A consistent, throbbing pain in the arch of your foot is a common issue for runners. But how serious is arch pain, and what's the best way to stop it if you are experiencing soreness in your inner arch, whether walking or running?
Whether it's caused by plantar fasciitis, tendonitis or a high arch, we have the expert advice to help you work out where the root of the problem lies and how to treat it.
According to Lloyd Clark-Morris, podiatrist and co-owner of Theale Wellbeing Centre in Reading, your foot’s arch bears much of the force of your stride. ‘There are multiples of your bodyweight going through your feet – if you’re jogging, it might be 2-3 times your body weight but if you’re sprinting it could be 6-7,’ he says.
‘When your foot strikes the ground your arch will start to drop – it’s part of the shock-absorbency process and that is entirely normal. But in certain circumstances it is so rapid and forceful that the tissues designed to control that movement can’t cope. That’s when the problems can start.’ Over-training and increased load are usually to blame, although sometimes there can be other biomechanical issues that may be helped with the use of an orthotic.
Clark-Morris warns against ignoring a bothersome arch as it has a tendency to worsen quickly and take longer to fix. Instead, he advises seeing a foot specialist straight away; even one session can often provide enough arch-based advice to help you build your rehab plan. ‘Learn what tissues are hurting and why, and then, with the help of your podiatrist, you can identify how to reduce the load going through those tissues or begin to strengthen it so that it is better able to cope.’
With that in mind, we asked Clark-Morris to talk us through some of the common causes of arch pain and the best ways to treat them at home, whether it's using foam rollers and massage balls or inserts. Your arch education and recovery starts here…
What is it?
‘The plantar fascia runs from the heel bone and fans out into the base of the toes and helps support the arch,’ says Clark-Morris. ‘When the fascia has been irritated or struggling with the job it is trying to do you can get pain – usually in the heel but sometimes in the arch, too.’
Plantar fasciitis will often present as ‘first step pain’ so you might be pain-free while running but when you step out of bed the following day, it can be agony. There are several ways to diagnose plantar fasciitis: by flexing the big toe upwards and putting the fascia under tension it can be seen (and felt pressing along the fascia). However, the gold standard for diagnosing plantar fasciitis is diagnostic ultrasound (carried out at Theale Wellbeing Centre by its musculoskeletal specialist Edd Henstridge). The sound waves create an image that shows the damaged tissue.
What causes it?
‘In the majority of cases, it's an imbalance between the forces we are subjecting our body to and what the body is able to take at that particular time,’ says Clark-Morris, who often sees it in those new to running, or runners who have dramatically increased their mileage. ‘But the great news is that if we can get the balance right we can prepare our bodies to be able to deal with more force. You just need to be patient.”
How do I treat it?
Clark-Morris recommends that you temporarily dial back your mileage and replace it with lower-impact sports such as swimming and cycling. Then you need to start rehab. ‘A lot of people with plantar fasciitis tend to have quite tight calf muscles, so we recommend stretching the fascia and calves,’ he says. ‘To do this, pull your big toe towards you to put the fascia under tension, then roll the sole of your foot across a tennis ball or cold bottle.’
However, Lloyd suggests that the best exercise is to ‘stand on the bottom step, heels overhanging the tread, with a tea towel under your toes to help lift them slightly. Very slowly go up on tiptoes and then back down, which helps strengthen the feet and calf muscles while the plantar fascia is under stretch. Once that’s easy, try doing it on one leg.’ In long-term cases, Clark-Morris says in-shoe orthoses might be required. ‘Usually off-the-shelf orthoses will do the job but in extreme cases we may need to make them specifically for the runner.'
When returning to running increase mileage slowly remaining mindful of any discomfort. ‘You don’t have to be completely discomfort-free [to run] but how does it feel in 24 hours?’ asks Clark-Morris. ‘If the discomfort has gone, it suggests that you can carry on and even begin to increase the load. If it’s worse you should take a step back.’
If the plantar fascia refuses to improve despite load management and exercises it could benefit from shockwave therapy, a series of acoustic pulses applied to the tissue, which facilitates speedier healing. Often six or seven sessions are needed at one-week intervals. There’s also injection therapy, which involves inserting a fine needle into the fascia under local anaesthetic to clear away the thickened layers of fascia. One injection is usually effective.
What is it?
Tendonitis, sometimes referred to as tendinopathy, is a catch-all term for any inflamed tendon or tendon sheath. For runners, a commonly affected tendon is the tibialis posterior tendon, which runs from deep in the muscle in your calf, around your medial malleolus and attaches to a bone called the navicular – known as the keystone of the arch – and under the arch of the foot. The tibialis anterior tendon, which runs from a muscle in the front of your leg and connects to the top of the arch in the same area on the navicular can also be irritated and overworked in runners.
What causes it?
‘It usually comes down to the body’s ability to control the force that is being put through the foot and control the rate that the foot absorbs that force,’ says Clark-Morris. ‘Pronation is often thought of as bad but it is essential and without it we would be unable to run.’
The posterior tibialis, along with many other tissues, help to control the rate of pronation as the arch of the foot drops when the foot moves over the ground. ‘If the work being required of those tissues is more than they are able to successfully control, it is likely the runner will experience discomfort on the inside of the ankle and into the foot.’
How do I treat it?
‘It is worth getting this type of injury checked by a podiatrist as there can be other structures involved and treatment for this will depend on how well they are working,’ says Clark-Morris. ‘For a tibialis posterior injury, orthoses can help. If you put something in the shoes that helps do some of the work otherwise done by the muscle and tendon, it will reduce the stress on the tissues.’ Clark-Morris recommends patients wear the orthoses until the problem resolves, usually for 3-6 months. Although some patients decide to wear them forever. ‘Runners often worry about them weakening muscles, but that’s not true – research shows that orthoses do not weaken muscles, they can actually strengthen them.’ The orthosis is only part of the rehab plan – you must also retrain the tendons and strengthen the tissues, too.
‘Weakness may not only be in the tissues that are painful,’ says Clark-Morris. ‘Many runners with tibialis posterior tendon injury can have reduced control over internal rotation of the leg when running and this could start from the pelvis and the core muscles in the abdomen. It can often mean the gluteus medius is weak or inactive so you should work on strengthening that. Weak glutes may contribute to the leg internally rotating and the knee to collapse medially.’ Clark-Morris recommends doing single-leg squats in front of a mirror so you can check your knee remains over your foot. Your podiatrist should also give you daily resistance band exercises to help focus on the leg and foot muscles responsible for helping control pronation.
What is it?
A cavus foot or high arched foot.
What causes it?
In the case of extreme high arch (known as cavus foot), it can be caused by neurological conditions like cerebral palsy or muscular dystrophy; in milder cases, it is often an inherited foot shape.
How do I treat it?
‘High-arch feet are often less mobile, so there is usually reduced range of movement and shock absorbency, and the soft tissue structures are generally tight,’ says Clark-Morris. ‘The surface area that makes contact with the ground is usually just the ball of the foot and the heel. The tight tissues – that would usually adapt – are unable to distribute the force. With less range of movement, you often get compensation elsewhere.’ This is when an orthotic can help – by increasing the surface area where the force can go and ground contact, it makes it easier to manage the stresses in the foot. Runners with a high arch may benefit from a trainer that provides additional cushioning as well as a decent heel drop; barefoot-style shoes should be avoided.
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