Arch pain

What is arch pain, and how common is it?

Arch pain is pain along the inner curve of your foot. It isn't a diagnosis on its own: heel, arch and midfoot pain overlap, so a podiatrist needs to examine your foot to name the cause.

Figures for arch pain itself aren't clear yet, but related pain is common. About 1 in 10 adults aged 50 and over has plantar heel pain (pain under the heel)¹, and foot pain of some kind affects at least one in four older people².

What can cause arch pain?

One of the commonest causes is plantar fasciitis (also called plantar fasciopathy). It usually creeps on, with heel and/or inner arch pain, and intense pain on your first steps after waking or resting³. It's linked with long periods standing, long walks or runs, higher body weight, weak calf muscles, limited ankle movement and flat feet, though these are links rather than proven causes⁴. Heel spurs are often seen with it, but aren't considered the cause of the pain⁵.

The main alternative is adult acquired flatfoot, where the posterior tibial tendon (which helps support your arch) isn't working properly. Clues are pain and swelling along the inside of the ankle, a foot that is gradually flattening, and being unable to rise onto your tiptoes⁶. It's progressive, so it's best checked early⁶.

Arthritis in the middle of the foot is a common cause of midfoot pain in people over 50⁷.

How is the cause found?

A podiatrist mostly works it out from your story and an examination, and scans are generally not needed³. They'll ask where the pain is, whether it's worst on your first steps after rest, and whether it builds with standing or walking. They'll check for tenderness near the heel, how far your ankle bends, and whether bending your big toe upwards brings on the pain³.

An ultrasound or MRI can help when the diagnosis is uncertain⁷. Heel spurs and a thicker plantar fascia are more common in people with heel pain, but they show a link, not the cause⁸.

What can I do first?

Simple self-care is the first step.

• Adjust, don't stop. Cut back or change what you're doing at first, keep your foot and ankle gently moving, and build activity up gradually⁹⁵. Easing back on long walks, hills or running can help⁵.
• Wear comfortable, supportive, cushioned shoes that fit well³.
• Try gentle calf and arch stretches⁵. Check with a professional first if you have a health problem or injury, and stop if the pain increases.
• Ice packs are another common self-care step³.
• Insoles are a low-risk option for particularly high or low arches⁵, but expect a modest or uncertain benefit: they weren't better than fake insoles for heel pain¹⁰, and a benefit for adults with flatfoot couldn't be confirmed¹¹.

For adults with plantar fasciopathy, simple advice on staying active, easing painful activities and using a heel cup (a cushioned cup inside the shoe) may be enough as initial care¹².

What helps if that isn't enough?

If your pain isn't settling, see a podiatrist or your GP. They can revisit the diagnosis and check again for other causes¹⁴. Options such as steroid injections, shockwave therapy or surgery can be discussed, but the benefits are uncertain: no commonly used treatment for heel pain has been clearly better than another¹³. In adults with plantar fasciopathy, adding exercise or a steroid injection to simple advice and a heel cup gave no clinically relevant extra benefit after 12 weeks¹².

Will it get better, and how do I stop it coming back?

Many adults improve with simple care: in adults with plantar fasciopathy, people improved meaningfully over 12 weeks¹². It isn't clear yet how often arch pain returns or what prevents it, so these are general steps:

• Build activity up gradually, and pace higher-load activities such as long walks, hills or running⁵.
• Keep getting fitter and stronger, and wear comfortable, supportive shoes⁵⁹.
• If body weight is a factor, ask a health professional about support. In adult acquired flatfoot, extra weight puts more strain on the tendon that holds up your arch⁶.

For children, a flat foot is normal up to about eight years of age¹⁵, and in children aged six and younger a flexible flat foot is nearly always part of normal development¹⁶. A podiatrist can judge whether your child's foot posture is expected for their age.