Introduction

Plantar fasciitis is considered a widespread cause of pain in the heel. It develops when the plantar fascia, a strong, fibrous tissue band that runs down the sole, is inflamed.¹ The purpose of the plantar fascia is to support your foot and alleviate all of the stress you regularly place on it. On the other hand, your plantar fascia is put under a lot greater strain when you have high arches.²

An arch is the space between the ball and the heel of your foot. A high arch, also known as pes cavus, refers to an abnormally high foot arch that causes discomfort and structural instability.³ This excess stress caused by high arch leads to the plantar fascia becoming more inflammatory and causing greater discomfort.²

This article will examine the association between high arches and plantar fasciitis as well as the causes, symptoms, diagnosis, available treatments, and lifestyle changes.

Understanding plantar fasciitis

Plantar fascia is a long, thin ligament that runs just beneath the skin on the bottom of the foot. It connects the heel bone to the toe base and plays a crucial part in maintaining proper foot mechanics when walking, as well as aiding in supporting the arch. The plantar fascia is made to withstand the extreme pressures and strains that running, walking, and different activities like playing sports put on our feet. However, excessive pressure can occasionally rip or injure the tissues. This leads to inflammation as a body's normal reaction to injury and causes heel pain and stiffness.⁴

Causes of plantar fasciitis

Plantar fasciitis may be more likely to occur in people:^4,5

• Having peculiar anatomy of feet (high arch feet or flat feet)
• Between the ages of 40 and 60 
• Have recently started working out on hard ground 
• Wearing poorly supportive or cushioned shoes 
• Working out in shoes with inadequate cushioning or support
• Performing more walking, jogging, or standing up than usual and high-impact repeated exercise
• Placing weight on the foot while standing
• Extremely overweight
• Having tight calf muscles

Symptoms of plantar fasciitis

Pain around your heel and arch, as well as on the sole, is the primary symptom of plantar fasciitis. Plantar fasciitis is more probable to be the cause if:⁵

• Walking after sleeping or resting makes the ache considerably greater
• Exercise helps the discomfort, but upon resting, it reappears
• Getting your toes off the ground is hard

Diagnosis of plantar fasciitis

Diagnosis involves:^4,6

• An examination to look for high arches or flat feet
• Palpating and pushing on the heel and other parts of the bottom of the foot to check for any issues and determine the source of pain 
• Lack of signs associated with other medical conditions, including plantar nerve entrapment, calcaneal stress fracture, or insertional Achilles tendonitis
• Examining for restricted ankle dorsiflexion, or "up" movement
• Imaging techniques like X-rays can be used to obtain images of bones and to rule out stress fractures, heel spurs, and arthritis
• MRI or ultrasound can be used to obtain pictures of soft tissues and can help identify if the pain is coming from an inflamed fascia or an irritated or inflamed nerve

Prevention and management techniques

Greater than 90% of cases of plantar fasciitis can be treated with non-surgical approaches. Ensuring rest and reducing or even discontinuing the activities that worsen the pain is the first step towards lowering it. Other strategies include:⁴

• Cutting down on the amount of time spent standing up
• Performing exercises that strengthen the muscles in the feet and calf
• Adapting exercise routine to lessen the strain on feet
• Applying ice to the affected tissue, massaging the region, or combining the two methods two to three times a day for five to ten minutes at a time. A simple kind of massage is rolling the ball of the foot on a plastic surface that has gentle spikes on it
• Reducing overweight
• Nonsteroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen or naproxen, can be taken to reduce inflammation and discomfort
• Wearing a walking boot for three weeks to immobilise the damaged foot and relieve pressure when walking
• Using silicon heel cup inserts in shoes, cushioning and elevating heels to relieve strain on the plantar fascia
• Using a night splint for six to eight weeks to extend the plantar fascia as you sleep
• Acupuncture could be performed to relieve pain
• Working with a physical therapist to stretch the plantar fascia, Achilles tendon, and calf muscles

Other approaches include:⁴ 

• To reduce inflammation and pain in plantar fascia, corticosteroid injections, platelet-rich plasma injections, and botulinum toxin injections could be taken
• Shock wave therapy could be performed by applying high-energy shockwave impulses to injured plantar fascia tissue to promote healing
• Ultrasonic tissue repair is another approach where a probe is guided towards the impaired plantar fascia using ultrasound imaging. The injured tissue is subsequently broken up and removed by the vibrating tip of the probe

However, for patients with no improvement with non-surgical treatment, surgical treatment like gastrocnemius recession and partial plantar fascia release could be considered.⁴

Understanding high arches

Medical terminology refers to a high arch foot as a "subtle cavus foot." Individuals with high-arched feet typically have very little flexibility in the major midfoot joints and an extremely rigid midfoot. It is frequently directed downward and extremely inflexible (plantar flexed). The medial column of the foot tips the heel inward (varus) by functioning "like a kickstand." It puts a lot of strain on the base of one's great toe and can lead to a variety of issues, like plantar fasciitis.⁷

