Arch pain is often felt as a burning sensation under the long arch of the foot.

There are a number of causes of this. The most common is plantar fasciitis, but such pain can also be due to the strain of any structure in the arch of the foot.

Causes of arch pain:
The more common specific causes of arch pain can be:

• plantar fasciitis (strain of the plantar fascia – a strong ligament that supports the arch)
• tarsal tunnel syndrome (a pinched nerve at the ankle that refers pain to the arch)
• foot strain from a pronated foot or flat foot
• There can be osteoarthritis of the joints in the midfoot that can cause arch pain.
• Overuse – running, walking, hard surfaces and/or OFAD (on feet all day), usually combined with inadequate or non-supportive footwear.

Self-management of arch pain:

The initial treatment for arch pain, especially if it is of sudden onset, is the use of ice to reduce the swelling. Later, heat and anti-inflammatory gels can be a big help.

Activity should be modified – if you stand a lot at work, see if you can use seating more; if you run a lot, consider swimming or cycling for a while.

Use footwear that is supportive in the midfoot and heel area.

Arch pain management:

An accurate diagnosis from a health professional is important early in the management of arch pain.

If the symptoms are mild, management will generally just consist of advice about fitting footwear, stretching exercises for the calf muscles and arch, and if indicated, the use of foot orthotics.

If the symptoms are more severe, tape can be used to restrict motion and support the arch; anti-inflammatory medication can be used to give some relief. Orthotics are usually indicated.

If there is no initial response to treatment, further investigations may be necessary to check for conditions such as arthritis or a pinched nerve.

Prevention of arch pain:

1. Consideration needs to be given to the cause and strategies put in place to prevent it happening again.
2. Advice should be sought on the adequacy of footwear.
3. Stretching exercises should be continued long after the symptoms are gone.
4. Foot orthoses should be used if structural imbalances are present.
5. Activity levels and types of activities (occupational and sporting) need to be considered and modified accordingly.

The concept of the arches of the foot and the need for arch support has been debated for a very long time. There are so many misconceptions about “arches” and “arch support”.

What are the arches of the foot?
There are generally considered to be two arches in the foot:

1. The longitudinal arch is the obvious one and is the one most people mean when they say foot arch.
2. The transverse arch is less obvious.

Dynamic function of the foot:

The foot is dynamic and during walking is always moving. The arch is going up and down – this is normal. So, while a “fallen arch” may not be a problem, it is there. This lack of feeling is caused by nerve damage, also called the arch functions during dynamic walking that is important.

The height of the arch – the “fallen arch”:

The height of the arch is not necessarily a problem – it is how the foot functions that can be the problem. There are a lot of people with high and low arches that never have problems.

There are a wide range of underlying causes for the arch lowering such as the foot pronating (there is not really such a thing as a “”fallen arch”” in the medical literature now).

What is arch support?

The arches are quite capable of supporting themselves if they are given help. The foot’s own arch support mechanism is often called the windlass mechanism.

Devices such as foot orthotics are used to alter foot function, so the foot can restore its own arch. The idea of foot orthotics, which may look like good old-fashioned arch supports, is to facilitate this mechanism. Foot orthotics is not an expensive name for arch supports.

What are the symptoms of the foot that may need arch support?
Those with arches that are low do not always get problems. They will often get problems if they have a foot that is pronated (rolls inwards at the ankle).

The symptoms can vary from mild aches in the forefoot to arch pain to heel spurs – but do not forget that other things can cause the same symptoms.

Exercises to help the arch:

There are a number of exercises that have been suggested as helping “fallen arches”, but the evidence is that they do not help (that does not mean they should not be done as many exercises can help some people).

Going to get a bit technical here to explain this.

• Some “experts” recommend exercises to strengthen the muscles in the arch to help “fallen arches”.
• These muscles generally run from the heel bone to the bases of the toes, so theoretically they could raise the arch.
• Research studies that have used needles in these muscles to see how they function when walking show that they do not start contracting until just about the time that the heel comes off the ground.
• Making these muscles stronger with exercises is not going to do a lot of good, if the arches have “fallen” while the heel is still on the ground (which most are)
• Also the muscles are small and during propulsion (push off), a very large amount of force goes through the foot – can having them stronger really resist those forces?

If an “expert” advises exercise, ask him/her about this and what constitutes their evidence.

It is also worth noting that strengthening exercises will help in two situations:

• The use of exercises is probably good anyway to keep the foot healthy.
• If the cause of the problem is contributed to by weak muscles (which is uncommon), then the exercises will help – that’s why the diagnosis of the cause is important.

