve function. A pilot study on the effect of Myofascial release, a form of massage using sustained manual pressure followed by a stretching of fascia, showed positive results in patients with chronic heel pain. A decrease in morning pain and an increase in activity level, as measured by daily step count, were noted in participants. Given these results it appears that physical therapy and massage offer great potential to improve patient outcomes for foot arch pain and should be considered for inclusion in the treatment plan.
Prevention and Self-Care Tips
How do you prevent foot and arch pain from developing or getting worse? Here are a few simple guidelines to follow. Make sure you wear supportive footwear. Replace old shoes that have lost their support. A good test is to make sure the shoe bends only minimally in the toe area, then twist it from side to side. Shoes should be replaced if they lack a sole that twists only a little. People whose activities involve long periods of standing should also wear supportive shoes. This includes teachers, hairdressers, and those in the medical and retail fields. If you must stand for long periods of time, rest one foot on a small stool to help reduce pressure on the lower back and the other foot. Low heeled shoes are better than high heels. Heel height should be no more than 1 inch. Avoid slippers and going barefoot because these types of footwear provide little or no support.
Choosing the right footwear
– Don’t wear a worn-out pair of shoes. Previous studies on plantar fasciitis have indicated that changing only the shoe in which someone runs in was adequate to reduce pain. It is known that supportive taping of the foot arch has similar benefits proven in research, so adequate support is obviously dependent on the condition of the shoe.
– Consider wearing orthoses – these are shoe inserts or inner soles designed to realign your foot arch and relieve foot arch pain. These can be custom made by a podiatrist (foot specialist) to fit your feet exactly, or alternatively, there are many different types of off-the-shelf inserts which can be effective.
– Arch support is a must – wear shoes that provide solid support underneath the arch, whether general shoes and sandals or sports footwear. It is important that your arches are adequately supported during daily standing and walking. This is especially important during athletic activity, so consider purchasing an arch support to insert into your trainers.
The type of footwear you choose can have a significant impact on foot arch pain. It is important to choose shoes that provide good arch support, and ideally, shoes that have been designed specifically to help alleviate problems linked to foot arches. According to the American Academy of Orthopaedic Surgeons, you should shop for shoes in the afternoon when your feet are at their largest due to swelling. Try on both shoes to assure a proper fit. Take into account these tips when shopping for the best possible shoe for your feet:
Maintaining a healthy weight
Obesity is one of the main causes of foot arch pain. Excessive weight gain or obesity may lead to a foot condition called plantar fasciitis. Plantar fasciitis is the inflammation of the plantar fascia – the tissue which connects the heel to the toes. In the initial stages, people suffering from plantar fasciitis may not feel any pain, but eventually the symptoms may worsen with increased pain and swelling. The pain is usually felt on the undersides of the soles and will be at its worst when getting up in the morning and taking the first steps. With added weight and pressure, the symptoms may become more severe. The increased pressure on the foot may flatten the foot arch and cause the stretch on the plantar fascia to be too excessive. This in turn may tear the tissue and cause bruising on the foot sole on the area of the affected tissue. A tear in the tissue can be further aggravated and lead to more pain and discontinuation of normal activities. Weight reduction is essential for people suffering from this disease to prevent further damage to the tissue and allow the foot to heal and return to a normal condition. Weight reduction may be achieved through exercise or controlled dieting. Low impact activities like swimming or cycling are helpful, but must be coupled with rest if any pain is felt. Weight reduction in an overweight person is the most difficult to achieve and the person must be persistent in efforts to alleviate the symptoms of plantar fasciitis.
Proper warm-up and cool-down routines
Before engaging in physical activity of any kind, it is important to warm up the body. A good warm-up before running can prevent foot arch pain from starting. A warm-up increases the body’s temperature, heart rate, and blood flow to the muscles. This can help to decrease stress on the foot’s arch. An appropriate warm-up would be to walk briskly, walk on tip toes for 30 seconds, and walk on heels for 30 seconds. It is also a good idea to stretch the muscles of the foot’s arch. This increases flexibility which is beneficial to the foot’s arch. Maintaining flexibility helps to move the force of impact and weight of the body from one part of the foot to another. Failure to do so can result in the same spot on the foot taking too much of the pressure. This can cause foot arch pain and discomfort. By stretching the foot’s arch, there is a lesser chance of repeated pain throughout physical activity. It is important not to stretch cold muscles, as this can result in injury. Stretching is more beneficial after the muscles in the body have been warmed up and in saying so, stretching exercises are recommended more so after the physical activity. Focus should be placed on the big toe, as this is where the foot pushes off the ground and the more flexible it is the less strain there is on the foot’s arch. Stretch big toe back towards instep of the foot. Hold for 10 seconds. Loosely cross the leg of foot being stretched over the other leg. Grasp the base of each toe and pull until stretch is felt in the top of the foot and/or bottom of the calf. Hold for 10 seconds and switch to the other foot. Pull foot up behind body and grab it with the opposite hand. Push the foot down and across the body until stretch is felt in the outside of the leg. Hold for 10 seconds and switch to the other foot. These exercises should help to increase flexibility in the foot’s arch. After stretching is complete, the physical activity should begin. Upon completion, it is important to cool down the body. Like the warm-up, it is equally important to decrease the stress on the foot’s arch. A cool-down gradually decreases the body’s temperature, heart rate, and blood flow to the muscles. This can prevent blood from pooling in the legs and feet, which is beneficial to foot arch pain. A light five-minute walk is an appropriate cool down and is the most useful form of keeping blood and fluid from accumulating in the feet. This should be cultivated with a few basic stretching exercises. As the purpose is to decrease temperature, heart rate, and blood flow, it is also necessary to stretch and exercise the muscles when they are still warm, as this is when they will achieve maximum flexibility in preparation for the next activity or in this case, recovery.
