If you’re suffering from pain in your heel, an important clue for diagnosis is whether your heel hurts in the morning after getting out of bed.
When my patients say they have heel pain, I first ask if they’ve injured their foot in an accident. If the answer is no, then I ask, “When does it hurt the most?”
They often answer, “In the morning, when I first get out of bed.”
Aha.
Of course, I’ll do a physical exam. I press firmly on the bottom of the foot where the arch meets the heel. If that spot is tender (i.e. the patient hisses or flinches), then the diagnosis is confirmed.
It’s plantar fasciitis.
What is plantar fasciitis?
The plantar fascia is a thick band of fibrous tissue that connects your heel to the front of your foot. It helps support the arch of your foot. Plantar fasciitis is inflammation of the plantar fascia. (Hint: “itis” means inflammation.)
Plantar fasciitis is responsible for at least one million visits to the doctor every year in the US.
The plantar fascia can become inflamed and tender for several reasons, including:
- Running, jumping, or standing more than you’re used to doing. Plantar fasciitis has afflicted many runners, including yours truly
- Wearing shoes with inadequate support
- Arch of the foot is too high or too flat
- Being overweight or obese
- Having tight calf muscles which makes it harder to flex your foot up towards your shin
I don’t usually order an X-ray unless I want to rule out arthritis or a stress fracture.
Why does plantar fasciitis hurt in the morning?
Any movement that stretches an inflamed plantar fascia can make it hurt. When you’re sleeping, your foot tends to curl up slightly, with little strain on the plantar fascia.
But when you wake up and plant your foot on the floor, the weight of your body causes a sudden stretching of the plantar fascia. Ouch.
So it’s not anything specific about the time of day, per se. If you work the night shift and sleep during the day, then your heel will hurt when you get up in the afternoon. That’s why your heel might hurt with the first step after any prolonged period of inactivity, like sitting down for a few hours.
The pain of plantar fasciitis tends to fade after walking around a while but worsens towards the end of the day.
What can I do about it?
Fortunately, most people recover from plantar fasciitis if treatment is started early enough.
When you’re first tackling the pain of plantar fasciitis, try rest, ice, and (if necessary) antiinflammatory medications.
Rest. Take a load off your feet. If you’re a runner, take a few days or weeks from pounding the pavement. Try cycling to maintain your fitness.
Ice. If the bottom of your heel is very painful, apply ice for 15 to 20 minutes. I have 2 favorite ways of doing this:
- Roll your foot over a frozen bottle of water
- Fill a paper cup with water and stick it in the freezer. Once it’s frozen, tear off the lip of the cup to expose the ice. It’s easy to hold and apply directly to your heel. Continue peeling away the cup to expose more ice.
Nonsteroidal antiinflammatory drugs (NSAIDs). These are over-the-counter pain relievers that most of us have taken for minor aches and pains, fever, and cold symptoms. Examples include ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve). Taking NSAIDs might help, but be careful about taking them too often because they can raise your blood pressure and have other side effects. I advise my patients to only use them as needed and for no longer than 2 weeks. People with very high blood pressure, kidney disease, or stomach ulcers should generally avoid NSAIDs.
Once the pain has settled down to a dull ache, it’s time to do exercises to massage, stretch, and strengthen your foot.
Roll your foot over a golf ball. You can do this massage while sitting at your desk or on the couch.
- Put a golf ball on the floor
- Roll the arch of your foot over the golf ball, rolling back and forth along the entire plantar fascia from the heel to the front of your foot
- Apply as much pressure as you can tolerate. It doesn’t have to hurt but it might be a bit uncomfortable. As you get used to this exercise, you’ll be able to tolerate more and more pressure.
- Roll for 3 to 5 minutes, several times a day
- If you don’t have a golf ball, use a tennis ball or water bottle
Stretch your calf muscle and Achilles tendon.
- Stand near a wall and put your hands on the wall for support
- Plant the affected foot back
- Lean forward, keeping your heel on the floor
- You should feel a gentle stretch in your calf muscle
- Hold for 30 to 45 seconds, several times a day
Check out more exercises for plantar fasciitis.
Some people find relief by wearing a splint at night to keep their foot in the neutral position. The idea is that the splint prevents the plantar fascia from getting too tight while you’re asleep so that the first step on the floor isn’t so traumatic. The research on this is mixed.
If you have flat feet, wearing orthotics or shoes with firm arch support might help.
Many people with plantar fasciitis find that they have to avoid going barefoot or else the pain will come back.
If you’re still having significant discomfort after trying all of the above, your doctor might offer other treatment such as:
- Steroid injection
- Cushioned walking boot
- Surgery
See additional information on plantar fasciitis.
What else causes heel pain?
Plantar fasciitis is the most common cause of pain in the bottom of the heel. Other conditions that can cause pain in the heel of or bottom of the foot include:
- Nerve entrapment
- Nerve damage from diabetes
- Nerve compression from spine issues
- Stress fracture
- Bone bruise
- Bone infection
- Bone tumor
- Tendinitis
- Arthritis
Have you suffered from heel pain in the morning? What did you do about it?
