Pain in Arch of Foot | Causes, Symptoms and Treatment

The arch of the human foot provides strength to the foot to allow us to take part in activities such as walking running jumping, lifting and so on. Unfortunately, pain in the arch of the foot can get in the way of weight-bearing activities like running and walking. For some people, the pain might be a minor niggle but for others, arch pain can be crippling. In our latest blog post, we provide an overview of the causes, symptoms and treatment considerations for arch pain.

What Causes Arch Pain?

Given that the arch has many structures that can be injured, a sore foot arch may be the result of one or a combination of different conditions that affect the foot. For example, arch pain can occur due to conditions such as:

• Plantar Fasciitis
• Peroneal Tendonitis
• Tibialis Posterior Tendonitis

Each of these conditions can occur individually with distinct symptom profiles but they can also overlap. Similarly they may share a common cause or result from unique triggers. This means working out the most likely cause of arch pain starts with sound knowledge of foot anatomy and an in depth understanding of how the arch can be injured, both of which your podiatrist would have received university training in.

Possible reasons for arch pain can stem from damage to the bones or the joints, strained ligaments and tendons, overstretched or overworked muscles and even irritated nerves. Injury to these structures can occur for a number of reasons. For example a sudden injury like landing awkwardly after jumping can jar the bone structure and joints and overstretch muscles and ligaments. In other cases, the arch can become chronically strained due to the way the foot works. For example, both collapsed arch/fallen arches and high arches can strain the main ligament (plantar fascia) that supports the arch. In other cases, some of the small muscles in the foot can be overworked and strained if the foot isn’t working as well as it should. A less common cause of a sore foot arch can be nerve irritation where the pain shoots or feels like it is burning.

Arch Pain Symptoms

You should see your podiatrist for an assessment if you experience arch pain, especially if you notice any of the following:

1. Your pain is worse in the morning but gets better after walking around;
2. Your pain increases as the day progresses;
3. You experience a sharp pain in the arch when weight-bearing;
4. You notice a burning pain or shooting pain;
5. Regular cramps in the arch of your foot;
6. You have high arches or collapsed/fallen arches (flat feet).

Foot Arch Pain Treatment

When it comes to sore arch treatment, although there are a number of possible options not all of them will necessarily be suited to your particular condition. Potential treatments range from initial injury management (e.g. RICER) and padding/strapping to foot arch supports and shoes that are more supportive. Stretches and strengthening may be relevant in some cases but not in all cases therefore, caution should be exercised to avoid aggravating the injury.

If you have arch pain, our podiatrists can offer their professional advice and support. They can assess and diagnose your pain and work with you to select a treatment option that is best suited to your specific needs. To discuss your arch pain and treatment options, contact Instep Podiatry Brisbane for an appointment.

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Foot arch pain, also referred to as arch strain, is a common burning, painful condition affecting the arch area of the foot. The arch facilitates the even distribution of body weight from the toes of the foot to the heel.

Severe strain to this area can cause foot arch pain which can then restrict foot movement and make the undertaking of normal daily activities difficult and painful.

The most common cause of pain in the arch of the foot is due to a condition known as ‘Plantar Fasciitis’.

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Diseases and deformities of the foot | Good to know

Almost every one of us has been familiar with foot diseases since childhood. From the school bench in the first-aid posts, blue or green footprints were left, and doctors diagnosed many with flat feet. Also, everyone knows about the limitation in fitness for military service due to flat feet. But hardly anyone seriously thought about why this is happening and how it is possible to correct the situation!

In fact, it doesn’t just happen!

With flat feet, the anterior, middle, and then the posterior arches of the foot are deformed. As a result, the axis of the entire limb is disturbed, which leads to rapid and significant disorders in the knee and hip joints, and this problem is a direct path to disability and joint prosthetics.

The disease occurs in both men and women.

But if a man was not taken into the army, he forgot about this problem for 20-30 years. In the future, most likely, he will not even think about the fact that his knees and hip joints began to hurt so early. Although most likely this happened due to a violation of the axis of the lower limb, formed since childhood. In women, everything progresses much faster, since the muscles and ligaments are weaker, and all women love to wear heels (so the legs will shrink and be longer and slimmer)

Unfortunately, the payback is not long in coming! “Corns”, “bumps” (deviation of the thumb), calluses on all other fingers, curvature of the fingers – all this is a consequence of the deformity of the feet. Pain in the legs, quick fatigue when walking, pain in the calf muscles, I want to throw away my high heel shoes and have to constantly fight with growing corns and bumps.

