Arch Strain: What Causes Pain in the Arch of the Foot?

There are 26 bones in each foot, which form the two arches. The transverse arch runs the width of the foot and the longitudinal arch runs the length of the foot. The bones of the arch of the foot are mainly held together according to the shape with which they fit with each other. Ligaments are the fibrous tissues which help in holding the bones against each other. The secondary support to the foot is given by the muscles of the foot and the plantar fascia, which is a tough and sinewy tissue. Fat pads present in the foot help in absorbing the impact and also with weight-bearing. A person experiences arch strain or pain in the arch of the foot when there is anything wrong with the interaction or in the function of any of these elements.

• First Grade Arch Strain: Pain in the arch of the foot is felt during activity only.
• Second Grade Arch Strain: Pain in the arch of the foot is felt before and after any activity and does not interfere with the patient’s daily life.
• Third Grade Arch Strain: Pain in the arch of the foot is felt before, during and after any activity, especially athletic activity and interferes with the patient’s daily life.
• Fourth Grade Arch Strain: Severe pain is felt in foot arch, so much so that it interferes with the patient’s daily life.

The primary structures in our body, which help in absorbing and returning the force to and from the body to the external world, while we are on our feet, are the foot arches. When something happens to these foot arches we feel pain in them. There are many causes for arch strain or pain in the arch of the foot, such as direct force trauma, muscle strains, ligament sprains, poor biomechanical alignment, overuse, stress fractures, inflammatory arthritis or lack of tightness or tightness in the joints in the foot; all these can cause foot arch strain resulting in foot arch pain.

• Arch Strain or Pain in the Arch of the Foot Caused Due to Plantar Fascia: One of the common causes of arch strain or pain in the arch of the foot is injury to the plantar fascia, which is a thick, connective tissue that helps in supporting the arch on the bottom of the foot. It extends from the calcaneus (which is the heel) toward the heads of the metatarsals.
• When there is damage to the plantar fascia, it can result in inflammatory response, which can cause pain in the arch of the foot.
• Arch Strain or Pain in the Arch of the Foot Caused Due to Trauma or Injuries: Strains, sprains, fractures and bruises, stresses to the foot can cause arch strain or pain in the arch of the foot. Blunt-force injury caused by someone stepping on the foot can result in a bruise, as well as damage to the primary and secondary structures of the foot.
• Arch Strain or Pain in the Arch of the Foot Caused Due to Muscular Injuries: There are many muscles of the foot and lower leg, which connect on the arch or near the foot arch. So, any injury or tightness in the muscles can lead to wrong biomechanics, which results in arch strain or pain in the arch of the foot.
• Arch Strain or Pain in the Arch of the Foot Caused Due to Overuse: Damage can occur to the foot muscles by overuse, bruising, overstretching or overloading resulting in arch strain or pain in the arch of the foot.
• Arch Strain or Pain in the Arch of the Foot Caused Due to Arthritis: Arthritis can also occur in the arch joints due to repetitive movements of the foot thus stressing and straining the arch of the foot.
• Ligamental Injury as a Cause for Arch Strain or Pain in the Arch of the Foot: Arch strain can occur when there is overstretching of the ligaments, which are holding the bones together and when there is tearing of the fibers.

• Any injury or trauma to the bones of the foot occurring as a result of twisting or a single blow to the foot arch can cause arch strain. Repetitive trauma to the arches can result in a stress fracture.
• Repetitive micro-trauma injuries can lead to plantar fasciitis, stress fractures, acute and chronic arthritis resulting in arch pain.
• Micro-trauma injuries also occur when the body structures are stressed and re-stressed repeatedly to the point where there is tissue damage around the foot arch.
• Foot arch pain can also occur from running on uneven surfaces, very hard/soft surfaces, wearing shoes which do not have shock absorption qualities or over exercising etc.

