Foot pain in the morning is most commonly caused by plantar fasciitis, an irritated band of tissue along the sole.
Most common cause
Plantar fasciitis, inflammation of the band of tissue (plantar fascia) along the sole. Pain is sharpest with the first steps in the morning, affecting about 1 in 10 people at some time.
Other causes
- Achilles tendinitis.
- Heel spurs.
- Arthritis and gout.
- Tarsal tunnel syndrome.
- Stress fractures.
- Neuropathy.
Treatment
- Stretch the calf and plantar fascia.
- Supportive shoes and arch supports.
- Ice and rest.
- NSAIDs.
- Night splints.
Prevention
Avoid walking barefoot on hard surfaces and replace worn shoes.
See a doctor if
Pain lasts more than a few weeks.
Recovery
Most improve in 6 to 12 months.
The most common cause
Heel pain on the first steps in the morning is typically plantar fasciitis, irritation of the plantar fascia, the thick band of tissue running from the heel bone to the toes. It affects about 2 million Americans a year, and 1 in 10 people over a lifetime. Rest overnight shortens the fascia, and the first steps stretch it, causing sharp pain that eases after a few minutes of walking.
Other causes
- Achilles tendinitis: pain at the back of the heel and the tendon.
- Heel spur, a bony growth, which is often found on X-rays but is not always the cause of pain.
- Stress fracture of the heel bone or metatarsals.
- Tarsal tunnel syndrome, nerve compression causing burning and numbness.
- Arthritis and gout.
- Flat feet or high arches.
- Bursitis.
- Nerve damage from diabetes.
- Fat pad atrophy.
Treatment
- Rest and avoid walking barefoot on hard floors.
- Stretch the calf and plantar fascia: pull the toes back for 10 seconds, several times, before getting out of bed.
- Roll the foot over a frozen water bottle for 10 to 15 minutes.
- Wear supportive shoes with cushioned soles and arch support. Use heel cups or over the counter orthotics.
- Take ibuprofen.
- Night splints to hold the foot flexed.
- Physical therapy, and custom orthotics.
- Corticosteroid injections or shockwave therapy for stubborn cases.
- Surgery is rarely needed, in less than 5% of patients.
Prevention
Maintain a healthy weight, since extra weight raises the load on the heel. Replace running shoes every 300 to 500 miles. Increase exercise gradually, and stretch calves regularly.
See a doctor if
Pain is severe, follows an injury, lasts more than a few weeks despite home care, comes with swelling, numbness or redness, or if you have diabetes. A doctor may order an X-ray or ultrasound.
Recovery
About 90% of people improve within 3 to 6 months with nonsurgical care, and many recover in 6 to 12 months. Early treatment shortens recovery.
Plantar fascia anatomy and numbers
Plantar fasciitis is the most common cause of heel pain and affects roughly 2 million people in the US each year. The plantar fascia is a thick band of tissue running from the heel to the toes that supports the arch. During sleep it tightens, and the first steps in the morning stretch it, causing sharp heel pain that eases after a few minutes of walking. Risk factors include ages 40 to 60, obesity, flat feet or high arches, tight calf muscles, and jobs that involve standing. About 90 percent of patients improve in 6 to 12 months with conservative care such as stretching, supportive shoes, night splints, orthotics and ice. Corticosteroid injections can give short term relief but may weaken the tissue. Other causes of morning foot pain include arthritis, gout, stress fractures and tarsal tunnel syndrome. Seek care for severe swelling, numbness or pain that persists after rest.
Based on data from the American Academy of Orthopaedic Surgeons and the American Podiatric Medical Association
