How To Solve Heel Pain In The Morning – causes, home remedies

Heel pain in the morning can arise due to a number of conditions. In most of these conditions the reason for heel pain is local inflammation built up overnight around the heel.

Your body naturally disperses inflammation throughout the day with movement. At night we are still, our heart rate lowers, and there isn’t the opportunity clear inflammation. This results in heel pain being more prominent in the morning before movement occurs.

In light of this, it’s important to understand the different conditions that can cause inflammation. Once a diagnoses can be made, we can explore some home remedies to help reduce the inflammation and treat the cause of heel pain.

If you need to skip ahead due to time, here is what we will be covering throughout this article:

Main causes of heel pain in the morning

Two common conditions are much more likely to cause heel pain in the morning. These are Plantar fasciitis and Achilles Tendinopathy (Or Tendonitis).

These two conditions will be discussed first, before exploring alternate reasons for heel pain in the morning.

1. – Plantar Fasciitis:

The Plantar Fascia is a ligamentous band that runs on the bottom of your heel, helping to support the arch of your foot.

Sometimes this band can get irritated where it attaches into the base of the heel, causing heel pain. This condition is known as Plantar Fasciitis.

Heel pain caused by Plantar Fasciitis is extremely common with as many as one in ten people experiencing this condition.

Excessive load on the Plantar Fascia is the starting point for Plantar Fasciitis.

This excessive loading of the plantar fascia can start for a number of reasons including; walking more than usual, suddenly doing long walks on uneven ground and running or sport when you’re not used to this activity.

Symptoms of Plantar Fasciitis involve:
  • Pain on the bottom of your heel, especially for the first couple of steps in the morning

  • The pain usually decreases with further walking, but is worse at the end of the day

  • Symptoms can also be present over the plantar fascia (arch of your foot)
Why does Plantar Fasciitis cause heel pain in the morning?

The plantar fascia can cause pain in the feet when you first get out of bed, because as your stand your fascia is stretched.

Over night the plantar fascia has not been moving and so the resultant rest means unwanted chemicals haven’t been flushed from the tendon.

After the first couple of steps the pain lessens as movement helps to return the tendon to its normal state. Movement helps most conditions heal, except for fractures that need immobilisation.

What treatment is there for heel pain caused by Plantar Fasciitis?

There are many things you can do to help with Plantar Fasciitis. The most important aspect of treatment is to understand the concept of load management.

This principle is essential to learn, as the first-line treatment involves reducing the activities that might aggravate the plantar fascia.

Some of these activities might include: Walking on uneven ground, running, weekend sports, excessive hill climbs etc.

Treatment for Plantar Fasciitis can include:
  • Calf raises
    We would recommend you begin with double leg calf raises. Begin with 3 sets of 10 repetitions. If this is too hard, there are easier exercises to start you off.

    If you are interested in help with treatment, please join our contact list for information on our upcoming plantar fasciitis online course.
  • Self-massage
    This can often work very well with a frozen water bottle under your feet.

    Try not to role the bottle right over the heel as this will aggravate the condition further. Just role on the arch of your foot and you may notice some pain relief.
  • Taping
    There are a number of taping techniques for Plantar Fasciitis. Most involve supporting the arch of the foot to take some load off the plantar fascia.

    Look at the below taping technique for Achilles Tendonitis as this can also be helpful with Plantar Fasciitis.
  • Orthotics
    If taping is beneficial then is might be worth trialling orthotics for your pain. Make sure you have the best shoes for Plantar Fasciitis before trialling orthotics.

    Most research suggests that orthotics just need to be comfortable, so we would recommend off-the-shelf orthotics over custom made ones. There is comparable evidence for off-the-shelf orthotics compared to custom orthotics.

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2. – Achilles Tendinopathy

Anatomical picture of mid-substance achilles tendinopathy

The Achilles tendon is the largest tendon in your body attaching the calf muscle to your heel bone. Achilles Tendinopathy occurs when there is extra stress placed on the Achilles tendon.

People will often experience symptoms in the back of heel after doing activities they are not used to doing. Any activities such as sport, running or long hikes have the capacity to place extra stress on the Achilles Tendon.

