What Causes Heel Pain in the Morning?

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Waking up with heel pain in the morning is a relatively common condition. Morning heel pain can refer to pain or stiffness in your heel area while you are awake but lying down in bed or to pain that occurs as soon as you take your first steps out of bed. Often, the pain fades away within an hour or two or diminishes to something that is a dull ache.

There can be several underlying causes of heel pain in the morning, the most common being plantar fasciitis and Achilles tendinitis. In most cases, morning heel pain resolves without treatment or is easily treatable with home remedies like ice and rest. However, if the heel pain persists and does not subside with home treatments, seeing a podiatrist can help you get a correct diagnosis and find a treatment plan that works for you.

What Causes Heel Pain in the Morning?

The heel is a weight-bearing bone, and constant repeated stress of standing, walking, running, and other activities can result in heel pain. Here are some probable causes of heel pain in the morning:

1. Plantar Fasciitis

Plantar fasciitis is a condition caused by the inflammation of the plantar fascia, a thick ligament that extends from the heel to the toes on the bottom of the foot. Plantar fasciitis can cause sharp pain in the heel or foot and tenderness in the entire lower part of the foot. Symptoms might be worse in the morning or after a long period of rest because of poor blood supply to the heel at rest. Plantar fasciitis can happen when the plantar fascia is overloaded or overstretched. Plantar fasciitis can occur to anyone, but obese people, pregnant women, people with diabetes, runners, volleyball players, tennis players, and athletes are particularly at risk of developing it.

Fortunately, plantar fasciitis is easily treatable. Often plantar fasciitis is caused by poor quality shoes or ill-fitting footwear. So, wearing proper footwear and changing running shoes every

400-500 miles can also prevent overuse pain. Sometimes the pain is relieved after a few minutes of activity after getting up from the bed.

2. Achilles Tendinitis

The Achilles tendon is a band of tissues that attaches the calf muscle to the heel bone. Achilles tendinitis occurs when the Achilles tendon becomes inflamed, causing pain and stiffness in the heel area. Overuse and injury are most often the primary causes of Achilles tendinitis.

Repetitive stress due to excessive exercise or physical activity, a sudden increase in the intensity of workouts without a proper warm-up, or wearing high heels for a prolonged period may increase the risk of Achilles Tendinitis. Generally, the symptoms are aggravated in the morning; however, the pain remains consistent throughout the day, especially if you are active. Most people recover from Achilles tendinitis with conservative treatments such as ice, rest, NSAIDs, physical therapy, and supportive shoes.

3. Stress Fracture

Stress fractures are tiny cracks in the bone caused by repetitive force, often from overuse. Stress fractures are mostly found in athletes and those who suffer from bunions, tendonitis, and low or high arches. Osteoporosis or other conditions affecting bone density can also play a role in stress fractures. Contact your physician if your pain becomes severe or if you feel pain even when resting or at night.

4. Rheumatoid Arthritis

People suffering from rheumatoid arthritis are often prone to plantar fasciitis, which can result in heel pain in the morning. If your symptoms do not go away with home remedies, consult your doctor, who may recommend wearing a night splint. The night splint will keep your foot flexed at night and helps the inflammation in your foot to heal so that you can wake up pain-free.

5. Hypothyroidism

If you experience unexplained morning heel pain, it could indicate hypothyroidism, and your doctor may recommend having blood tests done to check your thyroid. If you suffer from hypothyroidism, the chemical and hormone imbalance can contribute to swelling and inflammation in the feet, ankles, and heel. Additionally, hypothyroidism can lead to tarsal tunnel syndrome, where the tibial foot nerve is pinched or damaged.

6. Heel Spurs

A heel spur is a bony protrusion on the underside of the heel bone. Heel spurs sometimes exist from birth or develops over the years from calcium buildup. Heel spurs can also cause heel pain in the morning. Pain feels more intense first thing in the morning as the whole-body weight is  placed on the foot after a long period of inactivity; however, symptoms subside as the day continues.

90% of people get better with conservative treatments such as shoe inserts, orthotic devices, stretching exercises, physical therapy, night splints, etc. If conservative treatment fails, surgery may be necessary to relieve pain and restore mobility.

Home Remedies for Heel Pain

Heel pain that is not severe can improve with time, home care, and conservative treatments, and most people recover within months. Some therapies help ease pain and inflammation to improve foot flexibility and reduce stress and strain on the heel. The following are the treatments:

1. Rest

Rest is an important part of heel pain treatment as rest gives the muscles time to heal - especially if the heel pain is caused by injury or overuse.

2. Pain Relief

You can try over-the-counter pain medications, pain relieving ointments, gels, lotions, or therapies like heat therapy and electrotherapy for pain relief. Additionally, you can take prescription pain relievers under the guidance of a medical practitioner.

3. Ice

Apply cold packs over the area for 15-20 minutes up to 3-4 times a day to relieve pain and swelling. You can freeze a water bottle overnight, wrap it in a towel, and roll it along your heel and foot instead.

4. Massage

Roll a tennis ball along the bottom of your foot from your toes to your heel to help muscles relax and loosen. Alternatively, you can use a foam roller to roll your foot. Otherwise, you can hold your foot in hand and apply gentle pressure using your thumb along the foot and heel area.

5. Heel Support

You may use heel pain orthotics such as arch supports, heel protectors, heel pads, and shoe inserts to support the heel and help reduce the heel pain and prevent it from aggravating.

6. Stretching

Stretching exercises in the morning will help your heel and body feel comfortable all day. You can keep a towel or exercise band near the bed so that you can do stretching exercises first thing in the morning after getting out of bed. You can try the following stretches:


Standing calf raise:

  • Stand facing a wall and step back with one foot that has heel pain
  • Bend your front knee keeping the bag leg straight, with your foot on the ground
  • Lean forward towards the wall as you stretch
  • Hold ten seconds and then relax
  • Repeat with the other side

Ankle flexion with Resistance Band

  • Sit on the floor and hold one leg straight
  • Secure one end of the exercise band to a sturdy object and the other end to the top of the foot
  • Flex and extend at the ankle joint
  • Repeat on both feet

How to prevent Heel Pain?

  • Maintain a healthy weight by eating a balanced diet and regular exercise
  • Wear proper footwear with ample heel cushioning and support. Do not wear shoes with worn-down heels and soles
  • Warm up properly before intense exercises and sports activities that may place a lot of stress on the heels
  • Rest the feet whenever possible
  • Avoid barefoot on hard ground and rough surfaces
  • Perform stretches, especially after exercises

When to seek medical help?

Home remedies such as rest, ice, and non-prescription painkillers can effectively address many cases of morning heel pain. However, you may require consulting a doctor for more extensive treatment if:

  • If the morning heel pain does not improve after over two weeks, even after trying home remedies
  • Heel pain continues throughout the day, interfering with your daily chores
  • Severe pain and swelling near the heel
  • Pain, numbness, or tingling in the heel area, along with fever
  • Difficulty in walking normally

The sooner you identify the causes of your morning heel pain, the faster and more effective the treatment and pain relief will be.


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