If at the first appearance of foot deformity you immediately noticed and began to engage in treatment, then everything may not be so bad. Performing exercises, wearing orthopedic insoles or shoes, special physiotherapy and massage can stop and even correct further deformity, relieve discomfort.

But when the thumb has already deviated outward, “bumps”, “corns”, non-healing calluses appeared, one finger began to find on the other – this indicates serious changes in the bone, articular and ligamentous apparatus and you need to seek advice from an orthopedist.

The foot is one of the most complex parts of the human skeleton and only a competent specialist can determine exactly how your foot has tried to adapt under the influence of constant walking on a flat surface, wearing heels or tight shoes without arch support and what kind of treatment you need.

Foot orthopedics

The term “orthopedics of the foot” in modern medicine takes on a completely new meaning, significantly different from the doctrine common in Soviet medicine. For many decades, there has been practically no systematized approach to the complex solution of disorders associated with deformation of the osteoarticular o carcass of the foot. There was a small list of operations that were performed according to standard indications, without a sufficient in-depth diagnostic approach. Accordingly, few positive results were recorded, in the medical and patient communities there was a negative opinion about the severity and pain after surgery period, a small number of successful interventions. To a large extent, all this corresponded to reality due to the underdevelopment of diagnostic capabilities, the lack of knowledge of new data on the pathogenesis of the process, and the outdated technique for conducting operational benefits.

At present, on the basis of multicenter studies, orthopedic care for foot deformities has begun to be addressed on an integrated basis, including:

• Individual foot orthotics
• New methods of surgical interventions

In modern orthopedics, on the basis of a large amount of accumulated material, new principles of surgical treatment of the feet have developed, which are outlined below:

• Maximum correction of osteoarticular deformity
• Stable bone fixation with special techniques
• Complete correction of all arches of the foot

The principle of maximum correction implies the simultaneous correction of all components of the foot deformity with the restoration of the correct arches and the possibility of wearing ordinary shoes in the postoperative period without removing the internal fixing structures.

Most common foot deformity correction procedures

The approach to the choice of surgical intervention is always individual for each patient, but there are a number of universal approaches.

Deformity of the first finger (“bump”)

• Elimination of the “bump” itself
• Restoration of anatomical structures at the base of the 1st finger (correction of the ligamentous apparatus)
• Axis alignment 1 pin

The most important in the operation is the technique of osteotomy (dissection of the bone) and fixation (fixing the newly formed bones in the right direction with the removal of the connective tissue that has grown as a result of inflammation). In case of osteotomy orthopedic-traumatic log correctly exposes axis 1 of the finger. The osteotomy procedure itself is the secret to the success of the operation.

Previously, a transverse osteotomy was performed, followed by unreliable fixation with thin wires or a massive metal structure. After such an intervention, the load of the foot was excluded for 3-3.5 months. During this time, the ligamentous-muscular apparatus of the foot atrophies, the foot becomes unsightly, rehabilitation is delayed, the ability to wear normal shoes is sharply limited (the presence of massive metal structures on the bones).0023 ii). In the future, a second operation is performed to remove the metal structure ii. All this is extremely burdensome, painful and inconvenient, especially for the elderly. The results are usually very unpredictable. In the future, difficulties arise in the selection of shoes, scars develop on the foot. The overall recovery process is delayed for 6-7 months.

A completely different result is achieved with the modern technique of longitudinal or horizontal osteotomy, the so-called chevron or SCARF. Operations of this type are performed at the ANDROMEDA Clinic by leading trauma orthopedists by atologists using a minimally invasive oscillatory saw, used only in our Clinic. When special Baruk screws are used to fix bone fragments, the result of the operation exceeds all expectations.

In this case, the load vector on the foot propagates perpendicular to the osteotomy plane, and the bone fragments are well fixed. The screws are screwed into the bone “flush” with the surface, which allows the patient to walk in the immediate postoperative period, which prevents atrophy of the muscular apparatus of the foot and accelerates bone fusion. These screws are made from inert titanium and do not require further removal. Thus, modern technologies and materials allow to achieve excellent results in a short time.

