You swing your legs out of bed, hit the floor with your feet and — ouch! — your heels are hurting. Already. What a way to start your day.
"Heel pain is one of the top five reasons that patients go to a podiatrist," Nelya Lobkova, DPM, a podiatrist at Step Up Footcare in New York, tells LIVESTRONG.com. The heel is a weight-bearing bone; constant repeated stress of walking barefoot at home, standing at a desk or taking up running as a new hobby are a few reasons why foot docs have been seeing an uptick in heel pain problems lately.
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As for why heel pain strikes in the morning? When you're resting in bed, the plantar fascia — the fibrous connective tissue that runs from heel to toe along the bottom of your foot — is contracted, Dr. Lobkova says. "The first step out of bed aggressively wakes up and stretches the fascia, causing pain and micro-tearing where the [tissue] inserts in the heel," she says. Then, the heel hardly has a chance to recover as you constantly move about during the day.
There are quite a few reasons behind heel pain. Here are some common possibilities for why your morning steps hurt:
1. You Have Plantar Fasciitis or Fasciosis
When the plantar fascia becomes inflamed, it's called plantar fasciitis, and it's the most common cause of pain after taking the first steps in the morning. When this fascia is damaged through repeated stress, docs call this plantar fasciosis.
Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot, from the toes to the heel, as explained by the Cleveland Clinic. It usually causes sharp, stabbing heel pain in the morning or after a long period of rest or standing.
It's possible that if you have plantar fasciitis, you may also have bony growths called heel spurs. That said, a spur is likely not the source of pain here. "Heel spurs are not the cause of plantar fasciitis pain," Dr. Lobkova says, adding that while heel spurs are common in the general population, just 5 percent of those with spurs will have pain, she says.
2. You Have Achilles Tendinitis
Your Achilles tendon runs from your calf muscles down to your heel, but overuse injuries lead to tendinitis. You might suspect the condition based on where the discomfort is located. "Pain in the back of the heel in the morning is usually caused by tightness and micro-tearing of the Achilles tendon," Dr. Lobkova says.
Achilles tendinitis is inflammation of the Achilles tendon at the bottom of your calf muscles, per the Mayo Clinic. This tendon connects the bone of the heel to the muscles of the calf. The tendon is commonly inflamed by overuse during sports or running.
Some feel mild to severe pain, as well as tenderness and swelling. The tendon may be aggravated by flat arches and trauma. If untreated or injured further, the Achilles tendon may tear or rupture completely.
While stretching can help, the pain may increase during stretching because of the inflammation of the tissues. Some discomfort during stretching is normal. However, if you have a tearing feeling in your heel when stretching, stop immediately. Never stretch to the point of pain.
3. It’s a Nerve Issue
Nerve disorders are another cause of discomfort. Dr. Lobkova points to Baxter's neuritis, a pinched nerve near the heel bone, though there may also be a pinched nerve or disc herniation in the spine. With Baxter's neuritis, however, the pain usually gets worse after activity and as the day wears on.
4. It’s an Arthritis Disorder
This pain could be one of three types of arthritis disorders: rheumatoid arthritis (an inflammatory disorder that affects the joints), ankylosing spondylitis (a form of arthritis that affects the spine) or gout (inflammatory arthritis that affects the joints, including the big toe).
"These are systemic conditions that will commonly present in both feet or in other joints as well," Dr. Lobkova says. Be on the lookout for lower back pain and symptoms that you experience through flare-ups.
If your podiatrist suspects you could have one of these conditions, they'll likely ask that you see your doctor or a rheumatologist, who may order additional tests to rule out or confirm these conditions.
How to Relieve Morning Heel Pain
To get off on the right foot in the morning, stretch. Doing so will prime your heels — and your body — to feel comfortable all day. Dr. Lobkova suggests keeping a towel or Theraband near the bed. Try her four-stretch a.m. routine:
Move 1: Heel Rise Stretch
- Stand barefoot on the affected leg on a stair. Your heel should extend over the edge of the stair. (The unaffected leg hangs free).
- Place a rolled-up towel beneath the toes of the sore foot.
- Slowly raise and lower the affected heel for a count of three. Hold for a count of two. Then lower for a count of three.
- Do 12 repetitions. Ideally, do this three times per day.
Move 2: Towel Stretch
- Sit with the affected leg stretched out in front of you.
- Loop the towel around the foot and pull back to stretch. Hold for 20 seconds. Relax for 20 seconds.
- Pull the towel to the right side. Hold 20 seconds.
- Pull the towel to the left side. Hold 20 seconds.
- Bend leg to a 90-degree angle and loop towel around the forefoot. Pull foot back for 20 seconds. Relax for 20 seconds.
Move 3: Wall Stretch
- Facing a wall, put hands against the wall at eye level.
- Stand with the affected leg back (heel on the floor) and uninjured leg forward (knee straight with toes facing forward).
- Lean into the wall. Hold for 15 to 20 seconds. Repeat 10 times.
Move 4: Soleus Stretch
- Stand facing a wall with hands at chest level.
- Slightly bend both knees and place the injured foot toward the back.
- Lean into the wall to stretch the lower calf. Hold for 15 to 20 seconds. Repeat 10 times.
Pro tip: During the day, you can also roll a frozen water bottle under your foot or try a spiky massage ball (like this one on Amazon) to soothe soreness, Dr. Lobkova says.
Heel pain is a signal that your body needs rest. Give your body time to recover and inflammation to resolve by stopping high-impact activities, including HIIT or running, until you feel better, Dr. Lobkova says.
Finally, if you're experiencing heel pain, it's best to make an appointment with a podiatrist, Dr. Lobkova says. The longer the pain sticks around, the harder it can be to treat — and so it just prolongs the pain and possible time off away from the physical activities you love.
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.