Why Do My Heels Hurt in the Morning?

It’s a story we’ve heard over and over (and over) again.

We ask our patient to describe their pain to us. What are your symptoms like? And we get a variation on this story.

“Well, doctor, in the morning I cringe just thinking about putting my foot down on the floor after getting out of bed. It hurts so bad!”

“Any other times?” we ask.

“Well, now that you mention it, I went to see that new superhero movie last week and my heels hurt so bad when I finally got up out of my seat.”

“Where is the pain located most of the time?”

“The bottom of my foot. Right under the heel.”

Now, asking a few questions isn’t the same thing as making a full examination. And since a lot of different types of injuries can cause heel pain, we’ll take our time and be careful about our diagnosis.

But when we hear stories like this, the odds are very high that our patient has a condition called plantar fasciitis. Although several different symptoms are possible, that “early morning” stabbing heel pain is its most common and distinguishing feature.

So Why Do My Heels Hurt in the Morning?

Let’s assume your diagnosis is, in fact, plantar fasciitis. Here’s what’s going on.

In order to do this properly, we’re going to have to start from the beginning. Bear with us.

The Ballad of the Plantar Fascia

Basically, at the very bottom of each foot there is a long, tough, flexible band of connective tissue called the plantar fascia. You can think of this is being like a ligament or tendon in terms of its function or composition. In fact, all three types of tissues are primarily made from collagen and very similar to one another, with the main difference being their primary anatomical function:

• Tendons connect muscles to bones.
• Ligaments connect bones to other bones.
• Fascia surround muscles, organs, and other structures to separate them from the skin, attach them to a wide area of the body that they need to act upon, and provide support and stability.

In particular, the plantar fascia—which stretches all the way from the bases of your toes to the front of your heel—has a pretty complicated and tough job. This singular band of tissue has a huge role to play in supporting your arch, evenly spreading the weight of your steps over as much time and area as possible, and even propelling you forward.

It flexes like a bowstring, dampening and storing energy when bearing weight. This, ideally, prevents those impact forces from being too stressful or causing too much damage to any one particular muscle, bone, or part of the foot. Then, when you push off, that stored energy gets released like a spring, making your locomotion more efficient.

Pretty neat, huh? We think so.

But here’s the problem. Your plantar fascia is not invincible. And if it gets overstretched and overstressed without enough time to repair itself, it starts to break down, leading to pain and inflammation.

(More information about the most common underlying causes of this breakdown can be found later in this blog, so stay with us!)

The most common location for this pain and inflammation just so happens to be at the underside of the heel, right where the plantar fascia connects with the heel bone.

But Why Does It Hurt in the Morning Specifically?

So let’s return to the original question.

If you’ve got a painful, broken down plantar fascia, shouldn’t it just hurt all the time—whenever you’re using it? What’s with the spike in discomfort when getting up after a break?

Essentially, the answer has to do with what’s happening to the tissue when you’re not bearing weight. When you’re sleeping or taking a breather, the inflamed plantar fascia contracts and shortens slightly. Think of it like a muscle or joint that feels a little stiff until you’ve had a chance to warm up a bit.

Unfortunately, once you put weight on that foot again, the sudden force load comes as something of a shock to your plantar fascia. That initial re-stretching and re-aggravation of the damaged tissue can be quite painful. Give it a few minutes, though, and your discomfort will start to recede (though probably not totally go away).

Incidentally, this is why night splints are commonly recommended for plantar fasciitis sufferers. The splints keep the fascia in an elongated position during the night, so that its better prepared to handle that initial morning shock.

How Did I Get Here?

We touched on it briefly above, but let’s get into more specifics.

The “big picture” cause of most cases of plantar fasciitis is overuse. Simply put, your plantar fascia has to bear too much weight too often over too long a time without enough of a chance to rest and recover. Sooner or later, it’s going to break down.

But what specific activities or choices can lead to that kind of breakdown? There are lots of possibilities, but here are some of the most common risk factors:

• Tough jobs. Tons of us spend most of the day on our feet. If you work in healthcare, construction, education, logistics, or any of a couple dozen other fields, you know what we’re talking about. It’s even worse if the surfaces underfoot tend to be cement, tile, or other hard and flat materials without much give.
• Bad shoes. The right pair of shoes can really make or break it for your heel pain. A supportive pair with good cushioning and support will give your arch (and by extension plantar fascia) a little extra assist with every step you take throughout the day. Bad shoes leave the plantar fascia to fend for itself—with sometimes disastrous results.
• Active hobbies. No, we’re not saying you need to give up running or playing basketball. But it’s undeniable that certain activities—especially of the “running and jumping” variety—can seriously stress out your heels. If you like being active, wearing the right shoes and following a sensible training protocol becomes even more important.
• Foot structure. Unfortunately, for some of us genetic inheritance is on the list of culprits. If you were born with—or subsequently developed—an inefficient foot structure such as a flat foot, high arch, or gait abnormality, your basic way of walking might be putting more strain than usual on your plantar fascia.
• It’s no secret that obesity has become more prevalent in our society in the last few decades—and our home state of Oklahoma has the third worst adult obesity rate in the nation, at more than 36 percent. Since the impact force on your plantar fascia can actually be equivalent to a couple of times your own body weight, carrying a few extra points can really put a lot of excess strain on the plantar fascia.

Now, as you might imagine, the fundamental cause of your plantar fasciitis makes a major difference in terms of how best to treat and prevent it.

For one person, for example, the best remedy might include a new a pair of shoes and a squishy mat at their workstation. For another, custom orthotics are going to be a major piece of the puzzle. Athletes and workers, meanwhile, might especially be interested in some of our advanced therapies, such as shockwave, to accelerate the tissue healing process.

When you hobble into the Foot & Ankle Center of Oklahoma, we’ll be sure to get to the bottom of what’s troubling you and leading to your morning heel pain. That way, we can offer you the absolute best possible treatment plan—one that not only perfectly addresses the cause of your plantar fasciitis, but also makes sense within the context of your lifestyle.

So stop suffering from morning heel pain! The team at Foot & Ankle Center of Oklahoma provides effective treatments for people just like you literally every day. You can enjoy that relief, too.

To schedule an appointment with us in Oklahoma City—or at our new clinic in Moore!—just give us a call at (405) 418-2676. You can also request an appointment online.