It is also important to determine whether or not the ligament, fascia or tendon has been torn as this will determine which treatment path to take. Physical examination is usually sufficient but in complex cases the patient can be referred for ultra sound imaging. It is important to assess and diagnose which part of the foot is affected and causing the pain. The soft tissue in the arch can be torn and this can be detected via ultra sound or MRI. In extreme cases the pain can be excruciating and can cause burning and throbbing in bed at night. It will often feel worse in bare feet or thongs or flat and flimsy shoes such as ballet flats. Arch pain can be present every day and can be consistently present, in that it interferes with day to day activity. The pain in the arch can come on suddenly as in a one off day of increased walking or a sporting event, or progressively over a period of time as in walking in inappropriate shoes. Patients will often describe a tightness, pulling, strain, burning or ripping sensation through the mid arch of the foot, in front of the heel but behind the ball of the foot. Arch pain can be the result of one or a combination of conditions that develop in the sole of the foot.
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