Some common examples of aggravation involve:

  • Going for a long hike when you don’t usually hike

  • Playing sport after a long time off

  • Increasing running distance too quickly
Symptoms of Achilles Tendinopathy involve:
  • Pain at the bottom of the back of your heel, or the middle of the Achilles Tendon

  • Can be accompanied with calf tightness or cramping

  • Usually aggravated by a period of walking or running

  • Sometimes a lump in the Achilles Tendon can develop which may or may not be painful
Why does Achilles Tendinopathy cause heel pain in the morning?

The Achilles Tendon will cause pain during the first few steps as the tendon is stretched at the base of the heel. The chemicals built up over night have not had the chance to disperse due to lack of movement.

As you step, your morning heel pain will begin to resolve due to the unwanted chemicals and swelling being flushed from the tendon.

What treatment is there for heel pain caused by Achilles Tendinopathy?

All tendons will respond well to graduated loading. This is the same for Achilles Tendinopathy – the main aim of treatment is to stop aggravating the tendon, and then slowly introduce graduated load.

Initially when the Achilles is flared up it is always advisable to follow the principle of rest, ice, compression and elevation.

Still try to walk and don’t completely rest the tendon unless absolutely needed. This is because movement helps to disperse swelling and keeps the tendon fibres aligned correctly.

Unfortunately graduated loading is usually performed poorly. People tend to perform exercises and stretches that will flare-up the Achilles Tendon.

Treatment for Achilles Tendinopathy can include:
  • Calf Raises
    If the tendon is flared-up you can do a modified calf-raise from a seated position. This is explained in detail in our Ultimate Achilles Tendon guide.
  • Taping
    There are taping techniques that work well to stop the amount of ankle bend which blocks the tendon from being stretched.
  • Heel lifts
    These can provide instant relief to heel pain in the morning. You can find more detail in our heel lifts article.
  • Achilles Academy
    This is our 12-week Achilles course that takes you through all the exercises and advice needed to get you back to doing what you love. Click here to find out more.

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Other Causes for heel pain in the morning

Although Achilles Tendinopathy and Plantar Fasciitis are the more likely reasons for heel pain in the morning – there are other conditions to watch out for.

3. – Rheumatoid arthritis

Rheumatoid arthritis is an inflammatory auto-immune disease that can affect all joints, including the heel. This disease mainly affects the lining of the joints, and if it isn’t treated it can destroy the cartilage and underlying bone.

Rheumatoid arthritis is diagnosed by a rheumatologist who will perform blood tests and correlate these results with clinical symptoms. The disease is characterized by multiple joint pains that will not settle within the first 30 minutes of getting up.

Why does Rheumatoid Arthritis cause heel pain in the morning?

Like all inflammatory joint diseases, the inflammation will increase over night where movement is at a minimum. Heel pain can be increased in the morning from Rheumatoid arthritis due to a build-up of inflammation around the affected joint.

Treatment of Rheumatoid symptoms has come a long way for this disease although no complete cure exists. For the best outcome rapid detection of the disease is needed. There are many excellent medications that can treat the symptoms of Rheumatoid with great results.

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4. – Stress Fractures

Stress fractures are very small cracks in the bone as a result of constant stress. Bone will usually adapt to load by repairing any damaged tissue. Stress fractures occur when your bone is unable to repair fast enough.

Activities that could cause stress fractures in the heel are jogging or prolonged hiking or marching. Stress fractures will arise when these activities are increased too rapidly, without giving the body enough time to adapt. Stress fractures can occur in several bones, the heel bone is one of the more common locations.

Why do Stress Fractures cause heel pain in the morning?

Stress fractures usually result in constant pain, even when the heel is rested, that would be worse with activity. Stress fractures can cause heel pain in the morning due to the constant nature of the pain.

Diagnoses of stress fractures can be achieved with CT or MRI (X-rays will often miss stress fractures as they are small). Your doctor may choose to run other tests to confirm this diagnosis.

Treatment of Stress Fractures

Treatment of stress fractures involve resting from the aggravating activity and could even involve a period of non-weight bearing to give the bone time to heal. After this initial rest period, there will be a gradual increase in loading of the heel.

