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 in the heel, occurs when tissue supporting the foot's arch becomes irritated.

Key Takeaways: Heel Pain And Plantar Fasciitis

• Heel pain on first steps in the morning or after periods of inactivity is a hallmark of plantar fasciitis, caused by inflammation of the tissue connecting heel to toes.
• Gradual increases in activity, stretching of the calf and plantar tissues, and wearing supportive footwear help reduce stress on the plantar fascia and prevent pain.
• Maintaining a healthy weight, resting when needed, and avoiding abrupt increases in high-impact exercises can lower the risk of developing or prolonging plantar fasciitis.
• If symptoms persist despite home care, medical options include custom orthotics, physical therapy or injections to manage heel pain and improve function.

What Causes Plantar Fasciitis?

Plantar fasciitis is caused by inflammation and swelling of the plantar fascia, a long, thin ligament that extends from the heel to the toes on the bottom of the foot. This thick band of tissue forms part of your soft arch in your foot.

Chronic overuse or repetitive tension on the plantar fascia causes pain on the heel bone. 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.

Plantar fasciitis may be caused by:

• Calf or Achilles tightness
• Repetitive impact activities
• Excessive foot stretching
• Routinely putting too much weight on the inside edge of the foot
• Obesity or weight gain
• Pregnancy
• Tight tendons
• Shoes that are too tight or too flexible.

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. About 2 million people are treated for this heel condition each year, according to the American Academy of Orthopaedic Surgeons.

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. 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.

A person may experience heel spurs if they have long-standing plantar fasciitis, but the heel spurs themselves do not cause the pain.

Treatment options for heel spurs are like the treatments 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.

Can I Treat Plantar Fasciitis At Home?

Home treatment for plantar fasciitis includes:

• Stretching exercises to stretch out the calf, Achilles and plantar fascia
• Massage therapy
• Losing weight if needed
• Pain relievers such as ibuprofen and naproxen for heel pain and inflammation
• Avoiding walking barefoot
• Wearing a night splint or night sock if recommended by your doctor.

Icing the heel is important, and using a frozen water bottle can help a person stretch their plantar fascia while icing.

“You can try some gentle hands-on massage with your own hand or rolling a ball or a frozen water bottle to help decrease some of that sensitivity and increase the flexibility or mobility of that fascia,” said Austin Kiel, a physical therapist at Franciscan Health Indianapolis.

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.

What Are Common Stretches For Your Plantar Fasciitis?

“Stretching your calf, stretching your fascia, can be as easy as putting your foot up against a wall and leaning forward till you feel that stretching sensation,” Kiel said. “I like to recommend holding it between 15 to 30 seconds. If you can get to that higher range of duration, the literature and the data suggest that you're going to get more of an actual change in tissue length, but you can get improvements with less of a hold.”

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 can be helpful exercise alternatives with plantar fasciitis.

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 not to change the natural way you walk, trying to prevent pain, since this may cause additional foot, knee, hip or back problems to develop.

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 or a physical therapist may be in order. In Indiana, you can schedule your first physical therapy visit without a doctor's referral.

Treating plantar fasciitis without surgery

For most people, you won’t need surgery for your plantar fasciitis.

Treatment options your doctor may suggest include:

• Physical therapy
• Cortisone injections in the plantar fascia
• Wearing a custom orthotic splint that conforms to your specific foot. You place them inside your shoe to support your foot’s natural shape. They can help reduce pressure points and distribute weight evenly across the foot.
• Taping the foot or temporary immobilization using medical boots to limit movement and allow the area to rest and heal
• ASTYM therapy or surgery to separate the plantar fascia from the heel bone. 

Rest, icing, stretching, orthotics and physical therapy are some of the many treatment options.

“Typically, I always recommend to people try some of the stretching, try some of the self-treatment on your own,” Kiel said. “If you feel like you're not making any substantial progress, it's better to be seen earlier than waiting before this develops into more of a chronic condition.”

More than 90 percent of people improve within 10 months of starting treatment. Heel pain is usually treated conservatively without surgery.

Surgery for plantar fasciitis

While surgery is rare and typically considered a last resort for treating plantar fasciitis, it may be necessary for chronic and unresponsive cases. A surgeon will release part of the plantar fascia from the heel bone to relieve tension and reduce inflammation.

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 conservative treatments have failed to work for 12 months or more.

When To Seek Medical Advice

If your heel pain continues despite home treatments or it starts to affect your daily life, it’s essential to talk to your provider. “Don’t wait until the pain is excruciating,” advised Dr. Diel. “Early intervention can prevent the condition from worsening.”

Plantar fasciitis doesn’t have to limit your life. With proper guidance and care, you can manage this common foot condition. To take significant steps toward relief and recovery, recognize early symptoms, understand the causes, and explore home and medical treatments.