A 52 year old lady presents to the clinic complaining of arch pain in one foot of approximately 2 months. The pain in the arch of her foot came on while on a 3 week holiday in Europe, where she describes lots of walking and sight seeing with her husband. She has never had foot problems in the past and has always been a keen walker, and so it came as a surprise to her when the pain in the arch of foot developed and didn’t subside. She is otherwise healthy and takes no medications apart from the occasional anti-histamine for seasonal allergies. The arch pain that she describes is constant and can only be relieved by rest and sitting down with the foot elevated. She describes some throbbing in the arch at times, but this is usually after a big day on her feet. She is currently working in an office based environment so is still able to work as she sits at her desk daily. However, she feels arch pain when walking to and from the office and train station. She describes a tightness and a pulling sensation while walking, and almost a tearing sensation too. She reports that her holiday was spent in Italy and France, and involved lots of walking on cobbled streets and hard footpaths. She was wearing summer style shoes in Europe due to the hot weather and these offered less support than her regular footwear.
When the arch pain came on she initially ignored it and proceeded to walk the streets as planned. However, within 3 days she was unable to ignore it and she decided to buy some arch supports from the chemist. The Pharmacist advised that she may have Plantar Fasciitis and was happy to supply the arch supports to the patient and these gave some mild relief for a short period of time.
Note: Arch pain can be a result of Plantar Fasciitis but is commonly found in Peroneal Tendonitis and Tibialis Posterior tendonitis.
This lady also found some temporary relief from her arch pain when she applied ice packs to the sole of her foot. She also used her trainers for the remainder of the holiday and this helped a little too. However, she was still sore every day and the pain continued after she returned to Sydney.
When finger pressure was applied to the sole of the foot this would elicit pain in the arch. The pain was distal to the heel towards the toes and was most intense around the mid arch area. The arch pain felt like the same sort of pain that the patient would feel when walking. The affected area of the foot seemed to be the medial band of the plantar fascia. The patient was informed that she was likely suffering with Plantar Fasciitis.
With the patient standing on a pedestal in a relaxed position foot measurements were taken and recorded. The high arches observed in this patient stood out markedly and were re measured. Left arch height 32mm and right arch height 34mm. The extreme height of this patient’s arches results in an overload of pressure under the heel and forefoot and a problematic lack of support through the arch / sole of the foot. The lack of support from the summer shoes like ballet flats and sandals which have very little arch contour inside the shoe, causes problems in patients with very high arches. There is minimal contact from the shoe liner and this results in stretch and strain through the arch. This is a common problem in patients with arch pain. If the strain is prolonged and sufficient then the plantar fascia can become irritated and inflamed. Sometimes heel pain can develop too, as the plantar fascia pulls on the base of the heel bone.
This patient had vertical heels and minimal pronation. She had very slight out –toe but nothing more than the usual. Her leg length appeared equal and pelvic rotation was not noted. It was also noted that this patient had a reduced range of ankle joint dorsiflexion due to tight calf muscles. Tightness in the calf is common in patients with very high arches (Pes Cavus foot type) and is one of the common causes of arch pain.
It was essential to support this patients arches with prescription orthotics, in order to remove the strain on the plantar fascia and hence reduce the arch pain. Generic shoe liners and off the shelf arch supports were not high enough to make sufficient contact with the arch of the patient’s foot, and therefore would not aid healing. Furthermore, one arch was higher than the other and so the orthotics had to be made to reflect this asymmetry.
Digital foot scans were taken in order to prepare the orthotics and sports tape was applied to the affected foot, to reduce the arch pain until the orthotics were ready to be fitted.
Calf stretches were demonstrated and instructed and the patient was asked to continue using sports shoes or walking shoes as much as possible. She was asked to avoid walking barefoot and in thongs or ballet flats until her arch pain had subsided.
This patient was fitted with her orthotics and then reviewed at 4 weeks. She reported that her arch pain had gone completely and that she was able to walk without any discomfort. She had been using her orthotics daily and was wearing her sports shoes more than any other type of shoe. She would wear her trainers and orthotics to and from the office and would then change into her court shoes once at work. Her seated job made this acceptable.
She had occasionally walked barefoot and in thongs for short periods of time without feeling any pain in the arch of foot. She had been diligent with calf stretching and reported an increase in the range of ankle joint dorsiflexion. Due to her pes cavus foot type she would always need to be mindful of her calf range.
Please note: The information in this case study is specific to one particular patient and should not be taken as general advice. There are several cause of arch pain and if you are having foot problems you should consult with a Podiatrist or suitable healthcare practitioner.
Written by Karl Lockett