It is important to introduce loading slowly and systematically. Listen to your body and watch for pain after an activity. If you are a jogger, try cycling, and then walking before returning to jogging. Progress jogging slowly, some studies promote no more than 10% per week.

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5. – Gout

One cause of heel pain in the morning can be due to a build-up of uric acid in the joint. This is more commonly known as gout.

This condition can be very painful and result in pain, limping, redness and swelling.

Diagnosing gout is achieved with a combination of blood testing and imaging like X-rays and CT scans. These can all be arranged through your local doctor.

Risk factors for gout include male sex, increasing age and obesity.

There is no cure for gout, however there are ways to help improve symptoms such as heel pain. Medications are useful both in the immediate flare-up of the condition and to help prevent any further complications.

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6. – Low back referred pain

Low back pain can also result in localised heel pain. There are nerves that run from your spinal canal down the leg. Pinching or compression of these nerves can result in heel pain.

This heel pain will usually be accompanied by low back pain; however, it can occur reasonably isolated with minimal pain in the back.

Usually there would be a history of low back pain or symptoms in that area.

How does Low Back Pain cause heel pain in the morning?

Heel pain may be more pronounced in the morning due to local inflammation around the nerve in the low back, causing pain to refer down into the heel.

Treatment for this is often through physiotherapy and pain medication. This condition will usually resolve, however surgery may be required in specific cases.

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Home remedies for heel pain in the morning

It is always advisable to seek medical opinion for pain that isn’t going away after a couple of days, or that is extremely painful.

First line home remedies will always involve rest, ice, compression, and elevation for any acute pain. Ice can be 20 minutes on and off for the first day or two.

After the acute phase it is helpful to have a diagnoses so further home remedies can be applied. Bexter soda crystals can help with persistent swelling. We described how to use them on our knee bursitis page.

New shoes can also help in the management of heel pain in the morning – particularly if the cause is from Achilles Tendinopathy or Plantar Fasciitis.

For more information on home remedies for these conditions please refer to the above sections.

Take Home Message

Heel pain in the morning can arise from many different causes. The mechanism is usually related to swelling/inflammation in the area, where the body hasn’t been able to clear it overnight.

Treatment for heel pain in the morning is either through rest and exercise, and could involve medications for certain conditions.

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References

Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. (2018) JAMA, 320(13):1360–1372. doi:10.1001/jama.2018.13103

Sefati, N., Norouzian, M., Abbaszadeh, H. A., Abdollahifar, M. A., Amini, A., Bagheri, M., Aryan, A., & Fadaei Fathabady, F. (2018). Effects of Bone Marrow Mesenchymal Stem Cells-Conditioned Medium on Tibial Partial Osteotomy Model of Fracture Healing in Hypothyroidism Rats. Iranian biomedical journal22(2), 90–98. https://doi.org/10.22034/ibj.22.2.90

Sharma.J, Heagerty.R (2017) Stress Fracture: A Review of the Pathophysiology, Epidemiology and Management Options. Journal of Fractures and Sprains, 1(1), 1006

Trojian T, Tucker AK, (2019) Plantar Fasciitis. Am Fam Physician. Jun 15;99(12):744-750. PMID: 31194492.

Wendi-Jo Wendt, Allison Cator, Andrew Hashikawa (2019) Please Heel Me, I Can’t Walk! Clinical Pediatric Emergency Medicine, Volume 20, Issue 4

Whittaker GA, Munteanu SE, Menz HB, Tan JM, Rabusin CL, Landorf KB. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. Br J Sports Med. 2018;52(5):322–328.

 

Frequently Asked Questions:

Why does my heel hurt when I wake?

The most common reason for heel pain upon waking is inflammation that has built up overnight. The causes for this inflammation can differ and are talked about in detail in this article.

How do I get rid of the pain in my heel?

This will depend on what is causing the pain. The two main causes of heel pain are both dealt with by managing the load through your heel, and graduated exercises. Other causes may need medication and other treatments.

What helps Plantar Fasciitis in the morning?

Plantar Fasciitis pain should decrease when you stop aggravating activities. If it is acute, then you may need to do more, such as rest, ice, elevation and other techniques including exercise, taping, orthotics and more.