Tight calf muscles are a common cause of a pronated foot that does cause the arch to lower (fall), so stretching these muscles plays a very important role.

Do not believe anyone when they say that arch supports or foot orthotics weaken the foot. There is no evidence either way and there are good arguments both ways. If an “expert” tells you this, ask them for the evidence.

What are the alternatives to arch support?

The use of foot orthotics is the mainstay of the treatment of what some consider to be “fallen arches”.

Foot orthotics (or “arch supports”) will only help if the symptoms are due to abnormal function (or “fallen arches”).

Not everyone with a problem needs a foot orthotic.

There are alternatives:

• • exercises may play a role when indicated (see above)
  • good supportive footwear, especially running shoes, can be used in most cases that are not severe

Bunions (hallux valgus; hallux abducto valgus):

What is a bunion (hallux valgus; hallux abducto valgus)?
A bunion is generally considered as an enlargement of the joint (a lump of bone) at the base and side of the big toe – (specifically, the first metatarsophalangeal joint).

Bunions form when the toe moves out of place. As the big toe bends towards the others, this lump becomes larger and the bunion can become painful – arthritis and stiffness can eventually develop

Hallux valgus or hallux abducto valgus (HAV) is the name used for the deviated position of the big toe. Most of the time the two go together and can just be referred to as ‘bunions’.

Bunions symptoms:

Bunions starts as the big toe begins to deviate, developing a firm bump on the inside edge of the foot, at the base of the big toe. Initially, at this stage the bunion may not be painful.

Later as the toes deviate more, the bunion can become painful – there may be redness, some swelling, or pain at or near the joint. The pain is most commonly due to two things:

1. Pressure of the footwear on the bunion
2. Arthritis-like pain from the pressure inside the joint .The motion of the joint may be restricted or painful.

A hammer toe of the second toe is common with bunions. Corns and calluses can develop on the bunion, the big toe and the second toe due to the alterations in pressure from the footwear. The pressure from the great toe on the other toes can also cause corns to develop on the outside of the little toe or between the toes. The change in pressure on the toe may predispose to an ingrown nail.

Bunion causes:

Wearing footwear that is too tight, causing the toes to be squeezed together, are the most commonly blamed factor for the cause of bunions and hallux valgus and is undoubtedly the main contributing factor.

Bunions are most widely considered to be due to an imbalance in the forces that are exerted across the joint during walking. The resulting abnormal motion and pressure over the joint, over many years (combined with poor fitting footwear) leads to instability in the joint causing hallux valgus and bunions.

Bunions are really only a symptom of faulty foot mechanics and are usually caused by a combination of the way we walk, the foot we inherit and inappropriate footwear use.

Bunions are not inherited, but do tend to run in families.

A number of other factors are known to play a role in the cause of bunions and hallux valgus:

1. Foot injuries
2. Neuromuscular problems.
3. Flat feet or pronated feet.
4. Some activities (for example, ballet dancing) put added pressure on the joint.

Bunion treatment:

There are many treatment options for bunions, and they will vary with the type and severity of each bunion and will also depend on what is causing the symptoms.

The initial goal of treatment options is to relieve pressure on the bunion and any symptoms that may be present and to halt or slow the progression of the joint deformity. There is no effective to “get rid of” a bunion without surgery.

Some conservative approaches used to manage bunions and hallux valguses include:

• Padding with a number of different materials (such as felt) to reduce pressure on the painful prominence of the bunion.
• Physical therapy can be used to help the symptoms and improve the range of motion.
• Any corns and calluses that are causing symptoms should be treated.
• Footwear advice – the correct fitting of footwear is essential.
• Foot orthotics may be useful in helping with the instability about the joint. They may play a role in slowing progression and in the prevention of bunions developing again after surgical correction.
• Exercises can be important in maintaining the mobility of the joint in those with bunions – this is especially important for the arthritic-type pains that may be originating from inside the joint and for the prevention of these painful symptoms in the future.

Self-management and exercises for bunions:

What can you do yourself for bunions?

1. Follow the advice given by a podiatrist.
2. Use felt pads to help keep pressure off the painful area of the bunions.
3. Wear shoes that are wide and deep.
4. Use exercises to keep the joint mobile.
5. Night splints may help with the bunion symptoms. The aims of these are to hold the toe in a more correct position.

Padding or foam between the big toe and the second toe is sometimes recommended; however, sometimes the padding may be needed to help with symptoms that originate inside the joint if the bunion is painful.

