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Arch pain doesn’t have to end your running story. Identify the likely pattern, make pragmatic footwear and training adjustments, and gradually train the tissues to tolerate what you’re asking of them.
Featured article from 
You don't often hear runners brag about their arches. Stride length, cadence, distance – sure. But arches are usually taken for granted until they hurt. When they do, something that once felt effortless can start to feel complicated.
“Foot arch pain” isn't one diagnosis. It's a cluster of issues that can show up in beginners working toward a first 5K training plan, marathoners building peak volume, or experienced runners in a hard training block. After years in clinic, there are three patterns I commonly see: flexor hallucis longus (FHL) tendinopathy, plantar fasciitis (more precisely, plantar fasciopathy), and sesamoiditis. Getting back to comfortable running often starts with working out which pattern you're dealing with.
It helps to think of the arch not as a simple curve but as a living suspension system made of fascia, tendons, ligaments and small bones. Its job is to store and release elastic energy with every step. When it's irritated, load can shift up the chain, gait might change, and the rhythm of running can feel off.
Flexor hallucis longus tendinopathy
The FHL is the big-toe flexor tendon (the tendon that helps your big toe push off). It runs from the big toe, under the arch and into the lower leg. When irritated, you might notice a tight or aching patch through the arch – often worse with those first morning steps – and more grumbling after hills, faster sessions or in very bendy forefoot shoes.
Rather than full rest, a well-planned loading approach usually works better. Tendons adapt to the loads they're asked to handle: too little and they decondition; too much and they flare. Many clinicians use a graded programme that starts comfortably and progresses gradually (Cook & Purdam, 2012), and trials in other tendons suggest progressive loading can outperform some traditional methods for flexor hallucis longus pain and function (Breda et al., 2021).
Footwear with a slightly stiffer forefoot or a modest rocker can limit big-toe dorsiflexion (bending the big toe up) and reduce forefoot pressure while things settle; recent lab work indicates these designs off-load the forefoot and reduce how much the big toe needs to bend during stance and toe-off (Kurnianto et al., 2024). Simple strength work ties it together: slow calf raises with the big toe lightly elevated can recruit the FHL; nudge load or tempo up over time as symptoms allow.
Plantar fasciitis (plantar fasciopathy)
The plantar fascia is a thick band from heel to toes (think of it as a built-in spring under your foot). When irritated, the classic story is sharp heel pain with the first steps out of bed, settling to a background ache that can return after long runs or long days on your feet.
Best-practice guidance points to a simple core recipe: taping, plantar-fascia-specific stretching (plus gentle calf stretching) and clear education about training load and footwear. If progress stalls, clinicians may consider orthoses (supportive shoe inserts) which can help when basics aren't enough (Morrissey et al., 2021).
The updated clinical practice guideline aligns with this: combine stretching and symptom-led loading with footwear or orthoses to modulate strain (JOSPT CPG, 2023). Prefab or custom orthoses can reduce pain in the short to medium term, though responses vary (Whittaker et al., 2018). Shoes with a rockered profile or cushioned heels can take the edge off during a flare. The practical takeaway is that this tissue carries load every step and benefits from the same sensible progression you'd use for muscles and other tendons (JOSPT CPG, 2023).
Sesamoiditis
Two tiny sesamoid bones under the big-toe joint (mini pulleys that boost push-off) can get irritated, causing outsized pain for such small structures. It often flares when the big toe bends upward or when you press directly under the joint. Runners with very flexible big toes or higher arches may notice it more.
Management is usually conservative and effective: shoes with a stiffer forefoot or gentle rocker can limit big-toe bend, and trimming hills and sprints for a period helps calm symptoms. From there, progressive strengthening of the big toe and FHL can share load across tissues. Reviews consistently highlight off-loading and footwear modification as first-line strategies, with most cases improving without surgery (Mason & Molloy, 2015).
