Arch pain: causes and treatment

Where it hurts is the first clue

Among the structures that hold up the arch are the plantar fascia, a band of tissue from the heel to the front of the foot, and the posterior tibial tendon, which runs behind the inner ankle bone to the bones of the inner arch.^[1,3]

Where and how it hurts	Common causes
Under the foot near the heel, worst with the first steps	Plantar fasciitis
Inner arch and ankle, with the arch flattening	Posterior tibial tendon dysfunction
A firm lump in the arch	Plantar fibroma
Burning, tingling or numbness in the sole	Tarsal tunnel syndrome or another nerve problem
An ache through the middle of the foot, often on top too	Midfoot arthritis
Pain that builds with running	An overworked tendon, or a navicular stress fracture

Causes can overlap, so an examination matters more than any single symptom. For pain elsewhere, see our guide to foot pain.

Arch pain near the heel: plantar fasciitis

Plantar fasciitis is the most common cause of pain under the heel. It hurts most with the first steps out of bed or after a long rest.^[1,2] Tight calves, flat feet or a high arch, extra body weight and long hours on hard floors raise the risk.^[1] More than 90% of people improve within 10 months of simple treatment.^[1] Stretching the plantar fascia and calf, with advice on shoes, is the core of care.^[1,8] For pain that lingers, a best-practice guide built on a systematic review recommends shockwave therapy as the next step.^[8] See heel pain and plantar fasciitis and plantar fasciitis stretches.

Inner arch pain: posterior tibial tendonitis and flat feet

When the posterior tibial tendon becomes inflamed, stretched or torn (often called posterior tibial tendonitis or tendon dysfunction), the arch gradually flattens. Early on, it hurts in the arch or along the inside of the foot and ankle, with swelling and weakness. Later, the heel shifts outward and the pain can move to the outside of the ankle.^[3,9] It is the most common cause of flatfoot that develops in adulthood, and often follows overuse from running, walking, hiking or climbing stairs.^[9] Trouble rising onto your toes on one leg is a warning sign.^[3]

Swipe sideways to see the whole drawing.

In one program for early-stage tendon problems, 39 of 47 patients had a successful result with an orthotic or brace, high-repetition strengthening and calf stretching over a median of about four months, and 5 needed surgery.^[7] A walking boot or short cast is sometimes used for 6 to 8 weeks to rest the tendon so it can heal.^[3,9] If your flat feet don’t hurt and aren’t changing shape, we usually don’t treat them. See flat feet and flat feet in adults.

High arches

A high arch concentrates pressure under the heel and the ball of the foot. In one small study of 70 people, 60% of those with high arches had foot pain, compared with 23% of those with typical feet.^[10] Custom orthotics have their strongest evidence in painful high-arched feet.^[11] A high arch caused by a nerve or muscle condition tends to get worse, so an arch that is getting higher should be checked.^[12] See high-arched feet.

A lump in the arch: plantar fibroma

A plantar fibroma is a firm knot inside the plantar fascia. It is benign (not cancer) and usually does not shrink on its own. It may hurt when a shoe presses on it or when you walk barefoot, or not at all.^[5] The condition is also called plantar fibromatosis, or Ledderhose disease.^[13]

We can examine the lump and arrange imaging, such as an MRI, when needed. Options without surgery include orthotics that take pressure off it, steroid injections that may shrink it for a time, and physical therapy. A lump that grows or becomes more painful should be rechecked. Surgery is considered when pain continues, but fibromas often come back.^[5] A systematic review found that the results of non-surgical treatment are still debated.^[13]

Burning or tingling: tarsal tunnel syndrome

In tarsal tunnel syndrome, the posterior tibial nerve is squeezed on its way from the inside of the ankle into the foot. It causes burning, tingling, shooting pain or numbness that can spread to the heel, arch and toes. A flat foot can strain the nerve, and a cyst, a swollen tendon or a bone spur can press on it.^[6]

Midfoot arthritis

The midfoot, the joints in the middle of the foot, is one of the places in the foot most often affected by arthritis.^[14] Most midfoot arthritis follows an old injury or comes from wear and tear.^[15] In one study, arthritis across the inner and central midfoot went with a lower arch and pain on top of the midfoot.^[16] A few small, low-quality studies suggest arch-contouring orthotics, shoe-stiffening inserts and image-guided steroid injections may help.^[17] Fusion is the main operation when they aren’t enough.^[15] See arthritis.

If you have diabetes or numb feet, a warm, red, swollen foot can be Charcot foot, in which the joints collapse and the arch falls, so it needs care right away.^[18] See Charcot foot.

Arch pain after running

Overuse of the posterior tibial tendon is one cause.^[9] Another, important not to miss, is a stress fracture of the navicular, a bone in the middle of the foot. Its pain is hard to pinpoint and worse with weight-bearing, and like other stress fractures it usually follows a sudden increase in activity. It can be hard to diagnose, may not show on the first X-ray, and needs surgery more often than other stress fractures.^[19] See stress fractures in runners.

Cramps in the arch

A foot cramp is a sudden, painful tightening of the muscles in the sole. Night-time leg cramps are reported by up to 60% of adults and probably come from muscle fatigue and nerve dysfunction rather than low electrolytes. Stretching is the usual self-help, though the evidence is limited, and quinine is no longer recommended. Cramps with numbness, weakness or leg pain when walking should be checked, because nerve and circulation problems can look similar.^[20]

How we evaluate and treat it

At our offices in Lyndhurst, Paramus and Millburn, NJ, we examine both feet standing and walking, check the arch, heel position, calf tightness and tendon strength, and take standing X-rays at the practice when needed. Treatment starts with stretching, strengthening and footwear.

For heel pain, inserts eased pain a little more than sham inserts at 7 to 12 weeks, though not clearly before or after that, and custom and prefabricated inserts performed similarly.^[21] For adult flat feet the evidence is limited, so we use them with exercise rather than alone.^[22] See custom orthotics and shockwave therapy.

Common questions

Why does the arch of my foot hurt when I walk?

Plantar fasciitis is a common reason, especially if the pain is near the heel and worst with your first steps. Inner arch and ankle pain points to the posterior tibial tendon, and burning points to a nerve.^[2,3,6]

Can flat feet cause arch pain?

Sometimes. A flat foot that becomes painful, or an arch that flattens in adulthood, needs a look, because an early diagnosis is one of the most important factors in treating it.^[4]

What kind of doctor should I see for arch pain?

A Foot and Ankle Surgeon or podiatrist. Dr. Ozturk is a Foot and Ankle Surgeon and podiatrist, double board certified (DABPM, FAPWH), who starts with treatment that doesn’t involve surgery.

When to seek care

Book an evaluation if arch pain lasts more than a few weeks despite rest, stretching and better shoes, or comes with a lump.