The elastic covering on the sole of the foot--the plantar fascia--runs the length of the foot and holds up the arch. When this shock-absorbing pad becomes inflamed, this is called plantar fasciitis, causing a dull ache along the length of the arch. The ache is due to over-stretching or partially tearing the arch pad. This happens most often to people with rigid, high arches. They feel the pain when they put weight on their foot or when pushing off for the next stride. Pain is particularly intense upon arising or after sitting for a long while. Plantar fasciitis is particularly common among middle-aged people who have been sedentary and who suddenly increase their level of physical activity. Runners are most susceptible, but almost any sport that keeps the athlete standing can lead to arch pain. Inappropriately fitting shoes or a weight gain of 10 to 20 pounds can also contribute to the condition.
Arch pain can be caused by several different factors. Tight calf muscles combined with repeated arch collapse on weight bearing, is the most common cause of arch pain.This can then often lead to a condition called plantar fasciitis, which is an inflammation of the connective tissue that connects the heel with the ball of the foot. When the connective tissue in the bottom of the feet gets stretched out too much, plantar fasciitis can result. The inflammation resulting from plantar fasciitis can result in arch pain. Arch pain caused by plantar fasciitis is often worst after long periods of rest, like when you first wake up in the morning. This is because the plantar fascia tightens when you are off your feet. When you wake up in the morning and start walking around, the plantar fascia stretches out again.
Typically, the sufferer of plantar fasciitis experiences pain upon rising after sleep, particularly the first step out of bed. Such pain is tightly localized at the bony landmark on the anterior medial tubercle of the calcaneus. In some cases, pain may prevent the athlete from walking in a normal heel-toe gait, causing an irregular walk as means of compensation. Less common areas of pain include the forefoot, Achilles tendon, or subtalar joint. After a brief period of walking, the pain usually subsides, but returns again either with vigorous activity or prolonged standing or walking. On the field, an altered gait or abnormal stride pattern, along with pain during running or jumping activities are tell-tale signs of plantar fasciitis and should be given prompt attention. Further indications of the injury include poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc complex, (muscles of the calf). Crouching in a full squat position with the sole of the foot flat on the ground can be used as a test, as pain will preclude it for the athlete suffering from plantar fasciitis, causing an elevation of the heel due to tension in the gastroc complex.
The doctor will examine your feet for foot flexibility and range of motion and feel for any tenderness or bony abnormalities. Depending on the results of this physical examination, foot X-rays may be recommended. X-rays are always performed in a young child with rigid flatfeet and in an adult with acquired flatfeet due to trauma.
Non Surgical Treatment
Arch pain can be treated with orthotics, inserts that have proper arch support to relieve the strain on the plantar fascia, mild stretching and anti-inflammatory medications. Orthotics will relieve most of the strain put onto the plantar fascia by supporting the band from underneath when pressure is applied. Tape can also be used in conjunction with orthotics to restrict movement and support the plantar fascia. Stretching should be used along with orthotics and continued long after the symptoms of arch pain are gone to prevent it from occurring again.
The procedure involves cutting and shifting the bone, and then performing a tendon transfer. First, the surgeon performs a calcaneal osteotomy, cutting the heel bone and shifting it into the correct position. Second, the surgeon transfers the tendon. Reroute the flexor digitorum to replace the troublesome posterior tibial tendon. Finally, the surgeon typically performs one or more fine-tuning procedures that address the patient?s specific foot deformity. Often, the surgeon will lengthen the Achilles tendon because it is common for the mispositioned foot to cause the Achilles to tighten. Occasionally, to increase the arch, the surgeon performs another osteotomy of one of the bones of the midfoot. Occasionally, to point the foot in a straightforward direction, the surgeon performs another osteotomy of the outside portion of the calcaneus.
Flexibility is important in preventing injuries. With a simple stretching exercise, you can rehabilitate the muscles of your foot to relieve arch pain and prevent future injuries. This simple exercise by Tammy White and Phyllis Clapis for Relay Health is a good way to strengthen your foot muscles and stretch your plantar fascia. Sit in a chair and cross one foot over your other knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat three times. When you can stand comfortably on your injured foot, you can begin standing to stretch the plantar fascia at the bottom of your foot.