I Have Extreme Heel Pain in the Mornings: Can You Help?

That first step out of bed shouldn’t feel like stepping on broken glass. But for many people, it does and, strangely, the pain eases after a few minutes of walking around. If that pattern sounds familiar, you may have plantar fasciitis, the most common cause of heel pain in adults.

At Cascade Foot & Ankle Center in Provo and Nephi, Utah, board-certified podiatric surgeon and wound care specialist Jared Clegg, DPM, FACFAS, and our team diagnose and treat heel pain at every stage, from early discomfort to chronic cases that haven’t responded to home treatment.

Why your heel hurts most in the morning

The plantar fascia is a band of tissue that runs the full length of your foot’s underside, anchoring at the heel and fanning out toward the base of your toes. Its job is to absorb the force of each step and keep your arch from collapsing under your body weight.

When that tissue gets overloaded from too much activity, prolonged standing, or poor foot mechanics, small tears and inflammation develop. 

While you sleep, your foot rests in a relaxed, downward position, and the plantar fascia contracts. When you stand and put weight on it again, that tight tissue has to stretch and bear your full load all at once. 

That’s why the pain is worst with those first few steps and tends to ease as the tissue warms up and loosens.

Who gets plantar fasciitis?

Plantar fasciitis affects about 2 million people in the United States each year. It can develop in almost anyone, but certain factors make it more likely, such as:

• Long hours on your feet
• Flat feet or high arches
• Unsupportive footwear
• A recent spike in activity level
• Excess weight
• Older age, as the tissue loses elasticity over time

If any of these apply to you, your heel pain is unlikely to resolve without addressing the underlying cause.

Other causes of morning heel pain

Plantar fasciitis is by far the most common culprit, but it isn’t the only cause of morning heel pain. Dr. Clegg evaluates your symptoms carefully because the treatment approach depends on the underlying cause of pain. 

Other common causes of heel pain include:

Heel spurs

Heel spurs are bony growths that develop on the underside of the heel bone, often as a result of long-term plantar fasciitis. The spur itself doesn’t always cause pain, but the surrounding inflammation does. 

Achilles tendinitis

The Achilles tendon attaches your calf muscles to the back of your heel. Inflammation here typically causes pain and stiffness at the back of the heel rather than the bottom. However, some patients experience a generalized heel ache, making it hard to pinpoint the source.

Tarsal tunnel syndrome

Less common but worth ruling out, tarsal tunnel syndrome occurs when the posterior tibial nerve, which runs along the inside of your ankle, becomes compressed. It can cause burning, tingling, or sharp pain in the heel and arch, sometimes mimicking plantar fasciitis closely enough to be misdiagnosed.

How Dr. Clegg treats heel pain

The right treatment depends on how long you’ve had symptoms, how severe they are, and what’s causing them. Dr. Clegg typically starts with conservative options and only moves to more involved treatments if those aren’t providing enough relief.

Early-stage heel pain often responds well to:

• Custom-made orthotics 
• Medication
• Night splints
• Physical therapy
• Athletic taping
• Shockwave therapy
• Ultrasound
• Steroid injections
• REMY laser treatment

Surgery is a last resort for severe pain that doesn’t ease with other treatments, and Dr. Clegg only recommends it after exploring all conservative options.

When morning heel pain is more than a bad start to your day

If your morning heel pain has lasted more than a few weeks, is getting worse, or is starting to affect how you move through your day, it’s time to have it evaluated. Call Cascade Foot & Ankle Center or schedule an appointment online with Dr. Clegg today.