Why this matters for performance, not just pain
Foot arch pain rarely sits on its own. It can chip away at running economy, nudge gait in unhelpful ways and interrupt the one thing most training plans rely on – consistency. Late in workouts and races, when fatigue exposes weak links, the foot complex – intrinsic foot muscles (the small stabilisers inside your foot), fascia, FHL and sesamoids – can be the difference between holding form and leaking energy. There's growing, if mixed, evidence that training those intrinsic muscles improves elements of foot function, arch support, balance and arch control (Wei et al., 2022; Jaffri et al., 2023) – think of it as building a slightly better spring to sit alongside your preferred shoe tech.
Prevention that actually works
None of this needs to be complicated. A few low-drama habits can keep you running more comfortably:
- Manage load: build volume and intensity gradually, and keep an eye on sudden spikes in hills, sprints and long runs.
- Match shoe to job: if your arch or sesamoids are touchy, consider arch support shoes most of the day, not just on the run. Rocker geometry and a stiffer forefoot can reduce forefoot pressures and limit painful big-toe bend while tissues settle (Kurnianto et al., 2024; Song et al., 2024).
- Strengthen the system: 2–3 short sessions a week targeting the calf complex, big-toe flexors and intrinsic foot muscles; start easy, then nudge load upward over time.
- For plantar heel pain specifically: start with taping and stretching for plantar fascia; consider orthoses if symptoms hang around after the basics (Morrissey et al., 2021; JOSPT CPG, 2023; Whittaker et al., 2018).
Bottom line
Arch pain doesn't have to end your running story. Identify the likely pattern, make pragmatic footwear and training adjustments, and gradually train the tissues to tolerate what you're asking of them. Running is more than lungs and legs – it's foundations. Look after the small structures that carry big loads, and they might repay you with steadier, happier kilometres.
A person holding a supportive running shoe designed to reduce arch pain and provide better foot alignment
Disclaimer
The information provided in this article is of a general nature only and is not intended to replace professional medical, health, or fitness advice. It does not take into account your individual objectives, physical condition, medical history, or needs. Before acting on any of the guidance or recommendations provided, you should consider whether it is appropriate for you in light of your personal circumstances. You should always seek the advice of a qualified healthcare professional (such as a physiotherapist, podiatrist, dietitian, or medical doctor) before starting, changing, or relying on any exercise, training, or nutrition program. Rebel Sport accepts no liability for any loss, injury, or damage suffered by any person relying on the information provided.
References
- Breda, S. J., et al. (2021). British Journal of Sports Medicine, 55(9), 501–509. https://doi.org/10.1136/bjsports-2020-103403
- Cook, J. L., & Purdam, C. R. (2012). British Journal of Sports Medicine, 46(3), 163–168. https://doi.org/10.1136/bjsports-2011-090414
- Jaffri, A. H., et al. (2023). Journal of Athletic Training, 58(11–12), 941–951. https://doi.org/10.4085/1062-6050-0162.22
- Koc, T. A., et al. (2023). Journal of Orthopaedic & Sports Physical Therapy, 53(12), CPG1–CPG39. https://doi.org/10.2519/jospt.2023.0303
- Kurnianto, R. R., et al. (2024). Clinical Biomechanics, 116, 105036. https://doi.org/10.1016/j.clinbiomech.2024.105036
- Mason, L. W., & Molloy, A. P. (2015). Clinics in Sports Medicine, 34(4), 725–739. https://doi.org/10.1016/j.csm.2015.06.010
- Morrissey, D., et al. (2021). British Journal of Sports Medicine, 55(19), 1106–1118. https://doi.org/10.1136/bjsports-2019-101970
- Song, Y., et al. (2024). Scientific Reports, 14, 13215. https://doi.org/10.1038/s41598-024-64177-3
- Wei, Z., et al. (2022). PLOS ONE, 17(4), e0266525. https://doi.org/10.1371/journal.pone.0266525
- Whittaker, G. A., et al. (2018). British Journal of Sports Medicine, 52(5), 322–328. https://doi.org/10.1136/bjsports-2016-097355