Regular foot care and hygiene
Regular care must be taken to avoid foot ailments for those who are diabetic or have a compromised immune system because infection can lead to serious complications. In this case, it is wise to enlist the services of a chiropodist. Trim your toenails straight across and not too short to prevent ingrown toenails. Smooth rough edges with a nail file and avoid cutting corns and calluses with non-sterile instruments as this can cause infection. Use a pumice stone daily in the shower to help reduce calluses and use a moisturizing cream on your feet (but not between the toes) to prevent the skin from drying and cracking. Wash your feet in warm soapy water each day and remember to test the water temperature with your elbow, not your feet. Pat your feet dry and inspect them to confirm there are no cuts, lesions, or infections. Wear clean socks or stockings, and if you suffer from cold feet, loose-fitting bed socks are preferable. Avoid socks with tight elastic bands that reduce circulation and ill-fitting stockings. Uncross your legs for long periods to prevent the pooling of blood in your lower limbs and exacerbation of varicose veins. A regular foot massage for 5-10 minutes is good for foot health and to increase circulation in the feet. Avoid massage if you have any type of acute foot injury or cracks in the skin. With these measures in place, you can avoid foot arch pain and maintain good foot health.
Seeking Professional Help in Singapore
Finding a podiatrist or foot specialist When seeking professional help in Singapore for foot arch pain, one can consider seeing a podiatrist or an orthopaedic foot and ankle surgeon. Podiatrists are healthcare professionals who have been trained to diagnose and treat foot problems. Podiatrists in Singapore are associated with the Podiatry Association Singapore. Podiatrists in Singapore offer a wide range of services including treatment for common foot problems like bunions and heel spurs, nail surgery to remove ingrown toenails, diabetic foot assessment and management, custom-made orthotics, and sports podiatry. Some podiatrists are well trained in the treatment of biomechanical problems and injuries in the lower limb. There are a small number of orthopaedic surgeons who have a special interest in foot and ankle disorders. These surgeons would also be able to diagnose and treat foot problems. Searching for the help of these professionals can be a good start to find out how the foot arch pain had developed and the treatment options available. Diagnostic tests and evaluations A podiatrist or orthopaedic foot and ankle surgeon will be able to make a clinical diagnosis based on a detailed history and physical examination of the affected foot. In certain cases, blood tests may be ordered to determine if the foot pain is related to a systemic condition like rheumatoid arthritis. To evaluate the standing foot alignment, weightbearing X-rays may be taken. In certain cases, an MRI may be recommended to further evaluate the soft tissue and bone condition. An accurate diagnosis is important in determining the most suitable treatment to resolve the foot arch pain.
Finding a podiatrist or foot specialist
When finding a podiatrist or foot specialist, it is important to find one that has experience in dealing with foot arch pain. To check if a podiatrist is registered to ensure professionalism and quality of care, you can visit the Podiatry Registration Board of Singapore. It is also important to look at the qualifications and experience of the podiatrist. Asking friends and family for any recommendations can be very helpful in finding a good podiatrist. A good podiatrist will: listen to the client, have a detailed knowledge of the problem and findings, explain things clearly and simply, and explain the treatment options. Remember that a podiatrist that suggests expensive treatments such as custom made orthotics or suggests surgery without simple solutions such as taping, stretching, and strengthening exercises, may not serve to deliver the least intrusive method of treatment. A great tool to find a registered podiatrist in Singapore is through the use of the Health Promotion Board’s ‘Health Point’. This is an online directory of healthcare professionals including podiatrists who are registered in Singapore. By using the online search function, you can find registered podiatrists and access information such as the address and specific area of clinical practice.
Diagnostic tests and evaluations
When attending a podiatrist or a foot specialist in Singapore, he/she will usually ask you questions regarding foot function and analyze your gait. Sometimes it may be suggested that you have a biomechanical assessment, which analyzes the function of the foot and lower limb. This is usually done at a podiatry clinic. If the podiatrist feels that there are bony alignment issues, x-rays may be taken to evaluate the foot structure. In some cases, a more detailed scan may be required. MRIs are useful for obtaining detailed soft tissue information. It may be used to further assess alignment issues or to evaluate damage to a specific soft tissue, such as a ligament tear. If a stress fracture is suspected, a bone scan may be required. This involves injection of a radioactive isotope which collects in areas of increased stress in a bone. It can be useful for determining the extent of injury and to monitor progress of stress fractures. Ultrasound is useful for imaging soft tissue injuries, such as ligament or tendon strains. It is a relatively cheap imaging modality and can be used as a step before getting an MRI, which is more expensive. Often diagnosis of plantar fasciitis may be based on clinical evaluation alone and imaging may not be necessary, especially if response to treatment is encouraging.
Treatment options available in Singapore
– Losing weight. If you are overweight, you are likely to benefit from losing weight. Any weight loss can reduce the stress on your arches and thereby reduce pain.
– Exercises. Stretching exercises may help relieve pain in some people. Your health professional can advise on the type and duration of exercise needed. The aim is to improve the range of movement in the affected foot. Exercises may strengthen the arch and the muscles that support the arch. This can help reduce symptoms and prevent the condition from worsening over time.
– A change in the type of shoes you wear. Wearing shoes with cushioned soles and good arch support can help relieve pain and prevent the condition from worsening. A small pad on the arch to relieve pressure may also help. At the other end, a firm (and possibly custom-made) arch support may be needed if you have a “fallen” arch. A high heel should be avoided if you have a “fallen” arch.
Most of the foot arch problems can be treated without the need for surgery. Treatment is designed to relieve pain and prevent the condition from worsening. The suitable treatment for you will depend on the type and severity of the condition. Your podiatrist or foot specialist will usually recommend one or more of the following treatments:
