Heel Pain in the Morning: 5 Possible Causes

Heel pain describes any discomfort around the heel, starting from the sole to the back of the ankle. One common complaint is that people experience heel pain in the morning, especially after getting up from bed.

According to the Australian Family Physician, approximately 3.6% of the population or 900,000 Australians suffer from heel pain.[1] The foot is a complicated body region with many bones, nerves, ligaments and tendons that can be responsible for heel pain.

Heel pain can greatly impact people’s lives, such as not being able to exercise or even walk properly. Persisting heel pain often requires a consultation with a relevant health professional (e.g. physiotherapist, podiatrist, doctor) for an assessment and treatment plan.

This article will highlight several reasons why you may have heel pain in the morning and what you can do about it.

Top 5 Causes of Heel Pain in the Morning

Many people who have foot and ankle conditions report experiencing heel pain in the morning. These conditions can sometimes flare up in the morning but improve as the day goes on. For others, the pain remains consistent throughout the day or even worsens.

1. Achilles Tendinopathy

Achilles tendinopathy is a condition where the Achilles tendon begins to break down, swell and become painful. The pain is usually located at the back of the heel as opposed to underneath.

This condition is particularly common in people who have just started or are presently active. For example, 21.5% of Australian Football Rules players experience Achilles tendon injuries.[2]

During the night the tendon can become tight and contracted. As weight is placed on the foot, the tendon can suddenly stretch which leads to pain.

2. Plantar Fasciitis

Plantar fasciitis is a condition which is caused by the thickening, tearing and tightening of the plantar fascia. The plantar fascia is a piece of connective tissue which helps absorb impact from the ground and help support the arches of the feet.

This condition is one of the leading causes of heel pain. Approximately 60,000 Australians seek medical attention because of it.[1] The pain usually occurs underneath the sole of the heel which can extend up towards the rest of the feet and arches.

Like Achilles tendinopathy, as you put weight on the feet in the morning, the plantar fascia suddenly stretches after tightening during sleep. This sudden load can lead to pain and discomfort along the heel and foot.

3. Arthritis

Heel pain can also be caused by inflammatory arthritis, such as gout, psoriatic arthritis and rheumatoid arthritis. These conditions are caused by the immune system attacking the cartilage between the joints, which leads to inflammation, swelling and pain.

Arthritis is one of the most common conditions in Australia. According to the Australian Institute of Health and Welfare, more than 2.2 million Australians suffer from arthritic conditions.[3]

Arthritis New South Wales notes that heel pain in the morning could be caused by swelling in the joints as the body remains still when sleeping.[4] Additionally, those with inflammatory arthritis are more likely to develop inflammation around the heel.[5]

4. Diabetes

Diabetes is a condition caused by high blood sugar levels. Long periods of high blood sugar levels cause damage to organs, nerves, blood vessels and tissue.

The Australian Institute of Health and Welfare reports that 1.2 million Australians live with diabetes.[6] There are many medical complications that arise from diabetes, including kidney disease, heart condition and even heel pain.

There are several reasons how diabetes can lead to foot and/or heel pain, including:

• Damage to the nerves entering the foot

• Foot ulcers

• Poor blood circulation through the lower limb.

5. Calcaneal Stress Fracture

Stress fractures are cracks and breaks in the bone from repetitive impact. Stress fractures of the (heel bone) lead to heel pain over time due to constant weight bearing movements, including jumping and running.

Pressure and weight through boney injuries, such as a stress fracture can cause further instability and pain. As a result, many people may require a crutch or brace to help support the injured area. Morning heel pain can develop when standing as the weight of the body compresses the fractured heel bone.

Home Treatments for Heel Pain

Home treatments can be considered to help ease heel pain from these types of conditions. Although these strategies may not ‘fix’ the condition, they can help improve quality of life and comfort.

Ice

Ice therapy (also known as cryotherapy) is often used to help reduce pain. By causing vasoconstriction (tightening) of the blood vessels, it stops blood flow to prevent swelling and inflammation.

Ice packs, baths or even frozen vegetables, can be used on the heel to ease pain. This treatment can be applied for 15 minutes 3-4 times a day.

In some circumstances, heat therapy can also be used, especially with long-term conditions. Increased blood flow from heat can help with healing.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are medications that can either be prescribed by doctors or purchased over the counter at a chemist. They are commonly used drugs to help relieve inflammation, pain and fever. Examples of these types of medications, include:

• Ibuprofen (e.g. Nurofen)

• Diclofenac (e.g. Voltaren)

• Celecoxib (e.g. Celebrex).

Rest

Being on your feet all day can sometimes worsen heel pain conditions, such as plantar fasciitis and arthritis. Sitting or lying for a few days can help the inflammation settle down. Especially those who have recently ramped up their physical activity, a period of rest allows the heel to heal and recover.

When To Seek Physiotherapy

Physiotherapists routinely see patients with morning heel pain, especially Achilles tendinopathy, plantar fasciitis and arthritis. They will be able to perform a physical assessment, help ease the pain and create a treatment plan going forward.

Additionally, physiotherapists routinely work together with other relevant health professionals, such as podiatrists, orthotists, doctors and specialists for the best patient outcome. Referrals to imaging may also be necessary to assist with a diagnosis.

Some signs that you may need to seek physiotherapy, includes:

• Persistent pain that does not go away, even after trying the home treatments

• When the heel pain begins to affect your normal daily routine

• Worsening pain throughout the morning and day

• Swelling around the ankle and heel

• Pain that occurs after too much training or exercise.

What treatment does a physiotherapist do?

Physiotherapists incorporate a range of treatments and strategies to help manage heel pain. Medical questioning and a physical examination will first be performed to determine why you are experiencing heel pain. Referrals, such as x-rays, MRIs and ultrasounds can be done to assist with a diagnosis.

Proceeding this, treatment and strategies will be performed to ease and/or improve heel pain. Examples, include:

• Stretching: Stretching helps lengthen tight connective tissue, such as the plantar fascia. Your physiotherapist will show you these stretches and help you develop a home routine.

• Strengthening exercises: Building up the strength around the heel, foot and ankle can help improve certain conditions (e.g. Achilles tendinopathy, arthritis). Your physiotherapist will show you these exercises and help you develop a home routine.

• Taping: Temporary taping can be used to support parts of your foot and ankle to ease your heel pain.

• Insoles and/or orthotics: Some physiotherapists may also recommend pre-made or store bought insoles as added support in your footwear. Referrals to podiatrists or an orthotist can also be made for customised orthotics which can offer a more tailored fit.

• Non-medicated pain relief: Techniques, such as massage, mobilisations, dry needling and electrotherapy can be used to help ease pain. These provide an alternative option to medications without the same risk of side-effects.

• Crutches: Crutches may be recommended for the short to medium term depending on the condition. This helps ease the weight off the foot to allow for the heel pain to recover. Physiotherapists may also adjust and teach you how to use the crutches properly for maximal comfort.

• Moon boots: For conditions, such as stress fractures, a moon boot may be needed for several weeks to allow for the injured area to heal.

Key Takeaways

There are many reasons for heel pain in the morning. Conditions, such as arthritis, Achilles tendinopathy, plantar fasciitis, diabetes and stress fractures are just some of the more common causes.

Heel pain in the morning can have several causes, including inflammation, swelling and tightness of the tissue.

Although there are home treatments that can help ease heel pain in the morning, you may need to seek a physiotherapist if symptoms persist or worsen. They will be able to help diagnosis, treatment and create a long-term management plan. Physiotherapists may also refer to other health professionals for optimal outcomes, including podiatrists, doctors, orthotists and specialists.