Sharp heel or arch pain when you first get out of bed in the morning is the most common complaint reported by people experiencing plantar fasciitis.
Whether you sleep on your back, side, or stomach, it is likely that your foot has been in a toes-pointed position for the vast majority of the time you were asleep. This foot position shortens the plantar fascia, a thick and strong band of tissue that runs from the ball of the foot to the front surface of the heel. When you stand up, this tissue is forcefully lengthened which aggressively pulls on the insertion points on the heel and the base of the big toe causing pain. This can also happen if we are in a sitting position for too long as well, like sitting at a desk or in our favorite chair.
An easy way to avoid shortening of the plantar fascia is to change the position you sleep or sit in. By changing positions, this will result in reducing the stress placed on the tissue when you do stand. Try to avoid positions that involve pointing of the foot for a prolonged time. If you sleep on your back or side, try placing your feet against the footrest of the bed. You may also want to consider placing your feet against the headboard to keep them in a non-pointed position. If you prefer sleeping on your stomach, try letting your feet hang off the end of the bed. When you are sitting, try putting a hardcover textbook under your foot to keep your feet from pointing.
If the suggestions listed above are not working, a more aggressive approach would be to sleep with your foot in a Strassburg sock or a night splint/brace. The sock is typically more comfortable to wear than a brace, so we recommend trying that first.
If you have been sitting for awhile or sleeping all night, the worst thing you can do is to hop out of bed immediately and start walking. We recommend performing the exercises we prescribe first. Some easy mobility exercises include ankle pumps, ankle circles, and a stretch of the plantar fascia prior to putting weight through your feet. If you have the time, it would be beneficial to massage the arch of your foot out as well.
Another theory as to why the heel can hurt more in the morning, is that we have poor blood supply to our feet, especially at rest. When we are not using our muscles, we do not have as much blood pumping to the area. This is why it can be very beneficial to do simple ankle pumps or ankle circles before getting out of bed.
Other possible causes of heel pain…
Achilles Tendinitis
Another main cause of heel pain in the morning can be achilles tendinitis. The achilles tendon attaches to the back of the heel. This can get pulled on and stressed when going from a pointed/shortened position to a weight bearing position in which your ankle is forced in dorsiflexion. Again, a stretching routine before getting out of bed would be very beneficial to treating the heel pain.
Stress Fracture
Another reason your heel may hurt right away in the morning or after periods of immobility is a stress fracture. These generally hurt with all weight bearing, no matter the time of the day or how long you were off your feet. A simple solution to this would be to put on shoes right away in the morning. Stress fractures are often difficult to diagnose and usually do not show up on x-ray imaging. A stretching routine would not be beneficial for this. Rest/avoidance of excessive activity and a long term foot strengthening program are best for this.
