They never inspired any sonnets by Shakespeare or songs by Sinatra. They're seldom pictured in a portrait and, in fact, are frequently pinched or abnormally elevated in the name of high fashion. Yet despite being the victim of abuse and neglect, they affect our every move--and our quality of life. They are what we--literally--stand on: our feet.

Arches make it possible for feet to do what they are designed to do. As Dr. John Gillick explains below, a host of problems can result-including pain in and damage to the feet, shins, knees, hips and lower back-if their proper functioning is compromised. Gillick, MD and MPH, is a specialist in occupational medicine and Associate Clinical Professor of Medicine and Anesthesia at the University of California, San Diego.

The Critical Role Arches Play

Normal foot arches are strong and springy. They hold the shape of the foot, balance the body and act as shock absorbers. The long arch raises and tilts the inside of the foot to ensure proper body balance over the center of the foot, while the sideways arch stabilizes the front of the foot and prevents the toe bones from rubbing. (The arches of the foot resemble those of the hand when it is set in a relaxed position on a table top.)

Arch structure is genetic. Although arch-related problems are more common in people with low arches, they frequently develop in people with normal or high arches depending upon how they are used.

Movement muscles of the shins, thighs, hips and back normally only fine-tune balance. If arches sag or go flat, they must hold the body in balance over the feet as well as perform their regular work. As a result, they become strained and prone to injury. (Try holding a book out at arm's length-after only 10 minutes of balancing work, the muscles hurt.)

Common types of arch-related problems include:

Foot Pain

Under the heel: "It's like an ice pick jamming up into my heel bone when I get up in the morning." The foot bones are held in their arched shape by a webbed strapping. When the strapping tears under the heel, pain and inflammation result (plantar fasciitis). Healing occurs at night. Re-tearing comes with getting up or with extra hard usage. Repeated tearing and healing create heel spurs. Treatments include taping, anti-inflammatory medicines, exercises, steroid injections, heel cups and even surgery; but the surest remedy is full-time use of arch supports.

Under the base of the toes: "It feels like there is a rock in my shoe." When the foot loses its sideways arch, the skin under the middle toes rubs against the shoe, causing calluses. In addition, the middle toe bones may rub and bruise each other and the nerves between them (Morton's neuroma). Tight shoes worsen this condition. The arch can be restored with a flexible sideways arch support put into the shoe.

Ankle sprains

When arches are low or flat, the ankle ligaments are stretched and become vulnerable to tearing (sprain). Meanwhile, the overactive shin muscles cause the foot to twist inward every time it leaves the ground. When a person is tired, tripping on in-turned toes is a common cause of ankle sprains.

Shin pain

The shin muscles normally fine-tune balance and add springiness to the feet. If arches are low, sagging or tired, the shin muscles become overloaded and tire much more quickly.

The shin muscles, which provide a spring-landing cushion effect for the feet, are strained to their limits by running on hard surfaces. Low arches magnify this strain. Over-strained shin muscles may tear from the bone, resulting in shin splints.

Knee pain

The outer side of the thigh and shin muscles tighten up to supplement low or fatigued arches and provide balance. These muscles connect with the outer side of the knee-cap, which slides in a groove at the end of the thigh bone. Persistent tightening of the thigh and shin muscles causes the knee-cap to scrape against the side of the groove causing pain and injury (patello-femoral disease).

Hip pain

When hip muscles strain to balance the body over sagging arches, they cramp-causing pain in the buttock or hip and sometimes down the side of the leg. Applying knuckle pressure above the hip bone will "light up" shooting leg pains that result from hip muscle cramping.

When hip and thigh muscles are chronically strained, a band that connects from the side of the hip to below the knee is pulled tight. This ileo-tibial band may click or snap where it passes over the hip bone or knee bone.

Low back pain

The low back muscles are the body's final mechanism for balance. Low back pain occurs when these muscles strain to balance a person with low arches. Low back, hip and leg pain caused by low arches is often misinterpreted as a disc problem. When a two-minute stretch of the low back and hip muscles temporarily relieves the pain, low arches should be suspected as the cause.

Checking for Low Arches

Look at a person who is standing relaxed. From the front, picture a line coming down from the hip, past the middle of the ankle to the floor. If this line goes directly through the center width of the foot, the arch is normal. When the line falls inside toward the large toe, the arch is low. From behind, if the ankle tendon is straight as a rod, the arch is normal; when it's curved, the arch is low.

Preventing and Treating Problems with Orthotics and Footwear

A properly functioning arch is key to balancing the body over the feet without muscle strain. Low or fatigued arches may be restored by full-time use of a foot orthotic. This arched insert should be worn whenever the sufferer is standing, walking, running or biking. Part-time wear will not allow the foot to recover.

Custom orthotics made from a mold or computer image of the foot ($150 to $400) are one option. However, if they are too thick, stiff, painful or don't offer adequate support, they should be remade or modified.

An alternative is a simple, flexible plastic foot orthotic as offered by Spenco (for work or play) or SuperFeet (for men's or women's dress shoes)-both available for less than $30. Leather or foam inserts and gel pads are not adequate. Orthotics can be found to fit almost any shoe style. For some feet, a wedge (four to six degrees) under the inner side of the heel may also be needed to further shift the foot under the body.

In addition to protecting feet from the ground, proper footwear should provide firm lateral support. Shoes must be wide enough to house the feet without rubbing. Rubbing causes skin thickening (calluses) and calcium deposits (bunions). Shoes should also be sized close enough to prevent bruising or blistering of the toes or heels. Shoes, including dress shoes and heels, need to be purchased with the orthotics already positioned in them.

Although these simple remedies usually prove effective in correcting arch-related problems, up to ten percent of sufferers may benefit from more careful evaluation and complex correction. Podiatrists and orthopedic surgeons specializing in ankles and feet are best equipped to diagnose and treat these conditions.

Excerpted with permission from Small Business Success, Volume XII, produced by Pacific Bell Directory in partnership with the U.S. Small Business Administration.