Arch pain in the foot most often comes from the plantar fascia, the thick band under the arch, or from the posterior tibial tendon, which holds the arch up from the inside of the ankle. Less common sources include stress fractures of the midfoot bones, midfoot arthritis and a squeezed nerve at the inner ankle. A physical therapist presses along the arch, watches a single-leg heel raise and checks calf flexibility, then combines foot and calf strengthening with footwear and load changes.
Last reviewed By the Monon Therapy Collective editorial team
- Most common source
- Plantar fascia irritation
- Arch that is flattening
- Often the posterior tibial tendon
- Useful home check
- A single-leg heel raise on each side
- Bruising under the arch after a twist
- Needs an X-ray: possible Lisfranc injury
Which structures cause pain in the arch?
Two structures account for most arch pain: the plantar fascia under the foot and the posterior tibial tendon along its inner edge. OrthoInfo describes the plantar fascia as a long, thin ligament under the skin of the sole that connects the heel to the front of the foot and supports the arch, and the posterior tibial tendon as the tendon that attaches a calf muscle to the bones on the inside of the arch.
Pain from the fascia usually sits under the arch toward the heel and is worst with the first steps of the morning. Tendon pain sits along the inside of the ankle and arch and builds with standing and walking.
| Likely cause | What it tends to feel like | Where to read more |
|---|---|---|
| Plantar fasciitis | Pain under the heel and arch, sharpest with the first steps after bed or a long drive | Plantar fasciitis |
| Posterior tibial tendon dysfunction | Ache along the inner ankle and arch, swelling there, and an arch that slowly flattens | Posterior tibial tendonitis |
| Navicular or metatarsal stress fracture | Pain that grows with every run or long walk and is tender over one bone | Stress fracture |
| Tarsal tunnel syndrome | Burning or tingling in the arch and sole, sometimes worse at night or after standing | Tarsal tunnel syndrome |
| Midfoot arthritis | Ache across the middle of the foot, stiffness in the morning or after rest | Arthritis |
What does a single-leg heel raise tell me about arch pain?
It tests the posterior tibial tendon and calf. Stand on one foot with a fingertip on a wall for balance and rise onto the ball of the foot. A healthy foot rolls slightly inward and the heel tips in as you rise, and most adults can repeat it many times.
- Pain along the inner ankle or arch as you rise points toward the tendon.
- A heel that does not tip inward, or not being able to rise at all, is a sign worth showing a therapist.
- Compare the number of comfortable repetitions on each side.
- Look at both feet from behind while standing: an arch that has dropped on one side only is a clue.
Why does my arch look flatter than it used to?
A foot that has become flatter on one side over months is often a sign that the posterior tibial tendon is struggling. OrthoInfo now calls the resulting condition progressive collapsing foot deformity, formerly adult acquired flatfoot, and explains that it may start with mild symptoms but can progress if ignored.
The good news, per OrthoInfo, is that most people get relief from nonsurgical treatment: orthotics are the most common choice, alongside bracing and physical therapy to strengthen the tendon. Early assessment matters for that reason. A naturally flat foot that has always been flat and does not hurt is a different matter and usually needs no treatment.
How does a physical therapist treat arch pain?
Treatment depends on the source but usually combines load management, strength and footwear. For the plantar fascia, that means calf and foot strengthening, calf flexibility, and supportive shoes; OrthoInfo reports more than 90 percent of people with plantar fasciitis improve within 10 months of simple treatment. For the posterior tibial tendon, progressive heel raises and inward foot strengthening are central, sometimes with a brace or insert early on.
Your therapist may teach the short foot exercise for the small arch muscles and banded ankle inversion for the tendon. Whether you need an insert is a fair question; orthotics for plantar fasciitis covers it.
Who tends to get arch pain around Carmel?
Runners ramping up for the Carmel Marathon in April or the Indy Mini in May, nurses and teachers on hard floors all day, and people who have recently gained weight or started a walking habit on the Monon Trail are frequent arrivals. OrthoInfo names standing for long periods on hard surfaces, a sudden rise in activity and tight calves among the risk factors for plantar fasciitis.
To start, choose “ankle and foot” on the questionnaire. A person on the matching team proposes an independent therapist in the network whose schedule fits, and the therapist’s office checks your benefits before the first visit.
When arch pain needs a doctor first
See a physician promptly if you have:
- Bruising on the bottom of the arch after a twist, fall or a foot being stepped on
- Being unable to put weight on the foot
- A hot, red, swollen foot, especially if you have diabetes
- Numbness in the sole that is spreading, or a wound you cannot feel
- Pinpoint bone pain that worsens with every walk or run
If you think it is an emergency, call 911.