• Patient suffering from arch strain feels pain and tenderness in the bottom of the foot, which is characteristic of plantar fascia strain. Symptoms of Pain and tenderness can be felt in a localized or in a general area.
• Stretching the plantar fascia can increase or decrease the pain.
• In mild cases of plantar fasciitis, there is decrease in the pain, as the soft tissues of the foot warm up. As the use of the foot increases, so does the pain in the arch of the foot.
• In severe plantar fasciitis, any stress on the arch of the foot increases the pain.
• Point tenderness or a pain in a specific region indicates that there is something wrong in that particular area.
• Ligaments help in joining the bones and both work together to form joints. Strain in the arch ligaments cause foot arch pain and if there is any point tenderness and joint looseness, then they indicate a sprain.
• If pain in the arch of the foot is felt upon complete extension, flexion, or turning in of the foot or working the foot against resistance; all these indicate muscle injury.
• Severe point tenderness present over an area of a bone indicates a fracture. A distinguishable gap or lump can be felt at the site of the fracture. A rotated forefoot or toe is another sign of a fracture.
• A direct-force injury to the foot can result in bruises. The tissues which make up the arch do not provide that much protection due to which any blow to the foot causes pain, swelling, discoloration in that region.
• Patient suffering from arch strain or pain in the arch of the foot may also have symptoms of “crunchy” feeling on the area due to inflammation.

Medical history and a thorough physical examination of the patient is conducted in order to assess the nature of the injury and the cause behind it. It is important to diagnose the correct cause for foot arch pain. A good general guideline is comparing the injured side to the uninjured side. Both the feet of the patient will be examined by the doctor. Injury can occur as a distinguishable lump or a gap felt in the affected region. The severity of the injury can be determined from the cause of the injury, type of the injury and the severity of the pain in the arch of the foot. The doctor will touch and manipulate the arch and the foot of the patient by applying pressure in order to detect any tender spots, deformities or any differences in the bones of both the arch and the foot. The doctor will also examine the function of the muscles of the foot by holding or moving the ankle and the foot against resistance. Patient may also be asked to stand, walk or even run. Any pain occurring as a result of any particular movement helps in determining the cause of the pain. The nerves of the foot are also tested to ensure that they are not injured. Imaging tests, such as x-ray, bone scan or MRI scan of the foot and the arch can also be done to assess any changes in the structure of the bone.

• R.I.C.E. (Rest, Ice, Compression, and Elevation) should be started as soon as pain or discomfort is felt in the arch of the foot. Ice application for arch strain should not be done for more than 20 minutes. Plastic bag or towel should be used for wrapping the ice. Adequate rest should be taken, so that the tissues are allowed to heal and also to prevent further stress to the foot arch region. Compression and elevation of the affected region helps in preventing any swelling in that arch of the foot region.
• Over-the-counter pain medications help in reducing the pain and swelling of the arch of the foot. Medicines, such as acetaminophen (Tylenol) and NSAIDs, such as aspirin, naproxen, ibuprofen help in inflammation along with the pain in arch of the foot. Patient should not exceed the recommended dosage of the medicine. Extra attention should be taken by those patients who have a history of stomach ulcers, chronic medical conditions and those who are taking other medications.
• Manual therapies for arch strain can be utilized to help in reducing the pain in the arch of the foot and increasing the circulation to the affected region in order to promote healing.
• Activity modification should be done in order to maintain the fitness level of the patient.
• Activities which cause pain, discomfort and soreness around the foot arch, such as running should be avoided. Those activities, which result in multiple impacts of the body with the ground, should also be avoided.
• However, elliptical trainers, bicycling, step machines, ski machines and swimming can be done, as they do not involve impact and allow the patient to maintain and improve his/her fitness level.
• Corrective prophylactic measures, such as replacing old shoes and replacing the insoles of the present shoes should be done. Shoes which have worn out soles should be replaced. Replacing the shoes every six months is recommended.
• Off-the-shelf orthotics or custom made orthotics help in improving the biomechanics of the foot.
• Exercises, which help in increasing the strength, flexibility and stability of the affected foot arch, should be done. Exercises which help in correcting the muscles which are not balanced should also be carried out. Flexibility exercises help in maintaining or improving the length of the muscle along with decreasing the chances of injury/re-injury to the muscle.

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