Treatment of Arch Pain with Walking

Initial Conservative Management (0-6 Weeks)

The American Academy of Family Physicians recommends beginning with conservative treatment including regular calf and plantar fascia stretching exercises (3-5 times daily), over-the-counter arch supports or heel cushions, NSAIDs for pain relief, activity modification, and proper footwear with adequate arch support—continuing this regimen for 6 weeks before considering referral 1, 2
Patient-directed measures include performing regular calf-muscle and plantar fascia stretching exercises 3-5 times daily, applying ice through a wet towel for 10-minute periods to reduce inflammation, using over-the-counter heel cushions and arch supports, avoiding flat shoes and barefoot walking, modifying activities that worsen pain, and considering weight loss if indicated to reduce pressure on the foot 1, 2, 3, 4
Medical interventions include NSAIDs (such as naproxen) for pain relief and inflammation reduction, padding and strapping of the foot for additional support, and proper footwear with adequate arch support and cushioning 1, 2, 3

Refer to a podiatric foot and ankle surgeon and continue initial treatments while adding customized orthotic devices, night splinting, limited corticosteroid injections, and considering casting or fixed-ankle walker-type device 1, 2
Customized orthotic devices have moderate benefit only in the medium term of 7-12 weeks, with no clear advantage over prefabricated orthotics 1

Continue conservative measures and consider cast immobilization if not previously used, surgical options (plantar fasciotomy), extracorporeal shock wave therapy, and exploring alternative diagnoses 1

Avoid corticosteroid injections near the Achilles tendon due to risk of tendon rupture, and inject carefully to avoid the Achilles insertion site when using corticosteroids for plantar conditions 2, 3