Calluses, hammer toes, stubborn calluses

Very often, in parallel with the appearance of “bumps” and a toe deviated outward, rounded keratinized painful skin areas appear in the area of ​​​​the heads of the 2-5 metatarsal bones on the plantar side, the appearance of corns on the surface of deformed “crooked” fingers. These formations are very painful and cause great discomfort. They appear due to the “flattening” of the arch of the foot, while the support from the 1st and 5th metatarsal fingers is transferred to the 2nd, 3rd, and 4th metatarsal fingers. Normally, fingers 2, 3 and 4 are not supporting when walking. In the case of transferring the main gravity of the body to them, a reaction of the plantar surface occurs in the form of coarsening and keratinization of the skin, the occurrence of pain, the inability to wear narrow hard shoes, and calluses appear on the back of the foot in the area of ​​​​the joints.

Operations that were previously performed according to the old methods did not bring a stable result and caused recurrence of weakness of the ligamentous apparatus of the foot with a return to “corns”.

The problem is radically solved with Weyl osteotomy – the formation of the function of the transverse arch of the foot with shortening of the metatarsal bones of the foot while maintaining the main joints of the fingers. During this operation, the heads of 2-4 fingers remain intact, are removed from the load and the tense extensor apparatus of the fingers is weakened. Osteotomy during the Weil operation is also performed using modern equipment that allows minimal trauma to the tissues. Weil’s operation is also the basis of hammer toe correction. It is also possible to use minimally invasive percutaneous methods of foot correction, which allow correcting the position of bones and joints, giving them the correct position.

Combined and individual application of various methods of operative correction of the arch of the foot is a mandatory approach used in the ANDROMEDA Clinic. The photo shows the results of treatment. The postoperative rd period in the hospital of the ANDROMEDA Clinic, as a rule, is 3-4 days. In the postoperative period, for quick healing and restoration of foot function, it is proposed to wear Baruk shoes.

The picture shows the result of surgery on the left leg

If we are talking about a small deformation, then the results are much better. The fact is that the neglected foot becomes “stiff” or rigid, so the correction requires a more massive intervention, mainly due to the osteotomy of a larger number of bones, while modern techniques can successfully correct even very complex cases presented in the photographs.

And most importantly, earlier correction of foot deformities will improve the condition of other joints of the legs – ankle, knee and hip.

Before surgery After surgery

Before surgery After surgery

Before surgery After surgery

Hollow foot – KinesioPro

Hollow foot syndrome (lat. pes cavus) is characterized by an excessively high longitudinal arch of the foot. People with this condition place too much stress on the heel and toe when walking and/or standing.

The spectrum of deformities associated with the cavus includes toe torsion (especially the big toe), hindfoot deformity (characterized by an increased calcaneal angle), contracture of the plantar fascia. They lead to an unnecessarily high load on the heads of the metatarsal bones, resulting in calluses and metatarsalgia.

Etiology

Occurrence
hollow foot may be associated with pathological processes in the head and spinal
brain, in peripheral nerves, or with structural foot problems. If in
foot, muscle imbalance occurs before the final formation of the skeleton, then
significant changes in the morphology of its constituent bones can be observed.
If the deformation occurred after reaching skeletal maturity, then usually
morphology remains the same or undergoes minor changes. Two-thirds
adult patients acquire a hollow foot against the background of such neurological
diseases such as peroneal muscular amyotrophy (Charcot-Marie-Tooth disease), spinal
dysraphism, polyneuritis, intraspinal tumors, poliomyelitis, syringomyelia,
Friedreich’s hereditary ataxia, cerebral palsy and spinal
tumors that can cause muscle imbalances leading to an increase in the arch. Patient
with newly diagnosed unilateral deformity of the foot, who did not suffer injuries in
past, should be examined for the presence of spinal tumors.

Read also the article: Patellofemoral pain syndrome.

Reasons
and the mechanism of deformity inherent in hollow foot syndrome is not fully understood. To the factors
responsible for the development of the hollow foot are muscle weakness and
muscle imbalance associated with neuromuscular diseases, residual effects
congenital clubfoot, post-traumatic bone malformation, contracture
plantar fascia and shortening of the Achilles tendon.

Disease
Charcot-Marie-Tooth (CCMT), also known as hereditary motor and sensory
neuropathy is a genetically heterogeneous disease
manifesting predominantly during the first decade of life and characterized by
retarded motor development, distal muscle weakness, clumsiness,
frequent falls. In adulthood, CMT is capable of provoking the onset of
painful deformity of the foot and, in particular, hollow foot syndrome. Despite
relative prevalence of this disease, little is known about the mechanism
distribution of muscle imbalances, severity of orthopedic deformities, or types
emerging pain. Currently, there is no effective treatment for
prevent the development of any form of CMT disease.

