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Arch pain

Arch pain affects the bottom of the foot between the heel and the ball, and it may interfere with everyday or favorite activities. Arch pain may be caused by adult-acquired flatfoot (fallen arch), which is loss of the arch and often caused by injury to one of the foot’s main tendons. Another cause of pain is an overly defined arch called high arch, which can be inherited or develop as a result of a medical condition.

  • Types

    Types of adult-acquired flatfoot include:

    • Flexible, which is an arch that is present when sitting but not when standing
    • Rigid, where there is no arch while sitting or standing

    There are no types of high arch.

  • Symptoms

    Adult-acquired flatfoot may cause:

    • Foot instability
    • Inward turning of the ankle, with outward tilting of the heel
    • Pain when standing or during activity
    • Swelling of the inside of the arch

    High arch may cause:

    • Calluses
    • Pain with standing and activity, especially strenuous exercise
    • Trouble fitting into shoes or discomfort while wearing them
    • Toe deformities, such as hammertoe and claw toe
  • Prevention

    • Exercise and a healthy diet may help patients avoid adult-acquired flatfoot by preventing conditions that can contribute to it, including diabetes, high blood pressure and obesity. Repetitive stress on the feet, especially from strenuous activity, can lead to adult-acquired flatfoot, so patients should vary their exercise routines.
    • If the foot appears to have an abnormal arch, patients should speak with their physician about the risk for medical conditions that can cause high arch and undergo examination or testing for them, as appropriate.
  • Risk factors

    Risk factors for adult-acquired flatfoot include:

    • Being female
    • Being older than 40
    • Diabetes
    • High blood pressure
    • Obesity
    • Overuse as a result of repetitive activity
    • Personal history of flatfeet

    Risk factors for high arch include:

    • Certain neurologic conditions, including muscular dystrophy, stroke, cerebral palsy and Charcot-Marie-Tooth disease
    • Family history of high arch
  • Diagnosis

    • Medical history. The physician will ask about the patient’s personal and family medical history, as well as symptoms.
    • Physical examination. To look for adult-acquired flatfoot, the physician may ask the patient to stand on his or her toes and will check for the appearance of an arch. If the physician suspects high arch, he or she may observe the patient’s gait while walking, look for toe deformities, test the foot’s strength and check reflexes in the leg.
    • Imaging tests. An X-ray or CT scan may be necessary to examine the bones of the foot or check for conditions, such as arthritis, that may be contributing to symptoms. The physician may also order an MRI to assess the soft tissues in the feet. X-rays may be necessary to assist with diagnosing high arch.
    • Neurologic assessment. The physician may recommend a neurologic evaluation to determine if an underlying condition could be the cause of the foot condition.
  • Treatment

    • Conservative treatment. The physician may recommend wearing a brace or orthotic insoles, or switching to shoes that offer more support and stability. Patients can use over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce discomfort. For adult-acquired flatfoot, other treatment options include wearing a medical boot to reduce strain on the foot followed by physical therapy to strengthen the arch’s main tendon.
    • Surgery. Surgery is an option for adult-acquired flatfoot or high arch if symptoms do not improve with conservative treatments. Multiple surgical approaches are available for each condition.
  • Follow-up care

    • After surgery, patients should follow their physician’s instructions for activities to avoid, pain management and rehabilitation.