Case Study - Arch Pain by Fatemeh Abdi

A 44-year old male presented to the clinic complaining of arch pain in both feet, but more noticeable in the left. He reported to the Podiatrist that the arch pain came on gradually over a period of 2 months. He mentioned he had plantar fasciitis of the base of the heel about 4 months ago, and this was treated with orthotics and stretches. The arch pain came on after his heel pain was eradicated.

He is not a very physically active person, but walks 3 times a week, and he informs the Podiatrist that he enjoys gardening frequently. His job involves him being mainly seated, and not standing on his feet for prolonged periods.

He has noticed that his arch pain reduces when he is not wearing his shoes and orthotics, and when he massages his arches. He has been to his GP, who has advised him he still suffers from plantar fasciitis, and to keep using his orthotics and performing the stretches initially advised.

A thorough footwear assessment was conducted by the Podiatrist to ensure enough stability and support is being provided by his footwear. It was noted that the sneakers he wears for walking are not supportive enough or appropriate for his foot type. His work shoes were also not providing the best amount of support. It was explained to the patient why his shoes were not supportive, and the features to look for when purchasing new shoes in the future. Some recommendations were given.

He also mentioned to the Podiatrist that he wears sandals around the house, which have minimal arch support. He has noticed that his arch pain significantly reduces when wearing these sandals, however he attributes this to being not very physically active around the house.

He was advised to continue wearing these sandals inside the house.

Arch Pain Examination by Podiatrist

A thorough physical assessment of the heels was conducted by the Podiatrist, whereby the most common structures to become inflamed were examined, namely the plantar fascia. Palpation of the origin of the plantar fascia did not elicit pain, however palpation through his arches elicited a lot of pain, more so in the left than right.

Other structures were also examined, but no pain reported. There was also some mild redness noted surrounding the arch areas.

The Podiatrist explained to the patient that the most common area to become painful as a result of plantar fasciitis is the base of the heel, where he was originally experiencing the pain. However, his pain had since moved to the arches, and there are typically a few reasons why he now has pain in the arch of his foot.

One of the most common reasons for this is if the prescribed orthotics are not matching with the height of the patient’s arches. If the device is too high and pushing into the arches, this can further aggravate the plantar fascia and cause arch pain over time.

The patient was asked by the Podiatrist to stand bare feet and his arches were measured to be at 22mm on the left, and 20mm on the right foot. His orthotics measured 30mm for both feet. He was then asked to stand on the orthotics bare feet, and it became immediately apparent that they were aggressively pushing up against his arches.

Therefore, the most obvious cause of his arch pain were the orthotics, however his biomechanics were also assessed to find out whether there were any further contributing factors.

Biomechanical Assessment for Plantar Fasciitis

The patient was asked to walk on a treadmill and his gait was carefully examined by the Podiatrist. It was noted that he significantly pronates through his subtalar joints, more so on the left than the right.

This, in combination with his extremely low arches, was also contributing to his arch pain. The range of motion at his calf muscles were also assessed, and mild tightness was noted. The correct technique of stretching his calf muscles, without giving him further arch pain was demonstrated by the Podiatrist.

It was explained that in addition to removing the aggravating factor (his orthotics) in order to reduce his arch pain, it is important to address the other factors which may also be contributing to strain on the Plantar Fascia, in order to ensure full recovery and to reduce the likelihood of flare-ups in the future.

Arch Pain Treatment

A treatment plan was put in place to treat his arch pain. This was determined by with the severity and duration of his condition, as well as the patient’s personal lifestyle factors.

Given that he pronated significantly, and had arches below average height, the use of orthotics for controlling these biomechanical abnormalities was advised. However, his current orthotics were not appropriate as they were too high in the arches, and thus further aggravated his arch pain.

A new pair of custom made orthotics were designed by the Podiatrist for this patient, ensuring the arch of the device matched closely with the patient’s foot arches. They also controlled his pronation and unloaded the plantar fascia.

His arches were also treated with 3 sessions of shockwave therapy to promote blood flow and accelerate recovery time.

At 5 week review, he advised the Podiatrist that his arch pain had completely subsided and that he had no other symptoms. He was asked to contact the clinic if his symptoms returned.

Please note: The information in this case study is specific to one particular patient and should not be taken as general advice. There are several cause of arch pain and if you are having foot problems you should consult with a Podiatrist or suitable healthcare practitioner.

Written by Karl Lockett