5 Reasons Your Heel Hurts in the Morning (and What to Do)

Waking up to sharp heel pain can be concerning, throwing a monkey wrench into your morning routine and affecting your overall well-being. This is a more common problem than people like to think it is. If you have been struggling with heel pain in the morning, please know that this is never normal and that there are treatment options available. To learn more about the most common causes of morning heel pain, and what you can do about this, keep reading.

5 Reasons Your Heel Hurts in the Morning (and What to Do)

1. Plantar Fasciitis

The most common cause of morning heel pain is plantar fasciitis. The plantar fascia is a thick band of tissue or ligament that connects your heel bone to the ball of your foot. One of the jobs of the plantar fascia is to create and support the arch of your foot. When this ligament becomes inflamed at the heel, it can result in intense pain when you take your first steps in the morning or after being seated for a while. This phenomenon is known as post-static dyskinesia.

The hallmark of morning heel pain that's caused by plantar fasciitis is that usually this pain will improve as you move around and spend more time on your feet. Once you sit, and then do to walk and stand, the pain is usually more severe.

 Heel Spur vs. Plantar Fasciitis

It’s common to wonder whether morning heel pain comes from a spur or plantar fasciitis. In most cases, the pain is caused by plantar fasciitis, not the spur itself.

Heel spurs often develop as a result of long-term stress from plantar fasciitis, but they usually aren’t painful on their own. A podiatrist can help determine the exact cause of your heel pain and guide you to the right treatment.

Causes of plantar fasciitis include

1.Overuse

Any sudden increase in your activity can increase your risk of developing plantar fasciitis. Starting a new exercise regimen, being a weekend warrior or someone who is super active on the weekend and not during the week all can be possible causes of plantar fasciitis and morning heel pain.

2. Sudden weight gain

Weight gain that is sudden, due to menopause, pregnancy, or other reasons can increase your risk of developing plantar fasciitis or morning heel pain. This is because the sudden increase in weight doesn't give the ligaments in your feet a chance to adapt in time, which can lead to morning heel pain.

3. Not wearing proper shoes for your foot type

Shoes that are too tight or too small can change the shape of your foot, which then changes the way that you walk, and can increase the risk of developing plantar fasciitis and heel pain in the morning.

There was a study done in 2019, that took a small group of participants, and measured blood flow to their heels with and without their big toe being squeezed into the rest of their toes. It was found that when the big toe is being pushed against the smaller toes (like in narrow, pointy-toe shoes) blood flow to the heel decreases. This increases your risk of developing plantar fasciitis even being able to heal plantar fasciitis. This is because, for everything in the body, blood flow is key for healing and regeneration.

4. Spending more time walking on unforgiving surfaces

Spending increased time standing or walking on surfaces that have little to no give, like tile or concrete can also increase your risk of developing plantar fasciitis.

2. Baxter's Neuropathy

Baxter's neuropathy is commonly misdiagnosed as plantar fasciitis. If you have been diagnosed with plantar fasciitis in the past, and have been dealing with morning heel pain which hasn't gotten better with orthotics, steroid injections, rest, icing, PT, or even PRP, you could actually be dealing with Baxter's neuropathy. Roughly 20% of chronic heel pain is caused by Baxter's neuropathy or nerve entrapment.

Baxter's neuropathy is caused by pressure on a nerve, specifically the lateral plantar nerve as it passed through the tarsal tunnel, a space on the inside on the ankle that also contains arteries, veins, and tendons.

Baxter's neruoapthy can lead to morning heel pain, and other symptoms like numbness or tingling as well.

Causes of Baxter's Neuropathy include:

1. Having a low arch or flat foot

Having a low arch or flat foot can increase the risk of pressure on Baxter's nerve.

2. Trauma or injury to the foot

Having a history of ankle sprains for example can also lead to Baxter's neuropathy, especially if these ankle sprains continue to happen due to weakened tendons.

3. Posterior Tibial Tendon Dysfunction (PTTD)

Posterior Tibial Tendon Dysfunction (PTTD) is a condition that affects the posterior tibial tendon, the other key structure to the arch of your foot. When this tendon becomes inflamed, weak or damaged, it can cause many symptoms including morning heel pain.

Morning heel pain from PTTD usually gets worse as the day does on, and does not improve with more activity.

