But more than anything else—along the lines of 15 times a day—athletes walk into his office complaining of heel and arch pain when running. “In the close to 30 years I’ve been practicing, it has definitely increased,” he says.
What’s to blame for this parade of aching feet—and what can you do if find yourself suffering? Here’s what Conenello and other sports medicine experts advise.
What causes arch pain when running?
In some cases, arch pain when running signals plantar fasciitis. If runners know the term, they probably associate it with heel pain, Conenello says. Indeed, many cases involve a stabbing, stepped-on-a-nail sensation near the back of the foot, especially first thing in the morning.
But the plantar fascia is a thick band of tissue that runs all the way from your heel to the base of your toes. When the four plantar muscles underneath it become weak or deconditioned, the plantar fascia sustains more stress with each step, triggering inflammation. This can cause soreness anywhere along the bottom of your foot, including your arch, he says.
Like many other foot issues, plantar fasciitis and other types of arch pain can come from two primary sources, says Maggie Fournier, D.P.M., a sports podiatrist in LaCrosse, Wisconsin, and past president of the American Academy of Podiatric Sports Medicine: Intrinsic factors, which are related to your individual anatomy and physiology, and extrinsic factors, which come from outside your body—think shoes, terrain, or training habits.
On the intrinsic side, high arches can cause pain if you don’t have the right footwear to support them. Conversely, low arches or flat feet can also contribute, especially in the wrong shoe, says Judith Sperling, D.P.M., a podiatrist at the Twin Cities Foot & Ankle Clinic in Woodbury, Minnesota, who has worked as part of the medical teams for the New York City, Boston, L.A., and Twin Cities Marathons.
As your arch caves in, your posterior tibial tendon—which attaches the calf to the inside of the foot—works overtime to support it, and eventually can become fatigued and painful. Arch pain when running can also result from osteoarthritis in the joints across the middle of the foot, she says.
External causes of arch pain from running include ramping up your training too quickly. Adding too many fast miles proves especially risky, due to the added pounding, Fournier says.
Making a switch from running on softer surfaces to harder ones—say, going from trails to roads or gravel to concrete—can also bring on tenderness in this area, as can always running on the same side of the road, if the street is sloped or cambered. Fournier also sees arch pain in runners who hang on to their running shoes well past their expiration date.
And then there are the things you do the 23 or so hours of the day you’re not running. Wearing non-supportive shoes, especially for activities that involve lots of standing or walking, don’t do your feet any favors. Of course, staying sedentary isn’t the solution—sitting too much contributes to weakness in your plantar muscles, Conenello points out.
How can you manage arch pain from running on your own—and when should you see a doctor?
More than three-fourths of the time, Conenello believes, runners can address arch pain from running at home. Try this stretch throughout the day: While seated, grab your big toe, pull it back as far as you can tolerate, and hold it for 10 seconds. Repeat 10 times. This will help release the plantar fascia.
While you have your foot in your hand, rub gently along the bottom. If you find a spot that’s particularly sensitive, massage it using a lacrosse ball to break up scar tissue, he says. You can also use a frozen water bottle, which adds the pain-relief and potential anti-inflammatory properties of ice. Just be sure not to leave your foot resting in one spot on it for too long, or you can get frostbite, Sperling warns.
Going barefoot at times might strengthen foot muscles when you’re healthy, but if you’re already in pain, wear supportive shoes at all times, even just around the house, Fournier says. Over-the-counter arch supports can give your plantar fascia an added bit of support and respite until you’re pain-free.
Anti-inflammatory medications can sometimes help relieve symptoms. “But if it’s not responding right away—within the first few days—stop,” Conenello says. It’s likely inflammation isn’t the culprit, and “you’re just going to be taking medication that you don’t really need and can actually be detrimental in the long run,” posing a risk of side effects like kidney damage and gastrointestinal issues.
If your arch pain doesn’t diminish with time and home treatment, if it alters your gait, or if you see external signs such as swelling, redness, or bruising, it’s a good idea to pause your running and book a doctor’s visit, Fournier says.
A podiatrist, orthopedic specialist, or other sports-medicine provider can use MRI or other imaging to rule out serious injuries, such as stress fractures or ruptures of the plantar fascia. They can also assess both your history and your body’s structure and function to determine the underlying cause of your pain.
What are the best treatments for arch pain from running?
If treatments like ice, rest, and massage fail to provide relief, your doctor may offer other options, depending on your diagnosis and contributing factors. Physical therapy often proves effective, Fournier says. Protocols may include strengthening, stretches, and hands-on manipulation.
Some doctors will suggest a cortisone injection, but Conenello recommends against it for athletes. “It’s a Band-Aid that’s short-lived and [the pain] is going to come back with a vengeance,” he says.
Many types of arch pain when—from plantar fasciitis to posterior tibial tendinitis to osteoarthritis—respond well to a newer treatment called extracorporeal shock wave therapy, or ESWT, Conenello and Sperling say. ESWT uses pressure waves to stimulate the production of proteins that may reduce inflammation, promote blood vessel growth, and allow soft tissue and nerves to regenerate.
While increasing evidence supports its use for these conditions, according to a recent research review in the Journal of Bone and Joint Surgery, some insurance companies consider it experimental and don’t cover it. Discussing the pros and cons with your doctor can help you determine if it’s worth it in your case.
Often, you can keep running while you have treatment. “If it doesn’t hurt while you’re doing it or when you’re done or the next day, then that distance is fine to do,” Sperling says. “But if the pain increases, then you really need to back off or hold off for a couple of weeks until it calms down.”
Cross-training—pool running, swimming, or cycling with a low resistance and high rpm—can replace some or all of your mileage, helping you maintain fitness with less strain on your feet, she says.
How can you prevent arch pain?
“As far as prevention goes, I think the shoe is the number one,” Sperling says. There’s no magical footwear type that’s right for everyone, though—head to your local shoe retailer, ask trained shoe-fitters for their advice, and choose a model that fits comfortably.
The shoe you end up with “might be against the shoe that I would normally recommend,” Conenello says. “But if that’s the one you feel good in, that’s the one you should wear.”
For example, minimalist shoes can relieve arch pain for some people by activating foot muscles. But for people whose issues stem from their posterior tibial tendon, the very same pair can prove aggravating, Sperling says.
In fact, consider buying more than one brand and model and rotating them, so you aren’t putting the exact same pressure on your foot with each run, Conenello suggests. Once you find the perfect fit or fits, track your mileage, and replace them approximately every 350 miles or so, Fournier recommends.
Besides good footwear, a proper training program—one that progresses slowly over time—also can prove protective. Instead of logging the same 30 minutes at a moderate pace on the treadmill or six-mile loop around your neighborhood, try faster runs, slower jogs, hills, trails, and track workouts. Not only will you protect your arches from too much repetitive motion, Conenello says, you’ll likely also wind up a stronger, faster runner.