Pain in the Arch of the Foot and Heel Region

The arch of the foot is a very important structure of the foot. It is responsible for proper gait and also balance of the foot. The heel with all its attachments is also very important to proper function of the the foot and ankle. Both of these areas lend themselves to a large amount of strain since they are used constantly when moving around. Arch pain is typically caused by two things, posterior tibial tendon dysfunction (PTTD), and plantar fasciitis. Heel pain can be a result of plantar fasciitis, achilles tendonitis, and nerve injury.

Posterior tibial tendon dysfunction or PTTD is caused by overuse and strain of the posterior tibial tendon (PTT). The PTT is the tendon responsible for supporting and maintaining the medial arch of the foot when ambulating. If the medial arch decreases in height this causes more strain to the PTT therefore causing pain. Rupture of the PTT can also occur if a traumatic incident has been suffered.

The symptoms typically experienced with PTTD is a painful burning to the inside of the arch while walking. Increased physical activity can exacerbate the condition. Orthotics or bracing are made for the patient in order to help reduce tension on the PTT. Rest, ice, compression, and elevation of the painful limb can also be very effective. The doctor may also dispense a walking boot in order to help decrease strain to the tendon.

Plantar fasciitis is a very common problem where pain can radiate from the bottom of the heel to the ball of the foot. This condition is caused by inflammation to the plantar fascia which is a band of ligamentous tissue on the bottom of the foot that helps to maintain the arch of the foot. When this structure becomes inflamed it can cause excruciating pain to the heel and arch of the foot. The doctor will diagnose this problem by performing a proper physical exam and appropriate imaging. Treatment will consist of anti-inflammatory injections, oral anti-inflammatories, icing, stretching of the plantar fascia, and orthotics. All of these conservative treatments used together will help to eliminate the problem. Surgical intervention is only needed if conservative treatment fails. The doctor will consider all options of surgery as a last resort.

Achilles tendinitis is a common injury and can be very debilitating. The Achille’s tendon is one of the strongest tendons in the body and therefore is subject to increased amounts of strain. The pain will typically be very painful when walking and using the stairs. Patients will oftentimes walk on their tip toes in order to avoid strain to the tendon. The doctor will initially treat the problem conservatively with a walking boot in combination with a heel lift. This lift decreases the amount of strain to the tendon therefore alleviating symptoms. Oral anti-inflammatories can also help to reduce symptoms.

Orthotics can be used to prevent abnormal motion of the foot which will reduce strain to the Achille’s tendon as well. This is an excellent long term fix especially for an active individual. Physical therapy can be used to help stretch the Achilles tendon and plantar fascia to reduce strain to these structures. The less strain the less symptoms the patient will feel.

Nerve injury can also cause pain in arch pain and heel since the nerves surround these areas. The two most common nerve injuries are tarsal tunnel syndrome and Baxter’s neuritis. Tarsal tunnel syndrome is a result of pressure on the nerve due to its surrounding structures. In the tarsal tunnel there is a large nerve called the tibial nerve. This nerve innervates the arch and bottom of the foot. When it is compressed it can cause painful sensations into the arch and heel of the foot. The most common structures to swell in these areas are the veins, tendons, and ankle joint. When pressure increases on the nerves the symptoms occur more frequently and severely. Treatment consists of decreasing the inflammation to the tarsal tunnel by isolating the exact cause. Steroid injections may also be utilized in order to attain some relief. The underlying cause needs to be found and treated in order to be effective.

Surgery is sometimes used to release the soft tissue that encloses the nerve so that the nerve is not entrapped with the inflamed structure. Surgery is reserved as a last resort. Baxter’s neuritis is inflammation of a nerve branch of the tibial nerve. Symptoms occur similar to plantar fasciitis but are not alleviated with the typical conservative treatments. MRI is helpful in determining this problem and injections into the nerve with an anti-inflammatory are very helpful.

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