Causes of PTTD

An example of a very flat foot

1.Overuse and Overpronation

PTTD often develops due to overuse of the posterior tibial tendon, especially in people who overpronate. Overpronation is an excessive inward rolling of the ankle when standing, walking, or running. This which can strain and weaken the posterior tibial or PT tendon over time.

2. Inflammation or inflammatory diseases

Inflammatory diseases, such as rheumatoid arthritis can affect the posterior tibial tendon and contribute to PTTD or heel pain in the morning. General inflammation, without there being a larger disease elsewhere in the body can weaken the PT tendon, and lead to pain as well as changes to the structure of your foot.

3. A Flatfoot

PTTD can lead to the development of a fallen arch or a completely flat foot. This is when the arch of the foot collapses. This can lead to morning heel pain.

4. Stress fracture

An example of an immobilization boot

A stress fracture can be painful, regardless of whichever bone is involved, heel or calcaneal stress fractures are no different. A heel stress fracture most commonly is seen from overuse or repeated impact to the heel bone or calcaneus. This is more likely in athletes or people who are very active. A stress fracture to the heel is a very likely cause of morning heel pain.

Those people with bone density issues like osteoporosis or osteopenia are at an increased risk of a heel stress fracture. Low Vitamin D levels over time can lead to bone density problems and increase your risk of developing a stress fracture.

Heel pain due to a heel stress fracture usually is constant, and not only present in the morning. This pain can even get worse at night.

5. Cancaneal periostitis

Calcaneal periostitis is a condition caused by inflammation of the periosteum - the outside layer of bone – in the heel, specifically in the area where the Achilles tendon attaches to the heel bone (calcaneus). Calcaneal periostitis is a less common cause, but still a possible reason for developing morning heel pain.

Morning heel pain caused by calcaneal periostitis usually will get better with rest and increase with activity.

Causes of Calcaneal Periostitis include:

1.Overuse or Strain

Achilles tendon overuse or strain can increase your risk of developing calcaneal periostitis and morning heel pain. Activities that involve excessive pulling or tugging of the Achilles tendon, such as running, jumping, or sudden increases in physical activity without proper conditioning, can increase the risk of developing calcaneal periostitis.

2. Not Wearing Proper Shoes

Wearing shoes that increase stress on the Achilles tendon without a proper transition can increase your risk of developing calcaneal periostitis and heel pain in the morning.

3. Tight Calf Muscles

Tight calf muscles can cause increased pull on the Achilles tendon and the heel bone. This tightness can be caused by not enough stretching, not warming up properly, or underlying foot or leg issues.

Treatment Options for Morning Heel Pain:

Heel pain that feels sharpest in the morning can often be managed, especially if you start addressing it early. Here are some treatment options that may help:

Home Remedies

• Stretching before getting out of bed: Gentle calf and plantar fascia stretches can reduce that first-step pain.

• Supportive footwear: Shoes with cushioning and arch support help reduce stress on the heel.

• Ice or massage: Applying ice or using a massage ball can calm inflammation after activity.

Professional Care

If heel pain continues beyond a few weeks, or if it’s interfering with your daily routine, it’s time to see a podiatrist. At Direct Podiatry Arizona, we offer non-surgical options like:

• Laser therapy for heel pain: Helps reduce inflammation and support tissue healing.

• Integrative podiatry care: A whole-person approach that combines foot care with overall wellness to address the root cause.

• Regenerative Medicine Injections: Injections that further stimulate the repair of damaged, inflamed tissues.

When to See a Podiatrist for Morning Heel Pain

Morning heel pain that lasts more than a couple of weeks, worsens with activity, or makes walking difficult shouldn’t be ignored. Getting a clear diagnosis early often means faster, simpler treatment — and prevents chronic issues down the road.

Don’t Let Heel Pain Start Your Day

Morning heel pain can cause major issues in your daily life, and keep you from doing simple activities from day to take and taking part in things that you love. The causes of morning heel pain are many as you can see, but finding a doctor that understands these causes, and provides you with the right diagnosis and treatment option for each cause is paramount.

By being proactive about your morning heel pain, you can get back to the quality of life that you so deserve, pain-free.

Schedule Your Free Consultation At Direct Podiatry Arizona Today

Ready to start your mornings without heel pain? My name is Dr. Tarr, and I am the owner of Direct Podiatry Arizona in Tempe. To view my available appointment times for a free 15-minute consultation, click the link here.