- “I limp with the first few steps in the morning”
- “The moment I stand up I am in pain”
- “After a while, the pain eases”
Does this sound like you?
Why do my feet hurt in the morning?
As Podiatrists we answer this question almost every day. Clients are looking for solutions to help explain why this pain is felt in the morning. They often wonder if they have done an injury to the area or are concerned of damage to the foot. There are a few different theories behind plantar fasciitis or heel pain with the first few steps of the day which we will go into in more detail.
The most common cause of morning pain is thought to be due to a rush of healing cells to the site of pain overnight. These white blood cells cause a buildup of fluid in the area, which increases pressure and pain when your foot hits the ground in the morning. Another popular theory is that the plantar fascia is responding like a painful tendon, and typically tendons are sore after rest yet ease with movement. Heel pain can also be from nerve pain from compression in the back or spine, down to the calf or foot. Nerve pain compression can occur in the evening with laying down, making the first steps of the day rather uncomfortable and stiff.
Would you believe that medically reviewed papers show that foot pain is commonly felt with the first 8 steps in the morning and 5 steps after lunch?!
Let’s run through the three main reasons why foot pain occurs in the morning.
The body tries to fix itself while you rest
While you rest and particularly at night while you sleep, your body does amazing things. We know that the brain clears out toxins that can lead to conditions like Alzheimer’s and dementia. Pain in your foot may be because your body is trying to fix itself, but not quite getting it right.
Did you know that at night time the immune system tries to fix up your foot pain too? Essentially white blood cells and other healing mediators (fluid) travel to the pain to attempt fixing it. Unfortunately when you stand up, there is a lot more pressure in the sore area, and pressure causes pain. By walking a short distance the pooled fluid is able to clear from the area. This is when you will notice that the pain eases off and limping settles, making it easier to walk heel to toe once again.
The calf muscle and plantar fascia runs cold in the morning
Have you ever felt a bit sore, then once you got moving you felt a lot better?
This is a typical presentation of muscle and tendon stiffness. Symptoms usually include pain or discomfort after rest in the morning, after lunch, and after sitting for a period at the end of the day. Typically this can be quite uncomfortable when working during the day, and can be worse for those with physically demanding jobs after rest in the evening. When the time comes to standing up to get off the couch, the plantar fascia can really hurt. It really is a difficult task to ‘rest’ foot pain indefinitely!
A lot of foot pain is directly related to the calf muscle and plantar fascia tightness. As the calf muscle comes down into the foot via the Achilles tendon, when this line of muscles are tight and weak it can directly cause foot pain. In the morning muscles “run cold” but with a few steps, blood flow runs into the muscle allowing the calves and fascia to move a lot easier. This takes pressure away and eases symptoms. Emerging research is showing that plantar fasciitis is responding very much like tendon pain. If you can imagine with plantar fasciitis, the fascia is acting as a tightrope which tugs onto the heel bone and can feel like sharpness, burning, aching or throbbing.
Nerve tension winds up overnight
The sciatic nerve is the largest and longest nerve in your body and can often be a cause of plantar fasciitis pain. The sciatic nerve runs from your spine at your low back, down the back of your leg through the hamstring, entering into the calf, and then into the heel and foot itself. It’s important to understand that compression or injury of this nerve at any level can cause symptoms. These symptoms can be local to that nerve area or further down along the nerve distribution. With this pathway in mind, any previous or current pains with the low back, hamstrings and calves can all increase tension on the nerves.
While you’re sleeping your feet are flexed down for quite some time with the added element of compression on muscles for hours at a time. It’s interesting as we often forget that for one third of our life we are in bed sleeping so sleeping postures are really important. This extends to having a supportive bed, mattress and pillow. Even a heavy blanket or quilt this can place extra pressure onto the foot and ankle. While your bedding may not be the full picture of what causes pain, it can be a large contributor for some people and can lead to further nerve irritation when bedding support is too soft or firm.
What can I do to help my foot pain in the morning?
To help in the morning with foot pain you need to get the blood flow moving down to the legs and encourage movement. Movement means the muscles, nerves, and tendons can warm up, and your feet will feel much more comfortable. Here are some self-treatment strategies that we find are very effective to reduce morning pain.
Big Toe & Arch Stretch
This is a fantastic stretch for plantar fasciitis which gently relaxes the muscles and tendons in the foot from the heel to the toes. It stretches both the big toe joint and the core foot muscles, taking pressure off the heel bone. Improved flexibility with both will help to relieve heel pain.
Stretch the big toe back as far as is comfortable and hold in position for thirty seconds. You will feel a nice stretch along your arch area.
Repeat this three times before getting up in the morning.
Foot and ankle mobility will improve your motion to assist with more comfortable walking. Through performing simple movements the muscles will warm up, and the nerves can freely slide and glide through the muscle groups.
Move your entire foot and ankle to spell out the whole alphabet. Focus on moving slow and controlled, and getting the foot into the most stretched out positions to exaggerate each letter you are making. This will warm up the heel before you place any weight on it in the morning.
Perform the entire alphabet.
This is an all time favourite exercise of ours at Pod Fit Podiatry. Using a firm ball underneath your foot to self massage can have many pain relieving benefits for those with plantar fasciitis and morning pain. If pain is too much with a firm ball start with a softer ball like a tennis ball, and work your way up to a golf, cricket or lacrosse ball as it becomes easier to do.
Roll the ball firmly from under the toe bones to the heel bone, with a focus on the arch and muscle part of the foot. This can be done in sitting or standing. Push and hold down on the ball for ten seconds on any sore spots. Avoid directly pushing into the base of the heel as this can actually aggravate symptoms!
Perform this exercise for two minutes under each foot.
If pain is not settling what can be done?
If you have been struggling with pain for weeks or months we would recommend having an assessment so that you can get the treatment you need.
A lot of people will be unsure who to approach, be it a Doctor, Physiotherapist or Podiatrist. Look no further here as our Podiatrists at Pod Fit Podiatry treat plantar fasciitis on the daily and have many treatment strategies to ease your pain (no matter how long it has been or severe it may seem). No doctor referral is required to see a Podiatrist and you can simply book straight in.
Our Podiatrists will assist you in getting rid of your sore arches and heels so that you can comfortably stand up in the morning or after rest once again.