Pain in the arch of the foot: common causes and what helps
The arch of the foot carries a lot of load with every step. Pain there is common in runners, people who stand all day, and people who have recently increased their walking. Where in the arch it hurts, and when, helps identify the cause.
What causes pain in the arch of the foot?
The common causes are plantar fasciitis (usually near the heel end of the arch), tibialis posterior tendon problems (inner arch and ankle), midfoot joint irritation or arthritis, strain of the small foot muscles, and less often a stress fracture or a nerve problem.
Pain in the arch near the heel
Pain under the heel and into the arch, worst with the first steps in the morning or after sitting, is typical of plantar fasciitis. In a randomised trial of 48 people, all given shoe inserts, those doing high-load strength training (slow single-leg heel raises with a towel under the toes, every second day) had better foot function at three months than those doing plantar fascia stretching, with no difference between groups at 1, 6 and 12 months (Rathleff et al., Scandinavian Journal of Medicine & Science in Sports, 2015).
See our post on plantar fasciitis.
Pain along the inner arch and ankle
Pain along the inside of the ankle and arch, sometimes with the arch flattening over time, points to the tibialis posterior tendon. A randomised trial found orthoses and stretching helped, and adding progressive resistance exercise improved pain and function further (Kulig et al., Physical Therapy, 2009).
See our post on inner ankle pain and a flattening arch.
Pain in the middle of the arch or top of the midfoot
Aching across the middle of the foot, worse with standing and walking, can come from the midfoot joints, particularly in people over 50 or after an old injury.
See our posts on foot arthritis and pain on top of the foot.
Pain in the arch after running
Arch pain after running usually follows a jump in distance, a switch to flatter or more minimal shoes, or more hill work. Focal pain on the bone that's worsening run by run should be checked for a stress fracture.
Pain in the arch at night or at rest
Burning, tingling or numbness in the arch or sole, especially at night, suggests a nerve rather than a tendon or fascia problem, such as tarsal tunnel syndrome or a nerve irritated in the back. Constant pain at rest is worth assessing.
See our post on pins and needles in the feet.
Pain in the arch after rolling the ankle
After an ankle sprain, the midfoot ligaments can also be injured. Significant swelling, bruising on the sole, or difficulty bearing weight needs an X-ray.
What helps arch pain?
Supportive shoes with good cushioning and arch support, avoiding long periods barefoot on hard floors, reducing the activity that triggered it, and gradually strengthening the calf and foot. Off-the-shelf arch supports help many people; a podiatrist can assess for custom orthoses.
What exercises help?
Calf raises (progressing to single-leg and slow), towel scrunches, short-foot exercises that lift the arch without curling the toes, and calf stretches. Strengthening matters more than stretching for most arch problems.
Does weight make a difference?
Higher body weight increases the load on the arch with every step, and is a risk factor for plantar fasciitis and tibialis posterior problems.
How long does arch pain take to settle?
Mild strains often settle in a few weeks. Plantar fasciitis and tendon problems commonly take three to six months, improving steadily with consistent loading and footwear changes.
Does flat foot or a high arch matter?
Both flat and high-arched feet are normal variations, and many people with either never have problems. Foot shape matters more when it changes, such as an arch flattening over months, or when combined with a sudden increase in load.
Does walking barefoot help or hurt?
For a painful arch, barefoot walking on hard floors usually aggravates it in the short term. Once symptoms settle, gradually spending more time barefoot on softer surfaces can help build foot strength. Make the change slowly over weeks.
How can an osteopath help?
We pinpoint the source, check the ankle, knee, hip and lower back, treat hands-on, and build a strengthening plan. We'll refer you to a podiatrist for orthoses, or for imaging if a stress fracture is possible.
When should arch pain be checked?
Book in if arch pain lasts more than two to three weeks, or your arch is visibly changing shape. See a doctor promptly for inability to bear weight after an injury, a hot, red, swollen foot, or a foot wound if you have diabetes.
See our foot pain guide. Book an assessment at our Berwick clinic. A 60-minute initial consultation is $149, with no referral needed and HICAPS on-site.
Sources
Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.
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