Arch pain is a common condition seen by our expert physiotherapy department at Circle Health. Due to the location of the pain and reliance on weight bearing through the foot in everyday tasks it can be extremely debilitating. Fortunately, there are a variety of solutions that our department can offer to rehabilitate from this condition. These involve exercises aimed at strengthening the muscles supporting the arch of the foot, loading the spring like soft tissue (known as the plantar fascia) which runs across the arch of the foot as well as stretches to offload stiff joints and muscles through the lower limb. Taping and other offloading techniques may also be employed when acute pain is present.
The most appropriate rehabilitation exercises for plantar fascia are determined once an in depth analysis of possible biomechanical causes have been examined by our expert physiotherapists. In many cases of plantar fasciitis, individuals may have a hypermobile or flat foot posture. As individuals with this type of foot posture place their weight through their foot, the supporting muscles and plantar fascia of the midfoot are placed under greater demand. As a result heel pain may result as the plantar fascia is unable to cope with the extra demands.
Strengthening the muscles supporting the arch of the foot may be one way to support the arch and plantar fascia. This may be done in a number of ways but most physiotherapists will prescribe exercises involving lifting the arch of the foot without flexing the toes. Often this is achieved by sliding the forefoot towards the heel with a towel underneath. This allows the intrinsic muscles of the foot to strengthen without contracting the long toe flexor muscles which do not support the arch of the foot in an appropriate manner.
The second type of important exercise to treat arch pain actually aim to place tension through the plantar fascia itself. When tension is placed through soft tissue structures such as the plantar fascia the body responds by strengthening the tissue. This in turn results in a better ability for the plantar fascia to be able to support the arch during activities such as walking and running.
The most favoured exercise type to load the plantar fascia is a heel raise from the floor. As the toes extend during this movement this tensions the fascia across the arch of the foot. This form of loading exercise can be done in sitting, standing and on a single leg or with weights to progress the loading slowly on the plantar fascia. Placing a wedge under the big toe may accentuate the tension through the plantar fascia even further and ensure some of the smaller muscles supporting the arch of the foot are activated.
Stretching exercises may also play a role in the rehabilitation of arch pain in certain cases. Certain individuals with a hypermobile, flat foot posture have significant stiffness through the calf muscles. Calf muscles stiffness places even more demand through the plantar fascia by accentuating the rolling in movement of the foot during walking (known as pronation). Calf stretches for arch pain often involve stretches for the gastrocnemius muscle rather than the soleus muscle and can be achieved by standing on a decline board or alternatively by taking a large stride forwards to stretch the back leg.
When arch pain rehabilitation exercises prove difficult due to acute levels of pain it may be that our expert physiotherapists at Circle Health intervene with treatments to offload the plantar fascia before commencing exercises. The most notable way of achieving an immediate reduction of arch pain is to perform a taping technique across the arch of the foot. There are several techniques but each involves tensioning tape from the forefoot area the heel, thereby recreating an external plantar fascia which is tensioned when weight is taken on to the foot. These taping techniques are often referred to as “low dye taping”.
Another way of offloading the plantar fascia to reduce pain is by utilising an external support of which there are many on the market. However, in the vast majority of cases taping is the preferred method as external supports are unable to cope with the different fitting requirements of feet.
Although the majority of arch pain rehabilitation focuses on pain emanating from the plantar fascia there can be other causes of arch pain which should not be ignored. These can include bony stress reactions or stress fractures through the metatarsal bones and in more rare circumstances the midfoot. Often these forms of injury are secondary to a significant increase in load such as a sports training error. In some cases there may be an underlying metabolic process contributing which Circle Health are able to provide expert rheumatology or sports medicine consultant review regarding.