If bunions aren’t getting you down, maybe the arch of your foot is causing you pain. Arch pain or arch strain occurs when the tissues in the middle of the foot become inflamed and results in a burning sensation.

The arch of the foot is shaped by a firm band of tissue that joins the toes to the heel bone. This band of tissue plays a vital role in the proper mechanics of the foot and assists in the transfer of weight from the heel to the toes. Thus, when this tissue becomes inflamed, even the slightest movement can cause pain.

There are many different factors that can lead to arch pain. Often arch pain can result from a direct cause such as a foot injury or a structural imbalance of the foot, such as flat feet or a low or high arch. However, the most frequent cause of arch pain is a common condition known as plantar fasciitis.

Plantar fasciitis is a condition that results from excessive stretching of the plantar fascia. This is a wide band of fibrous tissue that runs along the bottom surface of the foot. The inflammation of the plantar fascia usually causes pain to occur in the heel and arch areas. If Plantar fasciitis isn’t effectively treated promptly, further strain can be placed on the arch and a heel spur (a bony growth) may develop on the bottom of the heel.

The most common symptoms of arch pain are tenderness and pain in the arch region of the foot. Pain is usually severe when pressure is applied to the foot after a prolonged period of rest, such as after waking up from sleep.

The most common treatments used to help alleviate arch pain include:

• Supportive shoes – Avoid wearing high-heels as these shoes place a particular amount of stress on the arch region. Instead, wear footwear that properly fits your foot and provides it with proper support including shock absorbing soles, and a moderate, supportive heel. Furthermore, you should wear shoes to support your feet as much as you can. Also, limit the amount of time you walk barefoot, and don’t walk barefoot on hard surfaces.

• Insoles – Special insoles you can insert in your shoes known as orthotics help to alleviate pain by providing your foot with the support it needs to move normally.

• Stretches – Stretching your calf muscle and Achilles tendon causes you to flex your foot, which in turn allows you to stretch the arch. Stretching encourages circulation.

• Massage – Ice massages before bed can help ease sore feet and reduce inflammation. Another effective massage is to rub the bottom of your foot by moving it back and forth over a rolling pin. This helps ease pain caused by plantar fascia.

• Night splint – A night splint can help stretch the plantar fascia while you sleep and prevent stiffness.

• Anti-inflamatory medication – To help ease the pain you can take nonsteroidal anti-inflamatory medication such as ibuprofen. Acetaminophen is also often recommended.

If the above treatments fail to help your arch pain, or pain increases, it’s time for you to visit your doctor – or even better – a podiatrist. Remember, if you want to help heal your feet, you need to be good to them.

Heel pain is one of the most common painful conditions seen in an arthritis clinic. This article discusses the various types of problems that cause heel pain and what can be done to make the situation better.

It’s estimated that more than 1 million persons in the United States suffer from heel pain at any given time.

When a patient complains of heel pain, it must be clarified by history whether the pain is in the bottom of the heel or the back of the heel because the diagnosis and treatment are very different.

Pain in the bottom of the heel is often due to plantar fasciitis (PF). The plantar fascia is a tough band of tissue that begins at the medial (inside) part of the bottom of the heel and extends forward to attach at the ball of the foot. The fascia is responsible for maintaining the normal arch. When an excessive load is placed on the fascia, pain can develop at the origin (the heel) as well as the mid-portion (arch) of the fascia.

PF can develop in anyone but is more common in certain groups such as athletes, people older than 30 years of age, and obese individuals.

PF must be distinguished from other causes of bottom of the heel pain such as nerve entrapment, atrophy of the normal heel fat pad, stress fracture of the calcaneus (heel bone), rupture of the plantar fascia, bone cyst, bone tumor, and bone infection.

The history typically describes a gradual onset of symptoms with no prior trauma. The most telling symptom is severe pain in the bottom of the heel when taking the first morning step. Patients may report difficulty walking to the bath room. The pain tends to lessen with more walking. This “first step” pain is also present during the day if the patient has been sitting for awhile, then getting up to walk.

On exam, pain is noted with pressure applied to the medial bottom of the heel. Tenderness is worsened by pointing the toes and ankle toward the head. This is because the plantar fascia is being stretched. Pain in the arch may also be present.

