Pain in the arch of the foot

One of the most common injuries in sports like distance running is pain in the arch of the foot. And while you may assume that it’s plantarfasciitis, there are a long list of other possibilities and causes.

Foot pain can be divided into two categories – sudden (or acute onset) and gradual (or insidious) onset.

Acute injuries are typically associated with an incident. For example, your foot lands awkwardly or you misjudged a step.

The reason for an insidious onset injury is harder to pick. The foot gradually becomes more painful, although it’s hard to pick the exact moment that you first noticed it.

It might be linked to that one big run? The new shoes? Or a pair that’s overdue for replacement? Maybe it’s a bit of everything?

We’ll cover the most likely cause of your pain and how it could have started for acute and insidious onset pain the the arch of the foot.

Acute onset injuries

If the pain in the arch of the foot occurs suddenly, you can probably figure out what caused the overload.

Stepping on a stick or rock that bends the front of the foot. Landing heavily from a jump. Having your toes bent back sharply as you stumble.

As this happens, a number of structure take the brunt of the force.

If your toes bend back, the plantarfascia and toe muscles stretch rapidly. This can cause the connective tissues or muscle fibres to tear. It can also cause a reactive inflammatory response in these structures.

If your foot bends or twists in the middle, it can cause joints and ligaments in the midfoot to compress or stretch. This can strain ligaments, such as the Bifurcate ligament, or cause joint impingement (pinching).

How to diagnose & treat your acute injury

Diagnosis is quite important. If it’s a reactive tendinopathy or joint impingement, it responds really well to anti inflammatory medication. But if it’s a ligament or plantarfascia tear, that medication will cause further bleeding and disrupt the healing process.

Here’s some basic rules to follow:

  1. If you see bruising, don’t use anti-inflammatories. It means that one or more structures are damaged rather than just reacting or inflamed.
  2. If it’s obviously swollen, get some compression on to it ASAP. That’ll reduce how much more swelling accumulates in the area. Make it firm but not restrictive.
  3. If it’s worse after rest or sleeping but improves with activity, it’s got an inflammatory component. That doesn’t always mean that medication is helpful but it does indicate that prolonged rest is a bad call.
  4. If it aches constantly and is very painful to stand on, consider getting an x-ray to check for fracture.
  5. If it hurts to stretch the painful area, but not to compress it, it’s probably a ligament or connective tissue like the plantarfascia. Eg. pointing your toes away hurts on top of your foot but pulling your toes towards your shin is fine. It responds well to support, such as taping, and gradual reloading.
  6. If it hurts to compress the area but isn’t painful on stretching, it’s probably joint and should respond well to gentle activity and anti inflammatory medication.

Gradual onset injuries

Most episodes of foot pain begin gradually, with symptoms becoming more noticeable over time. This presents two issues.

Firstly, it’s difficult to figure out exactly when it started. Secondly, it’s hard to figure out the likely cause as there wasn’t a single incident or event that triggered it.

Finding the cause is vital. How can you fix an overload injury when the overload is ongoing?

As a hint to find the cause, one-sided injuries almost always have one-sided causes. If it’s just your left foot, it won’t be due to old shoes or too much training.

Those causes may contribute to an overload but they won’t create an injury on their own. Otherwise your injury would affect both feet (assuming you took both feet on every run…)

How to diagnose & treat a gradual onset injury

For gradual onset injuries, it’s important to know the difference between what makes it feel better and what actually fixes it.

Taking anti-inflammatories might take the pain away for hours, but is it helping? Or masking it while it declines?

Here’s some guidelines:

  1. If it loosens up with activity and stiffens up when you cool down, it has an inflammatory component. Try ice after exercise to manage the reaction.
  2. Nasty pain on waking, easing over the next 10-15 minutes, is a classic sign of plantarfasciitis. Wear supportive shoes and add strength exercises, particularly targeting your stabilisers.
  3. Constant pain that’s sore on walking could be a stress fracture. Get it checked out and scanned.
  4. Pain and swelling that’s localised to your big toe joint. It’s most likely a hallux valgus but it could be gout. If it flared up without obvious overload and it’s very red and swollen, consider getting screened for gout.
  5. Pain that’s just on the top of the foot and is sore to touch might be a joint impingement. If it loosens up with walking, try supportive shoes, ice after exercise and topical anti-inflammatory gel such as Voltaren Emulgel.