If you’ve ever struggled with persistent arch pain, you know how frustrating it can be. Every step becomes a reminder that something isn’t right, and the nagging discomfort can sideline even the most active individuals. The tricky part? Pinpointing the exact cause. While plantar fasciitis tends to steal the spotlight as the most common culprit of foot pain, posterior tibialis tendinopathy is another condition that often flies under the radar—despite being a major player in arch discomfort.
But these aren’t the only possibilities. Conditions like tarsal tunnel syndrome, stress fractures, and even nerve entrapments can mimic similar symptoms. So how do you figure out what’s really going on? Let’s break it down.
How Colorado’s Active Lifestyle Impacts Foot Pain
Living in Colorado means embracing an active lifestyle, but with that comes a unique set of challenges for foot health. Whether you’re running the scenic trails of the Rockies, skiing down powder-packed slopes, or crushing a long hike, the demands placed on your feet can lead to various overuse injuries, including arch pain. Different sports exert distinct stressors on the foot, which can contribute to the development of conditions like plantar fasciitis, posterior tibialis tendinopathy, stress fractures, and nerve entrapments.
Trail Running & Hiking: The rugged, uneven terrain of Colorado’s mountain trails forces the foot to adapt to constant elevation changes, increasing strain on the plantar fascia and posterior tibial tendon. This can lead to posterior tibialis tendinopathy, plantar fasciitis, or even stress fractures if repetitive impact isn’t properly managed.
Skiing & Snowboarding: The rigid confines of ski and snowboard boots can place excessive pressure on the posterior tibial tendon and the tarsal tunnel, potentially leading to posterior tibialis dysfunction or tarsal tunnel syndrome.
Rock Climbing: Tight, compressive climbing shoes and the foot’s extreme positioning can lead to nerve entrapments, flexor hallucis longus tendinopathy, and midfoot pain.
Cycling: While low-impact, cycling can still lead to arch pain if cleat positioning isn’t optimal. Excessive forefoot pressure can aggravate the posterior tibial tendon, contributing to medial arch pain and overuse injuries.
Being mindful of how your sport affects your feet—and taking proactive steps like strengthening exercises, proper footwear choices, and recovery strategies—can make all the difference in preventing and managing arch pain.
Plantar Fasciitis: The Usual Suspect
Plantar fasciitis is probably the most well-known cause of arch pain, often manifesting as a sharp, stabbing pain under the foot—especially with the first few steps in the morning. This condition occurs due to inflammation or microtears in the plantar fascia, the thick band of tissue that runs along the bottom of the foot.
How to Recognize Plantar Fasciitis:
Pain Location: Primarily at the bottom of the heel but can extend through the arch.
Pain Pattern: Worst in the morning or after prolonged periods of rest; improves with movement.
Trigger Points: Pressing on the medial side of the heel often elicits sharp pain.
Risk Factors: Tight calf muscles, prolonged standing, improper footwear, and high-impact activities.
Key Test: The Windlass Test – If dorsiflexing the big toe while standing worsens the pain, plantar fasciitis is likely the culprit.
Posterior Tibialis Tendinopathy: The Overlooked Cause of Arch Pain
While plantar fasciitis is more common, posterior tibialis tendinopathy is often missed or misdiagnosed. This condition affects the posterior tibialis tendon, which runs along the inside of the ankle and supports the arch. When this tendon becomes overworked or degenerates, the arch can weaken, leading to pain and instability.
How to Recognize Posterior Tibialis Tendinopathy:
Pain Location: Along the inside of the ankle and arch, sometimes extending up the shin.
Pain Pattern: Worse with prolonged activity, especially walking or running.
Trigger Points: Tenderness along the tendon, particularly behind the medial malleolus (inside ankle bone).
Risk Factors: Overpronation, flat feet, improper footwear, and repetitive stress (e.g., running, hiking).
Key Test: The Single-Leg Heel Raise – If standing on one foot and rising onto the toes is painful or difficult, posterior tibialis dysfunction is a strong possibility.
Tarsal Tunnel Syndrome: The Nerve Imposter
If your arch pain is accompanied by tingling, burning, or numbness, you might be dealing with tarsal tunnel syndrome instead of a tendon or fascia issue. This condition occurs when the posterior tibial nerve is compressed inside the tarsal tunnel, located along the inside of the ankle.
How to Recognize Tarsal Tunnel Syndrome:
Pain Location: Along the inside of the ankle, arch, and sometimes the toes.
Pain Pattern: Worse at night or after prolonged standing.
Trigger Points: Tapping on the tarsal tunnel (Tinel’s Sign) may reproduce symptoms.
Risk Factors: Flat feet, swelling, previous ankle injuries, or systemic conditions like diabetes.
Key Test: Tinel’s Sign – If tapping on the nerve behind the medial malleolus reproduces tingling or pain, nerve compression is a likely cause.
How to Approach Arch Pain: A Smarter Strategy
Since arch pain can arise from multiple sources, a step-by-step diagnostic approach is crucial:
Identify the Pain Location – Heel vs. arch vs. ankle vs. toes.
Assess Timing & Triggers – First steps in the morning? After a run? With prolonged standing?
Perform Simple Tests – Windlass Test, Heel Raise, Tinel’s Sign, Hop Test.
Consider Risk Factors – Foot structure, activity level, shoe choice, and systemic conditions.
Conduct a Functional Assessment – Evaluate movement patterns and biomechanical stressors.
If the pain persists despite conservative care (rest, ice, stretching, strengthening), it’s worth seeing a medical professional for imaging or a more detailed assessment.
Physical Therapy Assessment for Arch Pain
A thorough physical therapy functional assessment is critical for accurately diagnosing and treating arch pain. This assessment goes beyond isolated foot tests and evaluates how the entire lower kinetic chain contributes to dysfunction.
Key Components of a Functional Assessment:
Gait Analysis: Observing walking and running mechanics to detect excessive pronation, supination, or compensatory movements.
Single-Leg Balance & Strength Tests: Evaluating the stability and endurance of the posterior tibialis and surrounding muscles.
Mobility & Flexibility Testing: Assessing dorsiflexion range, calf flexibility, and intrinsic foot muscle function.
Palpation: Hands-on assessment to identify areas of tenderness, swelling, or tissue abnormalities.
Range of Motion Testing: Measuring joint mobility in the ankle, midfoot, and toes to detect stiffness or excessive laxity.
Resisted Muscle Testing: Evaluating strength and endurance of key foot and ankle muscles, particularly the posterior tibialis and intrinsic foot stabilizers.
Functional Movement Patterns: Squatting, lunging, and single-leg hopping to assess load distribution and pain triggers.
By combining these assessments with special tests (e.g., Windlass Test, Tinel’s Sign, Heel Raise), physical therapists can create a targeted treatment plan.
Final Thoughts: Listen to Your Feet
Arch pain isn’t something to ignore. Whether it’s plantar fasciitis, posterior tibialis tendinopathy, tarsal tunnel syndrome, stress fractures, or flexor hallucis longus tendinopathy, getting the right diagnosis is key to effective treatment. Pay attention to where and when your pain occurs, try some self-assessment tests, and if things don’t improve, seek expert advice.
Your feet do a lot for you—give them the care they deserve! Need help navigating your foot pain? Schedule a call with one of our Doctors of Physical Therapy for expert guidance and tailored solutions.