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Overview
The most common arch problem is the flat foot. This sometimes starts in childhood or may gradually develop in adulthood. In most cases the flat foot is related to a tight calf. The tightness of the calf forces the foot to overpronate (the inside of the foot rolls inwards) and the arch to break down and collapse. The arch collapse leads to abnormal stress on the plantar fascia leading to heel pain, as well as to the main medial tendon (the posterior tibial tendon), leading to tendonitis and even tears of the tendon. The other common symptom in severe flat feet is pain on the outside of the foot as well as calf and Achilles symptoms.


Causes
Conditions that affect the nervous system (brain and spinal cord) can also cause the arches to fall. Over time, the muscles gradually become stiffer and weaker and lose their flexibility. Conditions where this can occur include cerebral palsy, spina bifida and muscular dystrophy. Adult-acquired flat feet often affect women over 40 years of age. It often goes undiagnosed and develops when the tendon that supports the foot arch gradually stretches over time. It's not fully understood what causes the tendon to become stretched, but some experts believe that wearing high heels and standing or walking for long periods may play a part. Obesity, high blood pressure (hypertension) and diabetes are all risk factors.

Symptoms
Arch pain may have a variety of different causes. Proper evaluation and diagnosis of arch pain is essential in planning treatment. A good general guideline is to compare the injured side to the uninjured side. Injury may present itself as a distinguishable lump, a gap felt at that location, or a "crunchy" feeling on that spot caused by inflammation. The type, causes, and severity of pain are also good indicators of the severity of the injury.

Diagnosis
The medical practitioner will examine how the muscles of your foot function. These tests may involve holding or moving your foot and ankle against resistance; you may also asked to stand, walk, or even run. Pain caused by movements may indicate the cause of the pain. The nerves in the foot will be tested to make sure no injury has occurred there. An x-ray, MRI, or bone scan of the foot and arch may be taken to determine if there are changes in the makeup of the bone.

Non Surgical Treatment
Treatment for these injuries varies depending on the severity of the injury. Most strains and sprains can be treated with rest, ice, compression and elevation (RICE). Moderate to severe cases, however, may require some form of immobilization such as a brace or a cast. Certain injuries that don't heal within the expected time frame may require surgery. It is important to seek medical attention as soon as possible for foot and ankle injuries, especially if it is causing you to limp or there is swelling. Prompt and appropriate treatment and rehabilitation ensures the best possible recovery.


Surgical Treatment
The soft tissue surgeries usually would include a lengthening of the Achilles tendon, releasing of the plantar fascia as well as tendon transfers. These procedures are usually done in conjunction with bony procedures such as calcaneal osteotomies (to lower the heel bone and get it more under the leg itself), as well as metatarsal osteotomies. These procedures usually involve either cutting or fusion of the bones, and placement of fixation devices to allow the bones to heal. Healing time is usually at least 6-8 weeks and usually the patient must be non-weight bearing during the healing process. These types of surgical corrections are usually reserved for the more difficult, painful and deformed feet. They can require more surgeries down the line. These procedures are usually the last resort after all other modes of treatment have been exhausted (except in children where it is usually best to treat the deformity early). There are many different degrees of high arched feet and these procedures should be left for the more extreme cases. These cases usually require a very high degree of surgical skill and should only be done by those who frequently perform these types of cases.


Prevention
There are several things you can do to prevent pain on the bottom of the foot. Here are some tips to help you avoid this condition. Do simple stretches each day (See Plantar Fasciitis Exercises for a list of all exercises). Wear good shoes that fit properly and are appropriate for the activity you are participating in. Lose excess weight if possible. Build your stamina slowly, especially with new exercises. Rest and elevate your feet, whenever possible, keeping them at least twelve inches above your heart. Always follow your doctor?s instructions for treatment. Each day do a different activity. For example: one day ride your bike, and swim the next day.

Stretching Exercises
Start in an L-Sit position. (If you?re hips and hamstrings are tight sit up on a box or phone book to be able to achieve a tall back position. You can even sit on a box with your back supported against a wall!) Keeping the legs straight, but not locked, reach both heels out away from your body to ?Flex? the ankles. Try to avoid pulling back with the toes to flex. Keep the toes relaxed and lead from the heel to hinge the foot into the flexed position. Hold the flexed foot and breathe. Take 3-5 breaths and see if you can reach farther through the heel to deepen the flex on each exhale. To transition to the pointed position, begin by pointing the foot to move the ankles as far as possible in the other direction. Once the ankles have reached their endpoint, use the muscles along the sole of the foot to point the toes. Inhale to continue lengthening out through the top of the foot, exhale to deepen the contraction under the sole of the foot to point the toes. Take 3-5 breaths. Then release the toes, and begin reaching out through the heel to hinge the ankle into the flexed position to repeat the exercise. Continue to flex and the point for 5-10 repetitions.