Causes of high arches 

People are born with high arches so genetics is a crucial factor. Other causes include spina bifida, muscular dystrophy, cerebral palsy, polio, tumours of the spine, injury to the spinal cord, stroke, and Charcot-Marie-tooth disease.⁸

Symptoms of high arches 

Symptoms of high arches include calluses or corns on the side, ball, or heel of the foot, heel that tilts inward, difficulty obtaining properly fitted shoes, foot pain, especially while standing, walking, or engaging in physical activities, and bending toes while standing.⁸

Diagnosis of high arches 

A quick test to conduct at home to find out whether you have high-arched feet is standing with feet that are wet on a paper, letting the moisture sink in, then stepping off and looking at the impression. Only the heel and ball of the foot are visible in the impressions left by high arches, with a space in the centre.²

For diagnosis using physical examination, a healthcare professional could conduct:²

• Radiography
• Magnetic resonance imaging (MRI) 
• Nerve conduction study
• Electromyography

Complications associated with high arches

Planar fasciitis is the main complication associated with high arches.

Prevention and management techniques

It may not be possible to avoid high arch feet since they are either inherited or result from an underlying medical issue. With appropriate monitoring and treatment, however, high arch discomfort can be effectively controlled.

For those with high arches, there are many therapy choices. Flexibility of the foot is one of the elements that determines the ideal treatment strategy. High arch treatment includes:^2,5

• Night splints: this is particularly useful for plantar fasciitis due to high arches. It helps to extend the calf and arches while sleeping
• Icing: applying ice to your feet will help lessen pain and inflammation when there is occasional pain from high arches. At intervals of 2-3 hours, spend around 20 minutes applying ice to the arches of feet
• Orthotics: having inserts to shoes to offer them additional cushioning and to assist in repositioning the foot for better support. Although orthotics can be bought without a prescription, getting a customised pair will yield the best benefits
• Bracing: to relieve the symptoms of a high arch, bracing your foot and ankle could be beneficial
• Pain relievers: NSAIDs, which are available over-the-counter, can help reduce pain and swelling
• Surgery: surgery may be advised if non-surgical therapies fail to relieve high arch foot pain. It may involve removing bone in specific locations or modifying soft tissue, like tendons. In extreme circumstances, joint fusion might be required

Relationship between plantar fasciitis and high arches

Less surface area on the feet of those with high arches makes them less able to appropriately distribute weight and absorb stress. High arches can worsen plantar fasciitis by putting extra strain on the heel bone and the bottom of the foot. Consequently, the plantar fascia experiences increased strain, making it more prone to inflammation or tearing.⁹

Moreover, plantar fascia is more stressed in those with high arches since they may also have more tense Achilles tendons and calf muscles. Inflammation and discomfort may also result from this stiffness, which makes it more difficult to stretch the plantar fascia and the muscles that surround it.⁹

There are also several other complications associated with high arches. This includes:⁸

• Metatarsalgia (inflammation in the ball of the foot)
• Hammertoes (the 2nd, 3rd, and 4th toes bending at the middle joint, creating the impression of a hammer)
• Claw toes (toes that curl down and press on the soles of shoes)
• Ankle instability, leading to ankle sprains 
• Metatarsal fractures (recurrent stress fractures in their foot bones)

FAQs

What shoes should I avoid with high arches?

Shoes with hard or thin soles are not recommended for those with high arches since they do not offer enough support. Additionally, it's advisable to avoid wearing shoes with heels higher than one inch since they put more pressure on the ball of the foot and worsen arched foot issues.¹⁰

What happens if plantar fasciitis is not treated?

If plantar fasciitis is left untreated, it may result in plantar ruptures, tears in the plantar fascia, heel spur formation, and maybe other conditions such as plantar fibromatosis. These complications can worsen the pain and discomfort and may make daily activities difficult, which may require more aggressive interventions for management. Hence, early treatment is crucial to prevent such complications and promote healing.¹¹

Diagnosis involves physical examination and imaging tests. Treatment options include conservative measures such as taking rest, avoiding extensive physical activities, stretching, pain medication, and orthotic devices, as well as more advanced treatments including shockwave therapy and, in extreme circumstances, surgery. Overall, an understanding of the relationship between plantar fasciitis and high arches can offer much more effective treatment as well as prevent complications.

Summary

Plantar fasciitis and high arches are interlinked conditions that can cause foot pain and discomfort. Plantar fasciitis is a painful condition that arises from inflammation of the band of fibrous tissue under the foot known as plantar fascia. High arches increase the tension on the plantar fascia, which exacerbates pain and inflammation. Common symptoms include heel pain, difficulty in walking, and discomfort during physical activities.