It is believed that the development of the hollow foot syndrome observed in CMT disease is associated with a muscular imbalance of the foot and ankle. Various authors have proposed hypothetical models of this disease, according to which, due to the suppression of weak evertor muscles by stronger inverter muscles, the toe of the foot is in the adducted position, and the heel is in the retracted position. Similarly, weak dorsiflexion muscles are suppressed by strong plantar flexors, causing the first metatarsal to be in a flexed position, which causes cavus foot syndrome. According to statistics, the frequency of occurrence of the syndrome largely depends on gender: men are less predisposed to this disease, but more often they find the disease opposite in nature – flat feet.

Forms of cavus syndrome

Three main types of cavus syndrome are described in the literature: “pescavovarus”, “pescalcaneocavus” and “true” pescavus. These three types can be distinguished by their etiology, clinical features, and radiological findings.

• Pes cavovarus or adductus cavus, the most common form of cavus, occurs predominantly in neuromuscular disorders like CMT and in cases where the etiology cannot be determined, is usually referred to as “idiopathic”. Pes cavovarus is characterized by an outwardly turned calcaneus, plantar flexion of the first metatarsal, and twisting of the toes. Radiological examination of CMT-induced cavus usually shows plantar flexion of the toe relative to the heel.
• Pes calcaneocavus or calcaneus-hollow foot usually occurs with triceps palsy due to poliomyelitis. This case is characterized by a dorsally flexed calcaneus and a plantarly flexed toe. Radiological images show a large talocalcaneal angle.
• “True” pes cavus is characterized by a lack of dorsal flexion or an outwardly turned calcaneus, as well as a too high longitudinal arch due to plantar flexion of the toe relative to the heel. The combination of any of these features forms the so-called “combined” hollow foot, which then either retains mobility or loses it.

In addition, there are four types of hollow foot syndrome according to the position of the highest point of the longitudinal arch: anterior (toe), metatarsal, posterior and combined.

Epidemiology

At the moment, there is little reliable information about the prevalence of caval foot syndrome and the groups of people most susceptible to this disease. The number of people suffering from this disease, according to some studies, varies from 2 to 29%, but in recent works, the authors report about 10%.

Pathogenesis

For
descriptions of the pathogenesis of the hollow foot syndrome have been proposed a large number
theories. Duchenne and co-workers tied the rise of the high vault
feet with internal muscular imbalance. Other theories focus on external
muscles, as well as on the joint action of internal and external muscles, causing
imbalance.

Mann et al. (1992) described the pathogenesis of caval foot syndrome caused by CMT. The nature of the deformation, according to them, should be determined by the interaction of the agonist and antagonist muscles. In CMT, the tibialis anterior and peroneal muscles are weakened. At the same time, the antagonists – the posterior tibial and long peroneal muscles – begin to surpass other muscles in strength, pulling the foot towards itself and thereby deforming it. In particular, the peroneus longus suppresses the action of the tibialis anterior, causing plantar flexion of the first metatarsal and toe valgus deformity. The tibialis posterior muscle predominates over the peroneus brevis muscle, promoting toe adduction. Simultaneously with the contractures arising in the internal muscles, the long extensor of the toes is involved in the process of dorsal flexion of the ankle, which provokes twisting of the fingers. The lateral ligaments of the ankle can be placed under increased stress if the toe is turned out and the heel is turned in, which can subsequently create a risk of loss of balance.

Clinically relevant anatomy

C
from a clinical point of view, the hollow foot is characterized by an abnormally high height
longitudinal vault. From the point of view of biomechanics, the hollow foot is formed
turned inward toe, large heel angle, high
the middle part of the foot, plantar flexion of the toe.

With a decrease in the talocalcaneal angle, the navicular bone is located above the cuboid bone, and not in the middle. This leads to difficulty in the work of the Chopard joint. The scaphoid connects the foot and ankle. A healthy foot rotates around the navicular bone, in turn, the cuboid bone always moves simultaneously with the calcaneus.

Characteristic

V
during the stance phase of the gait cycle, the heel is in an inverted position, and
the toe is in varus, which leads to insufficient distribution of the load over
foot. This can lead to metatarsalgia, a stress fracture of the first
metatarsal bone, plantar fasciitis, pain in the medial part of the longitudinal
vault, iliotibial tract syndrome, and loss of balance.