Exercises for bunions:

Several exercises are recommended:

1. Grasp the big toe with one hand and do some stretches on the joint in all directions. Hold the position at the end range of motion for 10-15 seconds. Repeat several times in all directions.
2. Traction helps some people with spinal problems, and can also help keep the big toe joint mobile. Grasp the toe and the foot and try and “pull” the toe “off”. Hold for 10-15 seconds. Repeat several times.
3. Find some sort of elastic band and loop it around both big toes. Spread your feet so that the toe is “”straightened”” – hold for several minutes. Repeat several times.

Exercises will NEVER be able to correct the position of the bunion but they are important to keep the toe flexible and mobile.

Night splints for a bunion:

Wearing splints at night have been shown to provide some correction in adolescents with hallux valgus or bunions (where they are young enough for the bone to still adapt).

They may not be as effective in adults, but could be useful to help keep the joint remain mobile.

Shoes for bunions:

As footwear plays an important role in the development and symptoms of bunions, proper fit is vitally important.
The use of the correct footwear is YOUR responsibility.

Surgery for Bunions:

If the bunion symptom does not respond to the conservative measures or if the bunion has progressed past a threshold where these measures are not effective, bunion surgery may be necessary to correct alignment and remove the bunion. A large range of types of surgical procedures for bunions are available.
The choice will depend on:

• What bone or bones are involved.
• The angular relationship between the different bones.
• The amount of damage to the joint and the presence of deformities other than the bunion.

What is the burning foot?

Burning feet are a common complaint and can be caused by a number of conditions – some are local and minor, and some are more serious. Burning feet can keep people awake at night and be a source of continuous pain.

It is more common in those over the age of 50 years, but a burning foot can occur in younger age groups.

Burning feet are more common in those with diabetes as part of the neuropathy (nerve damage) that can develop.

A burning foot may be mild and local and easily treatable, or it may indicate a more serious general medical problem that needs further investigation.

What causes a sensation of burning feet?

• many feet just ache and burn at the end of a long day, especially in those who are on their feet all day or are overweight (mechanical overload)
• hot and sweaty feet can cause a burning foot sensation.
• the neuropathy that occurs in diabetes can cause burning feet
• other types of neuropathy (nerve damage) that can cause a burning foot include those that occur in chronic alcoholism, vitamin deficiencies (usually B) and heavy metal poisoning
• blood disorders (such as thrombocytopenia, pernicious anemia) can cause burning feet
• Erythromelalgia is a rare circulatory disorder that can cause burning feet
• Reflex sympathetic dystrophy or complex regional pain syndrome can follow trauma (including surgery) and cause a burning foot sensation
• nerve entrapments, such as tarsal tunnel syndrome, which is the compression of a nerve at the inside of the ankle joint, can cause a burning sensation
• a localized burning sensation may be due to other specific problems. If it’s in the forefoot only, it could be metatarsalgia, Morton’s neuroma or some other cause. Athlete’s foot or a fungal infection can also cause a burning sensation in the area of the infection.
• it could also be due to a sensitivity to chemical substances in socks and shoes (contact dermatitis)

Self-treatment of the burning foot sensation:

The most important part of managing burning feet yourself is to get them checked to make sure they are not caused by one of the rare serious problems.

Once the cause is established, there are a number of things that you can do to help your burning feet, but this can depend on the cause:

• if it’s mechanical, good fitting shoes with support is a good place to start
• if hot and sweaty, there are various self-treatments for the sweaty foot
• some creams or ointments with cooling properties can help relieve the symptoms
• some relief in some people has been shown to occur with the use of magnets
• wear socks made of cotton rather than synthetic fabrics
• bathe feet in cool water
• avoid prolonged period of standing
• cushioning or shock absorbing insoles may make standing more tolerable

There is a lot of advice on the internet to take vitamin B12 to help burning feet. However, a burning foot occurring with the neuropathy that is associated with a deficiency of vitamin B12 is very uncommon and should be managed by a medical doctor. The taking of B12 for burning feet is not likely to help unless a deficiency is the cause and its is one of the more uncommon causes of the burning foot.

Treatment of the burning foot sensation:

Treatment of burning feet needs the cause to be established, so consultation with a podiatrist, rheumatologist (arthritis doctor), or a neurologist (nerve doctor) is important.

Treatment of a mechanical overload problem with foot supports or orthotics are usually very successful in helping the mechanical overload (they will not help if mechanical overload is not the cause of the burning feet).

Other local causes such as a fungal infection, nerve entrapment, and sweaty feet can be also be treated.

Treatment of underlying conditions may bring relief (but this will depend on the cause).

Pain relief medication may be needed for the treatment of any of the chronic causes of burning feet.