Heel Pain In The Morning: Help Plantar Fasciitis

Do the first few steps out of bed each morning cause you to wince in pain? Plantar fasciitis might be the cause.

Plantar fasciitis is one of the most common causes of heel pain, impacting more than 2 million people each year. The condition, which causes pain of the heel, occurs when tissue supporting the foot's arch becomes irritated.

What Is The Main Cause Of Plantar Fasciitis?

“The primary cause of plantar fasciitis is calf or Achilles tightness,” said board-certified foot surgeon Frank L. Narcisi, DPM, who specializes in Podiatric Medicine at Franciscan Health Podiatry Olympia Fields. “Other risk factors include repetitive impact activities and obesity.”

This ligament in the heel of the foot can become inflamed after wearing non-supportive footwear on hard, flat surfaces for a prolonged period. Also, being overweight or having a very high arched foot or a flat foot can irritate the ligament.

Plantar fasciitis is the most common heel injury in athletes, especially runners, because jumping and repeated pushing off can hurt the plantar fascia.

Other triggers of plantar fasciitis include:

• Excessive foot stretching
• Routinely putting too much weight on the inside edge of the foot
• Weight gain
• Overuse or excess exercise
• Pregnancy
• Tight tendons
• Shoes that are too tight or too flexible.

Plantar fascitiis is caused by inflammation and swelling of the plantar fascia.

What Is The Plantar Fascia?

The plantar fascia is a long, thin ligament that extends from the heel to the toes on the bottom of the foot. The inflammation and swelling of the plantar fascia can lead to a feeling of sharp pain in the foot, toward the heel, or a feeling of tenderness throughout the underside of the foot, especially at the ball of the foot.

“The plantar fascia is a thick band of tissue that forms part of your soft arch in your foot,” Dr. Narcisi said. “Chronic overuse or repetitive tension on the plantar fascia causes pain at the its origin on the plantar calcaneus (heel bone).”

Why Does Plantar Fasciitis Hurt In The Morning?

“Plantar fasciitis most commonly occurs with the first few steps in the morning or after sitting for a long time and toward the end of the day from prolonged standing,” Dr. Narcisi said. “Morning pain is from the sudden tension of the plantar fascia as it gets stretched after shortening overnight.”

Are Plantar Fasciitis And Heel Spurs The Same?

A bone spur is a small, abnormal bone growth that can cause pain if they rub on a nerve or other tissue. A heel spur may be located on the underside of the heel bone where it attaches to the plantar fascia.

“Heel spurs are frequently seen on X-rays in those with long-standing plantar fasciitis,” Dr. Narcisi said. “Heel spurs do not cause the pain, rather they are sign of long-standing tension on the plantar fascia.”

Treatment options for heel spurs are similar to treatment as for plantar fasciitis. These include home care including rest, ice, anti-inflammatory medicine, stretching and correct footwear or shoe inserts.

More serious heel spurs may require corticosteroid shots (injections) under a physician's guidance or surgery.

Can I Prevent Plantar Fasciitis?

It's important to maintain flexibility in the foot and the ability to fully extend the big toe at the joint. Proper footwear and proper training techniques are also important.

To avoid overuse injuries such as plantar fasciitis:

• Warm up properly before exercise and cool down properly after -- and be consistent about it.
• Allow the body time to recover after an intense workout.
• Make cross training a part of a workout routine.
• Gradually ramp up on exercise frequency and intensity.
• Stay hydrated by drinking plenty of water.
• Always listen to your body.

What Are Good Exercises With Plantar Fasciitis?

While plantar fasciitis may make it harder to do your regular activities, it is important to not change the natural way you walk, as this can lead to other joint, foot or back problems.

Most people with plantar fasciitis recover without much treatment in a few months.

“Non-impact exercises such as swimming, walking, or biking are well tolerated in those with plantar fasciitis,” Dr. Narcisi said.

Can I Treat Plantar Fasciitis At Home?

Home treatment of plantar fasciitis includes stretching exercises to stretch out the calf and plantar fascia, massage therapy, losing weight as well as avoiding walking barefoot. Pain relievers such as ibuprofen and naproxen also can ease heel pain and inflammation.

Icing the heel is important, and using a frozen water bottle can help a person stretch their plantar fascia while icing. Rest, elevating the foot and wearing good supportive shoes with a stiffer sole and slightly higher heel also can help during recovery from plantar fasciitis.

“The most effective treatment for plantar fasciitis includes calf and Achilles stretching, plantar fascia stretching, and a night splint or a night sock,” Dr. Narcisi said.

Heel pain is usually treated conservatively without surgery.

When Do I Need To See A Doctor For Heel Pain?

If home treatments for heel pain and plantar fasciitis fail, a visit to your doctor may be in order. Your doctor may suggest a steroid injection, physical therapy, wearing a custom orthotic splint, or ASTYM therapy or surgery to separate the plantar fascia from the heel bone. More than 90 percent of people improve within 10 months of starting treatment. Rest, icing, stretching, orthotics and physical therapy are some of the many treatment options.

“Should conservative treatment fail and the symptoms are severe enough, surgery may be needed,” Dr. Narcisi said.

A gastrocnemius recession, which releases and effectively lengthens one of the calf muscles to decrease the calf tightness and relieve the tension of the plantar fascia, and plantar fascia release are two options for surgery if conversative treatments have failed to work for 12 months or more.

What Happens If Plantar Fasciitis Is Left Untreated?

Not treating plantar fasciitis may result in chronic heel pain that makes it harder to do your regular activities. It is important to not change the natural way you walk, trying to prevent pain, since this may cause foot, knee, hip or back problems.

HealthDay News contributed information to this article.