Joel D. Stewart, MD
Pain in the arch of the foot is a common reason for which patients seek treatment from an Orthopaedic Foot and Ankle Specialist, especially when they have tried home remedies, OTC pain relievers and drug store orthotics with no relief. In this article, I’ll discuss a few of the most common causes of chronic arch pain and how I treat them. Acute pain is a different scenario, with tendon ruptures, fractures, and sprains being the most common cause.
I like to break these down into age groups. Younger children and young adults have slightly different causes for chronic midfoot pain than those of us that are older.
The location of the pain is also a great hint.
Medial pain in the younger group can be an accessory navicular (an extra bone on the inside of your foot that is very common and does not always hurt, but can) or chronic tendonitis of the fibularis longus or the posterior tibial tendon.
Many of these medial pains are due to a rigid or flexible flatfoot. Rest, ice, compression and arch supports are always safe and effective treatments.
Once the pain starts to calm down, an intensive stretching program along with oral or an injection of steroids to reduce inflammation and pain while exercising, can also be given. Stretching multiple times (20-30) a day has been proven to be the most effective way of helping the medial causes of mid foot pain.
Medial pain in the older patient can be some arthritis in the talonavicular joint, but more commonly, it can be tendonitis of the posterior tibial tendon and can lead to falling arches.
Central pain in the younger group can be Kohler’s osteonecrosis, which is a problem of blood supply in younger children and is usually self-limited, but may require casting or bracing.
In the active patient, a navicular stress fracture should be considered. It can easily be missed since it does not often swell and does not show up on x-rays right away. This can be serious and should be evaluated early to make sure surgery is not needed.
The most common cause of midfoot pain in adults is midfoot arthritis, but it can also be metatarsal stress injuries. Stiff soled shoes and arch supports can help.
Lateral pain in the younger patients can be Iselin’s disease, which is the foot version of Osgood Slaater’s, the painful bump on the front of the knee in young athletes. It can look like a strange fracture on the outside of the foot.
In adolescents and adults, it can be a stress fracture of the fifth metatarsal. This is more common if you have a high arch.
As we get older, the stress fractures can change from the metatarsal to the cudoid or part of the calcaneus (heel bone). It can be arthritis of the tarsometatarsal area, but this is less common. For these, a rocker bottom shoe like the Hoka One One or something like the GDefy/MBT can also protect this area.
Remember not all foot pain is “heel spurs” or plantar fasciitis. The location and what makes it worse or better can be very helpful in making the diagnosis. We are here to help you figure out the best approach to resolving your foot pain.
Call (757) 596-1900 to schedule an appointment with Dr. Stewart. Visit our Contact Us page for information on office hours. Our office is located in Newport News, VA. We are 40 minutes from Virginia Beach and an hour from Richmond, VA.