Arch Pain: Why Does the Arch of My Foot Hurt?

What arch pain feels like

The arch of the foot is supported by bones, ligaments, the plantar fascia (a thick band running from heel to toes) and the posterior tibial tendon, which runs behind the inner ankle into the arch. Pain may feel:

• sharp or stabbing, often with the first steps of the day
• aching or tired after standing
• burning or tingling, suggesting a nerve
• localized to a bony spot, suggesting a stress fracture

Causes of arch pain

Plantar fasciitis

Plantar fasciitis is irritation of the plantar fascia, usually where it attaches to the heel bone, but pain often spreads into the arch. Key features:

• pain worst with the first steps in the morning or after sitting
• improves after a few minutes of walking, then returns after long periods on your feet
• tender at the inner front of the heel
• common between ages 40 and 60, in runners, people who stand all day, and people who are overweight

Flat feet (fallen arches)

Flat feet can be lifelong and painless, but they can cause tired, aching arches, especially after standing. Flexible flat feet that look normal when you sit and flatten when you stand are common in children and usually need no treatment.

Posterior tibial tendon dysfunction

The posterior tibial tendon holds up the arch. When it is inflamed or stretched, it causes pain and swelling along the inner ankle and arch, and over time the arch collapses and the foot rolls in. You may find it hard to rise up on tiptoe on that foot. It is most common in women over 40, people with obesity, diabetes or high blood pressure.

High arches

High arches (cavus foot) concentrate pressure on the heel and ball of the foot and can strain the fascia, causing arch pain, calluses and ankle instability. Very high arches in both feet can be linked to nerve conditions such as Charcot-Marie-Tooth disease.

Stress fracture

Repeated impact, such as a sudden increase in running, can cause a small crack in the midfoot bones (navicular or metatarsal). Pain builds during activity, is pinpoint-tender on the bone and may be accompanied by swelling. See stress fracture.

Nerve compression

Tarsal tunnel syndrome compresses the tibial nerve behind the inner ankle, causing burning, tingling or numbness spreading into the arch and sole. Peripheral neuropathy from diabetes causes burning in both soles.

Other causes

• Plantar fibroma: a firm, painless or tender lump in the arch, in the plantar fascia
• Midfoot arthritis: aching across the top of the arch, with a bony ridge
• Overuse and poor footwear: flat, worn-out or unsupportive shoes, flip-flops and walking barefoot on hard floors
• Muscle strain from new exercise

Arch pain causes compared

When to see a doctor for arch pain

See a doctor or podiatrist if pain lasts more than 2 to 3 weeks despite home care, stops you walking normally, follows an injury, comes with numbness or a lump, or if one arch is visibly collapsing. People with diabetes should get any new foot pain or skin break checked promptly.

How arch pain is diagnosed

The doctor will ask about your activity, footwear and when the pain is worst, then examine the foot standing and walking, press on specific structures, test tiptoe standing, check ankle flexibility and look at the wear pattern of your shoes.

• X-ray for arthritis, flat-foot alignment and some fractures
• Ultrasound to measure plantar fascia thickness and look at tendons
• MRI for stress fractures, tendon tears and fibromas
• Nerve conduction studies for suspected tarsal tunnel syndrome

Arch pain treatment and relief

Stretching

• Calf stretch against a wall, knee straight and then bent, 30 seconds, 3 times each, twice a day
• Plantar fascia stretch: pull your toes back toward your shin for 30 seconds before getting out of bed
• Rolling the arch over a frozen water bottle or a firm ball for 5 to 10 minutes

Footwear and insoles

• Wear shoes with a firm heel counter, arch support and cushioning, including at home
• Replace running shoes every 300 to 500 miles (500 to 800 km)
• Over-the-counter arch supports help most people. Custom orthotics are an option for flat feet, high arches or tendon dysfunction
• Avoid going barefoot and wearing flat sandals while the arch is sore

Activity and pain relief

• Swap running for swimming or cycling for a few weeks, then build back gradually
• Ice the arch for 15 minutes after activity
• Acetaminophen (paracetamol) or an NSAID such as ibuprofen at the label dose, avoiding NSAIDs with kidney disease, stomach ulcers or blood thinners
• Lose weight if you are overweight, since every pound adds load to the arch

Medical treatments

• Night splints for stubborn plantar fasciitis
• A walking boot to rest a stress fracture or inflamed tendon
• Physical therapy for strength and gait
• Steroid injections, used sparingly, or shockwave therapy for persistent plantar fasciitis
• Surgery for advanced tendon dysfunction, painful fibromas or rigid deformity

Frequently asked questions

Why does the arch of my foot hurt?

The commonest reason is plantar fasciitis, irritation of the band of tissue under the sole. Flat feet, high arches, a strained posterior tibial tendon, a stress fracture and nerve compression are other causes. Footwear without support and sudden increases in activity often trigger it.

Why does my arch hurt when I walk?

Walking stretches the plantar fascia and loads the arch-supporting tendon with every step. If either is irritated, pain is worst with the first steps and after long walks. Pain that builds steadily during walking and is tender on one bony spot may be a stress fracture.

What is the fastest way to relieve arch pain?

Rest from impact, ice, calf and arch stretches, supportive shoes with arch inserts, and a short course of an over-the-counter pain reliever usually bring the quickest relief. Avoid walking barefoot. Most people notice improvement within a few weeks.

Can flat feet cause arch pain?

Yes. Flat feet put more strain on the plantar fascia and the posterior tibial tendon, which can cause aching arches, especially after standing. Many people with flat feet have no pain. A foot that becomes flatter over time, on one side, needs assessment.

How long does arch pain take to heal?

Mild strain settles in 1 to 3 weeks. Plantar fasciitis usually improves within a few months, and about 90 percent of people recover within a year without surgery. Stress fractures take 6 to 8 weeks.