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Instep or arch soreness or pain can range from a nagging problem when you run to a disabling injury that will stop you from running and become a chronic pain condition. If the pain only occurs when you run, that narrows the types of likely problems. Finding out where the pain is coming from will help you choose the right treatment and keep the problem small or help you know where to look for help 1.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Arch or instep pain may be a result of a stress fracture of the navicular, one of the bones in the midfoot, or a tendinopathy or inflammation of the extensors tendons of the foot 1. However, the most common cause of pain is a strain of the ligament than runs under the arch from the ball of the foot to the heel called plantar fasciitis 1.
Telling the Difference
If you have a poorly defined ache in the arch that is worse with exercise but feels better shortly after you stop, you may have a navicular stress fracture. There is also usually a tender spot on top of the foot. This condition will need to be treated by your doctor because you may need a cast. Tendinopathy may cause pain more on the top of the instep that is worse with running or pointing your toes. If the pain is worst on your first step out of bed in the morning, then feels better until you've been running or have been on your feet for a long time, you probably have a plantar fasciitis or heel spur problem.
Plantar fasciitis is a common cause of instep pain 1. If you have changed your running routine and have increased mileage or started running hills, are obese or running in poor shoes, or have tight calf muscles, you may have strained your plantar fascia. The fascia is a tough ligament that runs from the front of your heel to the ball of your foot 1. It stretches when you run. If you stretch it too much, it can tear.
You will need to stop running until you get these conditions under control. Apply 10 to 15 minutes of ice several times a day to the area of soreness and elevate your foot to reduce swelling. If you suspect a stress fracture, call your doctor. If you suspect tendonitis or plantar fasciitis, make sure you are wearing shoes with a good arch support. Find a good running store and ask if they can do a gait analysis to see if your running form puts too much stress on your foot 1. If you try these treatments and your pain persists or worsens, call a sports-oriented chiropractor or physical therapist for further evaluation of your biomechanics.
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