by Paul Stasko, DPM
Health Columnist

Dear Doctor:
I have been experiencing pain in my arches this summer. This pain began once I started to become more active, what should I do?

Dear Reader:
Thank you very much for your question. Pain in the feet, specifically in the arches, is something that patients can experience with an increase in activity, especially in the summertime when individuals become more active. During the nice weather in the summer, people like to wear sandals and flip flops, which can also be a contributing factor to pain.

Arch pain is due to different factors. I will cover the most common cause of arch pain that I see during this time of year. The most common cause of arch pain that I see is due to tendon pain. There is a tendon that supports the arch and when overused, the tendon can become inflamed. Inflammation of this tendon causes pain when walked on. In more severe cases, this tendon can become torn or dysfunctional if overused, damaged, and untreated.

When evaluating a patient with arch pain, it is important to take into account the foot type of the individual as this can be a cause for tendonitis and recurrent injury of the tendon. A flatfoot deformity can cause lowering of the arch, and placed tension on the tendon where it inserts into the arch. Over a period of time, damage and inflammation can occur to the tendon. Left untreated, flatfoot may continue to injure the tendon, sometimes to the point of tearing, stretching, and weakening of the tendon.

Treatment options vary according to the amount of tendon inflammation, damage and foot type. For a foot type that is normal, with normal tendon inflammation, offloading, bracing, therapy and anti- inflammatory techniques can be used. Often times allowing the tendon to rest in conjunction with the aforementioned treatments is enough to allow for healing and pain resolution. If the tendon does not respond to initial treatments, then advanced imaging can be done to look at the condition of the tendon.

If a flatfoot deformity is the underlying cause, then initial treatment options are similar to a normal foot type. It is important in flatfoot to treat the flatfoot itself to avoid recurrent pain. Supporting the arch is a mainstay in doing this. I recommend orthotics that range pre-made professional grade orthotics to custom orthotics depending upon the severity of the flatfoot deformity. If the tendon does not respond in predictable fashion, advance imaging such as MRI can be used to evaluate for tendon tears, accessory bones or arthritis.

In severe cases of flatfoot deformity, surgical procedures can be done to correct the flatfoot, which helps support the tendon, and create a foot that is better to bear weight on. This is reserved for more severe cases that are unresponsive to conservative, non-surgical treatment.
In conclusion, when arch pain is encountered that affects how you walk, and affects normal activities, it is important to have it evaluated by your local podiatrist/foot and ankle surgeon. This will ensure that the tendon is being treated appropriately and that the foot is being adequately evaluated for any underlying cause of the arch pain.

Thank you very much for your question.

Paul Stasko, DPM, a foot and ankle surgeon earned his medical degree from Des Moines University College of Podiatric Medicine and Surgery and completed his residency training at Geisinger Community Medical Center in Scranton, Pennsylvania. In addition, he completed a Foot and Ankle Fellowship at the Rubin Institute for Advanced Orthopedics, International Center for Limb Lengthening at Sinai Hospital in Baltimore. Dr. Stasko sees patients at Finger Lakes Bone and Joint in Newark and Geneva and performs surgeries at Newark-Wayne Community Hospital.