Treatment of Arch Pain with Walking
For arch pain with walking, begin with conservative treatment including regular calf and plantar fascia stretching exercises (3-5 times daily), over-the-counter arch supports or heel cushions, NSAIDs for pain relief, activity modification, and proper footwear with adequate arch support—continuing this regimen for 6 weeks before considering referral. 1, 2
Initial Conservative Management (0-6 Weeks)
The most likely diagnosis is plantar fasciitis, which commonly presents as arch and medial plantar heel pain with weight-bearing activities. 3, 4
Patient-directed measures:
- Perform regular calf-muscle and plantar fascia stretching exercises 3-5 times daily 1, 5
- Apply ice through a wet towel for 10-minute periods to reduce inflammation 5
- Use over-the-counter heel cushions and arch supports 1, 2
- Avoid flat shoes and barefoot walking 1
- Modify activities that worsen pain, though complete rest is unnecessary 6
- Consider weight loss if indicated to reduce pressure on the foot 1, 5
Medical interventions:
- NSAIDs (such as naproxen) for pain relief and inflammation reduction 1, 2, 7
- Padding and strapping of the foot may provide additional support 1
- Proper footwear with adequate arch support and cushioning 5
If No Improvement After 6 Weeks
Refer to a podiatric foot and ankle surgeon and continue initial treatments while adding: 1, 2
- Customized orthotic devices (though evidence shows moderate benefit only in the medium term of 7-12 weeks, with no clear advantage over prefabricated orthotics) 8
- Night splinting 1
- Limited corticosteroid injections (use judiciously) 1, 2
- Consider casting or fixed-ankle walker-type device 1
If No Improvement After 2-3 Months
Continue conservative measures and consider: 1
- Cast immobilization if not previously used 1
- Surgical options (plantar fasciotomy) 1
- Extracorporeal shock wave therapy 1, 9
- Explore alternative diagnoses 1
Critical Caveats
Avoid corticosteroid injections near the Achilles tendon due to risk of tendon rupture. 2, 5, 7 When using corticosteroids for plantar conditions, inject carefully to avoid the Achilles insertion site. 2
NSAIDs carry risks of gastrointestinal ulcers and bleeding, particularly with longer use, in older patients, or when combined with corticosteroids. 7 Use at the lowest effective dose for the shortest duration needed. 7
Expected Outcomes
Most patients respond to conservative treatment within 6-8 weeks. 5 However, approximately 44% of patients with plantar fasciitis continue to have pain 15 years after diagnosis, indicating this can be a chronic condition requiring ongoing management. 9