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5 Reasons You Have Heel Pain in the Morning


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, keep scrolling to learn more.



heel pain morning


Table of Contents:



5 Reasons You Have Heel Pain in the Morning


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 with morning heel pain thats 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.



Causes of plantar fasciitis include


heel pain morning

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 doesnt give your 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 heel with and without thier big toe being sqeezed 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) that 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.



Treatment options for plantar fasciitis include:

1.Stretching or massage

heel pain morning
The ball stretch, can be used to help with plantar fasciitis

At home treatment options for plantar fasciitis like stretching and massage can key to overcoming plantar fasciitis and morning heel pain. There are many stretches avaliable for those who are dealing with plantar fascititis like the tennis ball stretch, or wall stretches that focus on stretching your calf muscles as well, which has been shown to increase flexibility i in your ankle, and therefore decrease tension on the plantar fascia.


In addition to home treatment options, a tailored rehabilitation and streghtening regimen created specifically to a person's foot type, that adresses any muscle imbalances, or other foot, ankle, or leg issues they have can be extremly helpful in the treatment of plantar fasciitis and morning heel pain.


3. Steroid injections

For those people who have been dealing with intense morning heel pain due to plantar fasciitis which has not imporved with other conservative options, a cortisone shot can help knock out this type of pain.


As always in medicine, getting to the root cause of the probelm is key for healing. A cortisone shot plus adressing the changes that lead to the development of plantar fasciitis is key.


4. Shoe changes

Wearing the right type of shoes to allow your feet to heal from plantar fasciitis is critical. From dress shoes to tennis shoes, there are several options for you avaliable to overcome your morning heel pain.



2. Baxter's Neuropathy

heel pain morning

Baxter's neuropathy is commonly misdiagnosed as plantar fascititis. 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, specificially 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.



Treatment of Baxter's Neuropathy

heel pain morning

1.Rest and ice

Resting or immobolization along with icing is important in the early stages when trying to over come Baxter's neuropathy


A tailored rehabilitation and streghtening regimen created specifically to a person's foot type, that adresses any muscle imbalances, or other foot, ankle, or leg issues they have can be extremly helpful in the treatment of Baxter's neuroapthy and morning heel pain, overtime putting less strain on the tarsal tunnel.


3. Custom orthotics

Custom shoe inserts or orthotics at times can help mamage the symptoms of Baxter's neuropathy due to altering how you stand and how your foot functions.


4. Corticosteroid injections

A steroid injection intointo the tarsal tunnel can help lower inflammation and help symptoms like morning heel pain.


5. Surgery

In extreeme casesm esepcially if the Baxter's neuropathy is caused by a mass inside of the tarsal tunnel, surgery can help relive these symptoms, and remove pressure from this nerve.



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 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

heel pain morning
An example of a very flat foot

1.Overuse and Overpronation

PTTD often develops due to overuse of the posterior tibial tendon, espeically 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 completely flat foot. This is when the arch of the foot collapses. This can lead to morning heel pain.



Treatment options for PTTD include:

heel pain morning
An example of a custom orthotic

1.Rest and Ice

Rest is crucial in the early stages of PTTD to allow inflammation to quiet down and allow the PT tendon to heal. Applying ice to the affected area can help lower inflammation and lessen pain.


In addition to home treatment options, a tailored rehabilitation and streghtening regimen created specifically to a person's foot type, that adresses any muscle imbalances, or other foot, ankle, or leg issues they have can be extremly helpful in the treatment of PTTD and morning heel pain. In the early stages of PTTD, this strengthening regimen can even help bring back your arch height, and reverse collapse of your foot.


3. Orthotics: Custom orthotic devices or shoe inserts can provide additional support to the arch and reduce strain on the posterior tibial tendon in late stage PTTD. For this reason, if you would like to avoid the use and reliance on orhthotics as much as possible, see your local podiatrist as soon as possible to begin treatment of your PT tendon.


4. Surgery

In cases of chronic PTTD which can result in tears of the PT tendon, or complete degeneration of this tendon, surgery can be required to repair the tendon before rehab canbegin safely.



4. Stress fracture

heel pain morning
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 repeate 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 denisity issues like osteoporosis or osteopenia are at an increases risk of a heel stress fracture. Low Vitamin D levels overtime can lead to bone denisty 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.



Tretament for heel stress fracture

  1. Rest and immobilization



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 possible reason for developing morning heel pain.


Morning heel pain caused by calcalenal periostitis, usually will get better with rest, and increases with activity.



Causes of Calcaneal Periostitis include:

heel pain morning

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 increaee 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 of Calcaneal Periostitis:

1.Rest, ice, elevation

Rest is crucial in the early stages of calcaneal periostitis to allow the inflamed periosteum to heal. Taking a break from activities that put too much strain on the heel and Achilles tendon is essential. Icing and elevation have also been shown to help with the pain asociated with calcaneal periostitis.


A tailored rehabilitation and streghtening regimen created specifically to a person's foot type, that adresses any muscle imbalances, or other foot, ankle, or leg issues they have can be extremly helpful in the treatment of calcaneal periostitis and morning heel pain.



Key Takeaways

heel pain morning

Morning heel pain can cause major issues in your daily life, keep you from doing simple activities from day to take, and taking part in things that your 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.


If you are someone that has been dealing with morning heel pain that is not getting better, it is so important to see a podatrist or foot doctor that can address this heal pain, and get rid of this pain, before the pain becomes chronic in nature, and therefore much harder to treat.


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

Have your been dealing with morning heel pain, and are in need of a podiatrist or foot doctor? My name is Dr. Tarr, and I am the owner of Direct Podiatry Arizona in Tempe. To view my avaliable appointment times for a free 15 minute consultation, click the link here.


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