• Minnesota

    Fallen Arches

ROCHESTER, Minn. — Ongoing pain along the inside of the foot and ankle merits a visit to the doctor, according to the March issue of Mayo Clinic Health Letter. That pain could be a symptom of fallen arches — a change in the tendon that normally provides stability for walking and support for the foot's arch.

The earlier this problem, known as posterior tibial tendon dysfunction, is identified, the more likely that noninvasive treatment will help. Untreated, the tendon will continue to degenerate.

The posterior tendon is on the inside of the lower leg starting at a muscle in the calf and attaching to bones on the inside of the foot. Injuries to this tendon are among the most common foot and ankle problems. They may occur over time with wear and tear, with overuse during high-impact sports, or during a fall.

Obesity, diabetes, high blood pressure and steroid injections can increase the risk of tibial tendon dysfunction. Fallen arches are more common in adults over 40, and affect women more often than men.

Symptoms include swelling on the inside of the ankle, pain that worsens with activity or walking on uneven ground, difficulty walking or standing for long periods and, eventually, pain on the outside of the ankle due to the heel bone shifting outward.

Diagnosis requires a physical exam and often includes X-rays or other imaging. Treatment depends on the extent of the tendon problem. The goal is to reduce pain, stabilize the foot and prevent additional changes to the foot's integrity.

Conservative treatment choices include:

  • Stopping or decreasing activities that aggravate foot pain.
  • Applying cold packs to the painful area three or four times a day for up to 20 minutes each time.
  • Taking nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others) to reduce pain and inflammation.
  • Losing weight and participating in low-impact physical activities.
  • Wearing a short leg cast or walking boot to stabilize the tendon.
  • Wearing orthotics to control the foot position.

Surgery may be considered if pain doesn't improve after six months of conservative treatment. Surgical options include replacing the damaged tendon with another tendon from the foot, realigning bones to create a more normal arch, or fusing joints to stabilize the back of the foot.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call 800-333-9037 (toll-free), extension 9771, or visit Mayo Clinic Health Letter Online.