One in older patients should be ruled out and that is heel pad atrophy. Normally the heel has a thick feeling to it. In older patients the heel pad may lose this thickness and flatten out. The pain is located more centrally.

Another “fooler” is entrapment of the lateral plantar nerve. Pain is felt in the medial heel but may be present at rest as well. There may be weakness spreading the toes.

Fracture of the calcaneus (heelbone) causes pain at rest that is worsened with walking. Tenderness is present along the sides of the heel. Magnetic resonance imaging (MRI) can confirm the presence if fracture.

But what about “bone spurs”? The presence of a bone spur by itself means nothing. They are very common and by themselves are not a cause of pain. Some patients with inflammatory forms of arthritis such as psoriatic arthritis, ankylosing spondylitis, or Reiter’s disease have a specific type of spur that should prompt further evaluation looking for systemic forms of arthritis.

Diagnostic studies such as ultrasound and magnetic resonance imaging can be used to confirm the presence of plantar fasciitis. Electromyography (EMG) may be needed to rule out lateral plantar nerve entrapment.

So how is this condition treated?

The first thing is to institute a stretching regimen. Most people with PF also have a shortened Achilles tendon and the ability to dorsiflex (point the toes up) is limited. The plantar fascia is continuous with the Achilles fascia. Stretching the plantar fascia and the Achilles decreases the tension in the plantar fascia and helps relieve inflammation.

A temporary reduction in activity is important in athletes, particularly runners. Cross training with swimming and cycling can help maintain cardiovascular fitness while sparing the plantar fascia from pounding. Runners should avoid hills and make sure that any foot abnormality be corrected with custom orthotics.

Ice massage with ice cubes applied to the plantar fascia can also be helpful.

Shoes with soft heels and inner soles can relieve discomfort. Rigid heel cups and arch supports are generally not recommended. The patient may gradually resume normal activities over an eight week period of time. Rushing rehabilitation is not advised.

If there is no improvement, a night splint which holds the ankle in 10 degrees of dorsiflexion prevents the shortening of the plantar fascia.

If the night splint fails or the pain does not lessen, injection of glucocorticoid (cortisone) using ultrasound guidance is recommended. Injections should be limited to a maximum of two given over four weeks.

Patients who do not get better need to be reevaluated for systemic disease or other conditions causing heel pain.

Surgery is the last resort. Transverse release of the plantar fascia is the procedure of choice. This can be done using arthroscopic guidance.

Pain in the back of the heel is an entirely different condition.

The major structure here is the Achilles tendon which extends down from the gastrocnemius muscle to attach at the rear of the calcaneus.

Inflammation of the Achilles tendon can occur, usually in athletes or in people in engage in overxuberant physical activity involving running or jumping. Patient who are overweight are also at risk. The pain is usually described as a soreness. There is localized swelling and tenderness. Ultrasound can be used to differentiate an inflamed Achilles tendon from one that is partially or fully torn. The treatment involves anti-inflammatory medicines, physical therapy, and stretching exercises. Glucocorticoid injection is not recommended because of the danger of weakening the Achilles tendon leading to rupture. Using a foam rubber lift to elevate the heel in a shoe can help with symptoms.

Achilles rupture is handled surgically and requires a long recuperation.

Haglund’s syndrome, which is a condition where a spur develops at the back of the calcaneus and is often associated with localized Achilles tendonitis can also cause pain in the back of the heel. Ill-fitting shoes are the most common cause. Typically a bump develops at the back of the heel. Because of its association with ill-fitting shoes, this is sometimes referred to as a “pump bump.” Physical therapy, anti-inflammatory medicines, and stretching can often be of benefit. Glucocorticoid injection should be sparingly employed because of the danger of Achilles rupture. Wearing proper fitting shoes are an obvious adjunctive treatment.

Bursitis involving the retrocalcaneal bursa (the small sack that lies between the Achilles tendon and the calcaneus is a cause of pain behind the heel. Treatment involves the use of physical therapy modalities such as ultrasound. Sometimes glucocorticoid injection may be needed. It is important to limit the injection to one because of the danger of possible weakening of the Achilles tendon leading to rupture. Ultrasound needle guidance is advised to ensure proper localization of the injection.

The diagnosis is made by history and physical examination. Both MRI and ultrasound can be used for confirmation.