Pain In The Arch Of Foot

Overview
One of those often-painful soft tissue that attaches to heel spurs at the bottom of the foot is called "plantar fascia". Fascia, located throughout the body, is a fibrous connective tissue similar to a ligament. You can see fascia when you handle meat. It is the white, connective tissue separating layers of meat or attaching to bones. The "plantar" fascia in our bodies is that fascia which is seen on the bottom (or plantar portion) of the foot, extending from the heel bone to the ball of the foot. Compared to other fascia around the body, plantar fascia is very thick and very strong. It has to be strong because of the tremendous amount of force it must endure when you walk, run or jump. But while the plantar fascia is a strong structure, it can still get injured, most commonly when it is stretched beyond its normal length over long periods of time. When plantar fascia is injured, the condition is called "plantar fasciitis", which is usualy pronounced either "plan-tar fash-I-tis" or "plan-tar-fash-ee-I-tis." (Adding "-itis" to the end of a word means that structure is inflamed.) It is sometimes known more simply as 'fasciitis'. Plantar fasciitis is the most common type of arch pain.


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
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
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
Posterior tibial tendon dysfunction is a common cause of fallen arches in adults. The tendon runs along the bottom of the foot and up the back of the ankle, connecting to the tibialis posterior muscle in the calf. The posterior tibial tendon is an important support for the foot arch. Overuse, inflammation and tears of the tendon may cause progressive foot and ankle pain and the development of flat feet. The American College of Foot and Ankle Surgeons states that an ankle brace, leg cast or removable boot may be used to temporarily immobilize the posterior tibial tendon, facilitating healing. Physical therapy typically follows immobilization to strengthen the foot and restore normal foot structure and function.


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.


Stretching Exercises
Gastroc stretch. Stand on the edge of a step. Rise slowly on your toes. Lower yourself slowly as far as you can until you feel a stretch in your calf. Don?t roll your foot inward or outward. Hold for 1-2 seconds. Reps:10-20 (stop before you fatigue). Soleus stretch. Same as above, but start with your knee bent so that you feel a slight stretch in your calf or achilles. Maintain the angle of your knee throughout the stretch. Bicycle stretch. Lie on your side. Keeping your top leg straight, bring your knee toward your nose until you feel a slight stretch in the hamstring. Maintaining this angle at your hip, start pretending you are pedalling a bicycle with the top leg. Make sure you feel a slight stretch each time your knee is straight. Reps: 10-30 for each leg. If you feel any pops or clicks in your hip or back, try raising the top leg a little (making the thighs further apart) to eliminate the popping. Foot Intrinsic Exercises. Assisted metatarsal head raising. Sit in a chair. Find the bumps at the ball of your foot just before your big toe and just before the little toe. These are the first (big toe) and fifth (little toe) metatarsal heads. Place your second and third fingers from one hand under the first metatarsal head, and the second and third fingers from the other hand under the fifth metatarsal head. Now lay the thumbs from each hand in a diagonal across your toes so that they form a right angle meeting at the nail of the second toe. Your hands are now in position to assist your toes. Keep your toes straight, with the toe pads on the floor. Use your fingers to help raise all the metatarsal heads (the ball of your foot). Do not let your toes curl under keep them long. Now relax. Reps 7-10 for each foot. As this exercise gets easier, let your fingers do less of the work until your toes can do the exercise unassisted. This can take up to three weeks. When your strength has improved to this point, you can progress to the following three exercises, which are best done in stocking feet on a slippery floor. Active metatarsal head raising. Stand with your weight on both feet. Raise your metatarsal heads (the ball of your foot) while keeping your toes from curling under and maintaining your heel on the ground. Relax. Reps 6-7. Do one foot at a time. If you do more reps than you are ready for, you may well develop cramping in your foot. I once had a client who thought if seven reps were good, 10 were better. For good measure, she did the 10 reps 10 times in a day, and then she was unable to walk the next day from having used a set of muscles she had never exercised before. Don?t overdo it.