Arch pain

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Extensively used in certain sports (running, walking, activities requiring impulsions,...), the arch of the foot can sometimes suffer lesions.

What is the arch of the foot?

The arch of the foot is also called plantar aponeurosis or plantar fascia. It is made from thick collagen fibres with little vascularization, forming a membrane that connects the heel to the forefoot and toes.

This plantar membrane support the plantar arch, and provides its tension and shape. This is what creates the anatomical shape of the foot, that can be flat, normal or high-arched.

At each step or stride, the plantar fascia is stimulated and tensioned by forces transmitted from the gastrocnemius to the toes. This is why it is so involved when running or power walking.

Plantar fasciitis (inflammation of the fascia) is commonly seen in athletes who use impulsions or brutal landings (jumping sports, running) or changes in directions. It is increased by flat or high-arched feet and by foot-shoe conflict.

Biomechanics reminder

Steps or strides start with a strike of the heel on the ground, absorbing body weight-related strains in order to prepare the propulsion phase, to transfer the motor energy to the forefoot in three phases:        

1-Cushioning

The cushioning phase begins with the contact of the heel with the ground and ends when the vertical projection of the centre of gravity coincides with the vertical of foot rest.  

2-Support

This is when the centre of gravity is level with foot rest.  

3-Propulsion

The last phase, called propulsive or power phase, starts with the support and ends when the foot leaves the ground.

Discomfort experienced or clinical sign

Plantar aponeurositis or fasciitis is a painful inflammation of the plantar fascia. The membrane that makes up the fascia can be subjected to high tensions during exercise. Due to its lack of elasticity, it becomes more fibrous and less resistant to microtraumas. It can therefore get inflamed, or even torn.

The key sign: pain

Characteristics of the pain

  • Pain in the heel at rest , usually on the inner side and when standing up, that disappears when starting to walk

  • Then pain when walking, that increases and may even cause walking disability

  • Tenderness on palpation of the heel at the insertion of the plantar fascia on the calcaneum

  • "Sandpaper" sensation or cracking when the foot or toes are mobilised

  • Please note: in case of a tear, there may be a swelling and a bruise associated with the pain

Confirmation of the medical diagnosis

After a physical examination, your doctor will consider prescribing an ultrasound and an X-ray scan to identify a possible calcification, called heel or calcaneal spur, or bony outgrowth

An IRM scan can be very useful in confirming the diagnosis when it shows signs of a thickening membrane or sometimes a real rupture.

A bone scan can also help determining elements of the diagnosis

The causes are many:

  • Alteration of the plantar statics: flat feet, high-arched feet, foot pronation or supination

  • Heel spur with or without associated bursitis

  • Local trauma from a shock such as shopping cart at the supermarket

  • Inflammatory rheumatic disease

  • Overtraining or inappropriate technical gesture

  • Lack of stretching

  • Hard surface or frequent changes in surfaces

  • Sport type (jumps, running variations, board grip)

  • Excess weight

  • Worn out shoes or weak cushioning

  • Use of certain antibiotics or other drugs

  • Acute or chronic dental problem

Medical and manual treatments

Rest (avoid exercice), and possibly use of a support (walking with crutches) in everyday life.

Orthopaedic treatment with plaster cast if needed and walking with a specific plaster shoe.

Icing applied two or three times a day, following usual precautions to avoid local burns.

Wearing appropriate orthopaedic insoles manufactured by a sports podiatrist or buying a shock-absorbing insole, preferably a heel cushion.

Anti-inflammatory or homoeopathic treatments early in treatment.

Massages with balms, essential oils or talcum powder.

Deep transverse friction massages (DTFM).

Acupuncture, mesotherapy…

Infiltrations in moderation, performed by a specialist.

Physiotherapy and electrotherapy such as ultrasounds or iontophoresis.

Extracorporeal shock waves. Be careful, this technique may be painful and requires an accurate assessment by your  physiotherapist.

Stretching, and foot and toes mobilisation.

Conclusion

The plantar fascia is less elastic that most other tendons while it plays an important mechanical function. It is extensively used during sports, which makes quite frequent the onset of inflammatory pains that need to be treated to avoid tears that would cause long and incapacitating functional disability. The best prevention is achieved through a combination of appropriate footwear, proper technique, post-workout stretching and adequate hydration while avoiding excess weight.

 

Docteur Patrick Bacquaert

Médecin chef de l'IRBMS

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