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.
The most common acquired flat foot in adults is due to Posterior Tibial Tendon Dysfunction. This develops with repetitive stress on the main supporting tendon of the arch over a long period of time. As the body ages, ligaments and muscles can weaken, leaving the job of supporting the arch all to this tendon. The tendon cannot hold all the weight for long, and it gradually gives out, leading to a progressively lower arch. This form of flat foot is often accompanied by pain radiating behind the ankle, consistent with the course of the posterior tibial tendon. Compounding matters is the fact that the human foot was not originally designed to withstand the types of terrain and forces it is subjected to today. Nowhere in nature do you see the flat hard surfaces that we so commonly walk on in present times. Walking on this type of surface continuously puts unnatural stress on the arch. The fact that the average American is overweight does not help the arch much either-obesity is a leading cause of flat feet as the arch collapses under the excessive bodyweight. Furthermore, the average life span has increased dramatically in the last century, meaning that not only does the arch deal with heavy weight on hard flat ground, but also must now do so for longer periods of time. These are all reasons to take extra care of our feet now in order to prevent problems later.
Pain in arch of foot is really the only symptom of this condition. It is unlikely to see any swelling or bruising and instead there will be a deep tender spot near the heel. Occasionally the pain may radiate further down the foot. With this condition, pain will usually be felt first thing in the morning or after periods of sitting. This is because the plantar fascia tightens and shortens slightly when there is no weight on it and by standing on it it suddenly stretches and becomes painful. After a few steps it starts to loosen off and the pain may subside. If this is the same pattern of pain you experience it is quite likely you have plantar fasciits. Pain may also be felt when walking up stairs or standing on tip-toes (anything that stretches the fascia).
Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.
Non Surgical Treatment
The treatment is to put an arch support under the foot immediately to prevent the arch from collapsing and the plantar fascia from stretching. Also, put an arch support in your slippers and wear them as soon as you rise. Even a few steps barefoot without support can stretch the plantar fascia. Arch supports usually relieve pain within a few days. To head off arch pain, begin an exercise routine slowly, take off any excess weight and wear arch supports in your athletic shoes. Arch pain commonly smolders for months because people do not take the proper precautions. Continuing to do weight-bearing exercises will perpetuate the pain. While the foot is recovering, swim or do water workouts. Or work the upper body only. Some people are able to use a stationary bicycle by placing only the front part of the foot on the pedals.
The soft tissue surgeries usually would include a lengthening of the Achilles tendon, releasing of the plantar fascia as well as tendon transfers. These procedures are usually done in conjunction with bony procedures such as calcaneal osteotomies (to lower the heel bone and get it more under the leg itself), as well as metatarsal osteotomies. These procedures usually involve either cutting or fusion of the bones, and placement of fixation devices to allow the bones to heal. Healing time is usually at least 6-8 weeks and usually the patient must be non-weight bearing during the healing process. These types of surgical corrections are usually reserved for the more difficult, painful and deformed feet. They can require more surgeries down the line. These procedures are usually the last resort after all other modes of treatment have been exhausted (except in children where it is usually best to treat the deformity early). There are many different degrees of high arched feet and these procedures should be left for the more extreme cases. These cases usually require a very high degree of surgical skill and should only be done by those who frequently perform these types of cases.
Achilles stretch. Stand with the ball of one foot on a stair. Reach for the step below with your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. Balance and reach exercises. Stand next to a chair with your injured leg farther from the chair. The chair will provide support if you need it. Stand on the foot of your injured leg and bend your knee slightly. Try to raise the arch of this foot while keeping your big toe on the floor. Keep your foot in this position. With the hand that is farther away from the chair, reach forward in front of you by bending at the waist. Avoid bending your knee any more as you do this. Repeat this 15 times. To make the exercise more challenging, reach farther in front of you. Do 2 sets of 15. While keeping your arch raised, reach the hand that is farther away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 15. Towel pickup. With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel. Resisted ankle plantar flexion. Sit with your injured leg stretched out in front of you. Loop the tubing around the ball of your foot. Hold the ends of the tubing with both hands. Gently press the ball of your foot down and point your toes, stretching the tubing. Return to the starting position. Do 2 sets of 15. Resisted ankle dorsiflexion. Tie a knot in one end of the elastic tubing and shut the knot in a door. Tie a loop in the other end of the tubing and put the foot on your injured side through the loop so that the tubing goes around the top of the foot. Sit facing the door with your injured leg straight out in front of you. Move away from the door until there is tension in the tubing. Keeping your leg straight, pull the top of your foot toward your body, stretching the tubing. Slowly return to the starting position. Do 2 sets of 15. Heel raise. Stand behind a chair or counter with both feet flat on the floor. Using the chair or counter as a support, rise up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the support. (It's OK to keep holding onto the support if you need to.) When this exercise becomes less painful, try doing this exercise while you are standing on the injured leg only. Repeat 15 times. Do 2 sets of 15. Rest 30 seconds between sets.