B
In the case of hollow foot syndrome, the calcaneus produces internal rotation under
talus, resulting in a small talocalcaneal angle.
Since the cuboid bone follows the calcaneus, the latter is in
plantar position relative to the navicular bone, and not next to it. Such
position leads to blockage of the midfoot and overload of the lateral
its parts.

The mobility of the foot can be assessed differently by looking at it from the front and drawing a mental line along the foot through the Lisfranc and Chopart joints. The parallelism of this straight surface is the condition for free flexion of the foot. With an increase in the angle between the straight line and the surface, the mobility of the foot decreases markedly. In the case of very high longitudinal arches, the load is distributed unevenly along the heads of the metatarsal bones and the lateral border of the foot. This can cause pronation of the foot and injury to the calcaneus due to excessive pressure, as well as the formation of osteophytes at the junction of the metatarsal bones with the cuneiform bones.

Symptoms and clinical manifestations

Signs
hollow foot syndrome are the patient’s complaints of pain in the foot (especially in
its lateral part due to increased load), loss of balance, problems with
walking and wearing shoes. Symptoms may vary depending on
from deformation. To the main symptoms of hollow
feet include such disorders as:

• metatarsalgia;
• pain under the first metatarsal;
• plantar fasciitis;
• painful calluses;
• ankle arthritis;
• inflammation of the Achilles tendon.

K
other symptoms include:

• keratosis;
• lateral destabilization of the ankle joint;
• heel varus;
• plantar toe flexion;
• stress fractures of the lower extremities;
• knee pain;
• iliotibial tract syndrome;
• back pain;
• buckling.

Treatment

The treatment of caval foot syndrome is to restore the patient’s ability to walk without any problems and pain. The patient must understand that surgery is not able to completely correct the deformity of the foot. The main goal of surgical treatment is to increase the area of ​​contact between the foot and the surface, as well as getting rid of pain. Multiple surgical procedures may be necessary, especially if the foot deformity progresses. Surgical procedures are performed both on soft tissues and on bone. Practiced in their framework, tendon transposition and osteotomy allow you to correct the deformity without the need for arthrodesis.

Clinical tests

The Coleman block test is used to assess subtalar joint mobility. A wooden block 2.5 mm thick is placed under the outer part of the foot, while its first metatarsal bone hangs from the block and turns out to be plantar bent. If the heel returns from an inward or outward turn to a neutral position, then the joint is mobile. Otherwise, it becomes rigid. In addition, as part of clinical tests, the heel angle is also measured.

Physiotherapy treatment

Suggested
conservative treatment strategies usually include methods to reduce and
redistribution of the plantar load with the use of orthoses for the foot and
specialized shoes with supportive cushions. The orthosis used must
perform the following tasks:

• Increase the contact area of ​​the sole of the foot with the ground. Overloading of the metatarsal heads is the result of little sole-surface contact due to an overly high arch and limited dorsal ankle flexion. Increased contact area promotes load transfer from the metatarsal heads to the arch (level of evidence: 4).
• Prevent excessive supination of the foot. Lateral displacement of the ankle and the axis of the subtalar joint is often associated with the formation of a hollow foot. This position results in increased torque of the supinator muscle around the axis of the subtalar joint.
• Counteract underpronation and supination. Heel destabilization is due to lateral displacement of the axis of the subtalar joint. In the movable form of the hollow foot syndrome, excessive elasticity of the transverse tarsal joint complicates the final stage of the stance phase of the gait cycle. The pathological condition of the toe of the foot contributes to the supination of the transverse tarsal joint, leading to excessive pronation of the heel. Some patients with a hollow foot suffer from both lateral ankle destabilization during the stance phase and heel pronation during the final phase of the stance phase. Treatment options include stretching and strengthening tense and weak muscles, plantar callus debridement, bone mobilization, massage, and chiropractic manipulation of the foot and ankle (LE: 5).
• To level the high arch of the foot and prevent chafing of the toes, it is possible to use various orthopedic devices, in particular, orthopedic shoes with a sole that repeats the arch of the foot. In the case of varus deformities, it is possible to modify the shoes with an orthopedic wedge. The use of a splint for foot drop or mild deformity may allow the patient to move; however, in patients with decreased sensation in the foot, the use of splints with polymer foam linings is recommended, as well as frequent examination of the skin for ulceration (level of evidence – 1b).

Surgical treatment

Surgical
methods of dealing with hollow foot syndrome are based mostly on
tendon transposition.