Heel Pain On Your First Steps Of The Morning: Causes & Relief

Sharp heel pain on the first few steps after waking that then eases after walking a little is a very specific pattern. It almost always points to one thing: plantar fasciitis.

What is plantar fasciitis?

The plantar fascia is a thick band of tissue running along the sole from the heel to the base of the toes. It works like a bowstring holding up the arch of the foot. When that band takes on more load than it can handle, its heel end becomes inflamed and painful.

Why does it hurt most in the morning?

During sleep the foot sits pointed downwards for hours, and the plantar fascia shortens in that position. The first step of the morning stretches it out fully and suddenly — and that is what causes the sharp pain. After a few minutes of walking the tissue warms and becomes pliable again, so the pain fades. The same pattern repeats after sitting for a long time.

What causes it?

• Standing or walking on hard floors all day
• Flat footwear with no arch support, including thin sandals
• Excess body weight
• Tight calf muscles — they pull on the heel and add tension to the plantar fascia
• Increasing walking or running distance abruptly
• Arches that are either very high or very flat

Three stretches before getting out of bed

1. Toe pull. Before standing, sit on the bed, cross your legs, and pull your toes towards your shin. Hold 30 seconds, three times.
2. Bottle roll. Roll the sole over a cold water bottle for two minutes.
3. Wall calf stretch. Stand facing a wall, one foot back with the heel pressed into the floor. Hold 30 seconds each side.

Can warming massage oil help?

It helps the muscular side of the problem, not the inflammation itself. Apply warming massage oil to the calf and sole at night, then massage the sole with your thumb from heel towards toes for five minutes. A looser calf means less pull on the heel the next morning. Do not press hard on the most painful point of the heel while it is inflamed.

Tight calves are also a common cause of leg cramps at night — both respond to the same calf stretch.

How long does it take to heal?

Most cases resolve within six to twelve months with daily stretching, supportive footwear and less standing on hard floors. It is slow, but it does heal. What speeds it up is consistency of stretching, not any single treatment.

When should heel pain be seen by a doctor?

Get it examined if the heel is swollen and warm, the pain began after a sudden injury, you cannot walk at all, there is numbness or tingling in the sole, or nothing has changed after six weeks of daily stretching. Heel pain can also come from a stress fracture or a trapped nerve, and both need different treatment.