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Morning heel pain – why your feet hurt and how to treat them effectively

Do you get pain in your heels each day?

Do you get a sharp, stabbing pain in the bottom of your heels in the morning or after a period of sitting?

Well you’re not alone.

We as Podiatrists call it ‘first-step pain’ and it is a very common problem. Heel pain can affect anyone, from elite athletes to people who have never experienced heel pain before. I am going to discuss a few articles which will clearly describe why you get this type of pain and how we go about treating it.

One important thing to remember is this pain can be treated and you do not have to live with it for the rest of your life. There are a large number of treatment options you can use to help with morning pain, aching pain after long walks, and the pain you experience after prolonged periods of sitting or rest.

Why do you have pain in the morning?

Firstly, what is heel pain? Well Sulivan et. al. (2015) described it as a common foot disorder which is aggravated by weight bearing activity. It is simply foot pain brought on by walking, standing or running.

You most likely have a condition known as plantar fasciitis. The pain you experience in the morning is due to the sudden onset of tension on the fascia in the morning when getting out of bed after shortening overnight.

Typically once you have warmed up the foot and pushed through those annoying first few steps, the pain eases off. This is because the blood flow goes down into the foot, making the fascia more like a rubber band where it can move more freely, rather than like a tightrope when you first get up.

It is often common for health professionals to send for an X-Ray or Ultrasound of the foot to see if there is any soft tissue or bony damage in the foot. In around 50% of cases, there can be a heel spur found from the X-Ray. People often jump to thinking this is the cause of their pain. The spur can often press on the plantar fascia and cause it to be painful. So it is important to understand the spur is not the cause of the pain. 50% of people have a spur but don’t know it unless they have had an X-Ray.

plantar fascia illustration diagram

Is walking good for heel pain?

Walking is good for heel pain, however the amount of walking should be monitored or limited depending on the pain levels of the individual. If we stopped walking, our calf muscles would atrophy or simply become weaker and tighten. Along with this, the ankle joint can stiffen up and reduce how much motion is in the joint. So, walking is very important in the right amounts.

It is super important to maintain correct motion in the foot and not allow the Achilles tendon to stiffen. Many studies have shown that reduced ankle mobility increases the chances of getting first step heel pain and regaining this is often one of the biggest components of treatment.

Should I stay off my feet with plantar fasciitis?

Many people believe that you should rest the foot, ice it and keep off of it so it can heal. However this is not the case. We should continue to move, as movement is the best form of medicine for most common injuries.

There are some common beliefs that the heel pain is caused from a heel spur or small piece of bone sticking out from the heel bone. This however is not the case. Severe heel pain is typically caused by the plantar fascia being damaged and over used. Sullivan et. al. (2015) and Martin et al. (2014) stated that there is an increased risk of plantar heel pain in runners of all experience levels and those with poor fitting footwear. Although a heel spur can be painful, in most cases it is the actual trauma to the fascia which is painful and not the incidental finding of the spur.

What are the treatment options for morning heel pain?

One treatment option for plantar fasciitis or morning heel pain is Trigger Point Dry Needling. One study published in the Journal of Orthopaedics and Sports Physical Therapy by Martin et. al. 2014 showed that needling compared to non-penetrative sham needling, improved morning heel pain within the first 6 weeks.

The same article looked at the use of extracorporeal shockwave therapy in the treatment options for a painful plantar fascia. Shockwave therapy helps to aid in reducing the sensitivity of the damaged plantar fascia, promote healing and improve overall function through reducing pain.

Another treatment which has been heavily researched is the use of custom orthotics or shoe inserts. As the pain experienced with morning pain is due to the increased tension and stretch on the fascia, orthotics reduce or limit that stretch and provide the support needed to reduce the pain.

orthotic morning heel pain relief

Other common treatment options include:

  • Rolling a hard ball or frozen water bottle under the heel and arch of the foot
  • Calf stretching or foam rolling to increase the mobility of the ankle joint and loosen the calf muscle
  • Night splints may be used to hold the foot and plantar fascia in a stretched position over night so that it doesn’t have to ‘warm up’ when getting out of bed
  • Intrinsic or toe exercises may be used to increase the strength of the smaller muscles in the foot. This way these muscles can take more of the load and allow the fascia to heal
self massage under foot

So, where to from here with heel pain?

So if you do you wake up with a sharp pain in your foot, help is at hand. It’s important to have heel pain assessed by a health professional so you will know how to treat it at home effectively. This post will help you be better prepared when you visit your Podiatrist. Morning heel pain occurs when you weight-bear on your plantar fascia. The strain caused by the movement is transmitted through the plantar ligaments and tendons to the muscles and bones of the foot. The correct and specific treatment plan can be designed to suit your lifestyle by your podiatrist to get your feet feeling happy and healthy again!!!!

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