Sharp pain at the inside of the heel at the first step in the morning is a classic sign of plantar fasciitis. Plantar fasciitis is the tearing and resultant inflammation of the plantar fascia, a ligament-type structure in the bottom of the foot.
The pain is not limited to the bottom of the heel, the pain may extend through the arch or to the back of the heel. The pain experienced at the first step in the morning tends to work itself out after 15-20 minutes, but usually returns during the day or with activity.
There are many causes of plantar fasciitis. The condition generally develops as a result of repetitive stress on the fascia. Repetitive stress can be from activities such as jogging or running or sports such as soccer or tennis. Even simple activities such as gardening in a poor-quality shoe can place excess stress on the fascia, causing small tears and resulting in inflammation and pain.
Small changes in activity, changes in your job, or your shoes are all common causes of plantar fasciitis. It is not the activity alone that causes the condition. A new activity in combination with a poor quality shoe is one of the most common causes of plantar fasciitis.
Individuals with flat feet and over-pronation are more susceptible to developing plantar fasciitis. Over-pronation is the excess rotation of the foot in association with the collapse of the arch. This motion places excess stress on the plantar fascia. Identifying factors that contribute to the development of the condition is the first step to treatment.
Treating Morning Heel Pain
1. Identify the cause and contributing factors: The condition is not generally associated with an injury or trauma. But, there is almost always a small change in activity, shoes, or job that contributes to the development.
2. Avoid aggravating activities: Any activities which place excess stress on the arch will aggravate the condition. Walking up and down stairs or hills, squatting, lifting heavy items, or walking on uneven terrain will aggravate this condition.
3. Stop impact activities: Daily exercise is important for weight maintenance but running, walking, the stair-master, the elliptical machine, and any impact sport will aggravate the condition. Consider swimming or cycling. When cycling, avoid steep hills, pedaling in high gear, and dropping the heel. More on decreasing activity.
4. Ice massage your arch: Place a sports water bottle in the freezer and when frozen, place it on the floor and roll your foot over the water bottle for 20 minutes 2-3 times a day. Ice helps decrease inflammation and also acts as a topical analgesic. Icing is most effective the first few weeks after the condition begins and when the heel is inflamed and tender.
5. Roll a ball under your foot: Place a tennis ball, softball, or rolling pin on the ground and roll your arch over the ball. This will stretch the plantar fascia and should be done as often as possible throughout the day, but should not feel painful. Check out the best foot rollers.
6. Alternate between hot and cold: Icing decreases inflammation by causing vessel constriction. Heat will cause the vessels to dilate. Alternating between the two will attempt to create a pumping action within the small vessels in the injured area to pump the excess fluid (inflammation) back to the heart. Alternate between ice and heat, using each for 5 minutes for a total of 30-40 minutes.
7. Stretch your calf each morning: In the morning, BEFORE you step down, stretch your calf. Wrap a band around the ball of the foot and pull the foot towards you, keeping your leg straight. Hold for 1 minute and repeat 2-3 times if possible.
8. Stretch the plantar fascia: A plantar fascia specific stretch can be performed by placing the affected foot on the unaffected knee. Grab the toes with the opposite hand and pull the toes, stretching the arch. More on the plantar fasciitis specific stretch.
9. Stretch throughout the day: Stretch the calf and the plantar fascia multiple times throughout the day. Spend 1-2 two minutes each hour stretching. More on stretching for plantar fasciitis.
10. Take anti-inflammatory medications: Anti-inflammatory medications will help decrease the inflammation which results from the tearing of the plantar fascia. They can work well in the early stages of plantar fasciitis and in conjunction with other treatments. Even if the anti-inflammatory medications reduce the pain, they are not a cure for the condition. An adjunct therapy is important.
11. Lose Weight: Most people gain weight after developing plantar fasciitis because they have reduced their activity considerably. Increased body weight transmits excess force to the feet and the plantar fascia and the more weight gained, the slower the healing process. More on weight loss.
12. Wear supportive shoes: This is one of the most important steps. Soft flexible shoes will only cause more problems, despite how comfortable they may feel. Test all shoes. More on choosing shoes for plantar fasciitis.
13. Avoid walking barefoot: Don’t walk without shoes, even in the house. Find a pair of supportive shoes that can be worn while in the house.
14. Use a heel cup: Heel cups aid in shock absorption and decrease stress on the heel. They are helpful only when the heel is very tender and should be used in conjunction with other treatments listed here. More on heel cups.
15. Try heel lifts: When the heel is lifted, stress is decreased through the arch, decreasing force on the plantar fascia. Heel lifts can be placed in the shoe or shoes with up to a 1” heel can be worn.
16. Try anti-fatigue mats: Anti-fatigue mats add shock absorption to the floor and decrease stress through the heel. The mats work well for those who work on hard surfaces or stand in one place for long periods of time. See the APMA’s list of approved anti-fatigue mats.
17. Strengthen your foot muscles: Place a thin towel on the floor. Place the front of your foot over the base of the towel. Clinch your toes around the towel and slide the towel under your foot by gripping the towel with the toes. Another exercise is to place marbles on the floor and pick up each marble, one by one, with your toes and place them in a bucket or bowl.
18. Try foot taping. Taping the foot can support the arch and decrease stress on the plantar fascia and prevent tearing and re-injury. More on fasciitis taping.
19. Use a night splint: A night splint is designed to stretch the plantar fascia while you sleep. The splint holds the ankle at 90 degrees and pulls the toes back, stretching the plantar fascia. There are rigid night splints and soft night splints which can be used for a few hours in the evening or during the night while you sleep. More information on night splints.
20. Wear orthotics: Orthotics are not soft insoles, they are semi-rigid devices that fit into the shoe and control abnormal foot motion. By controlling abnormal motion, the orthotics help to decrease stress on the plantar fascia. More on orthotics.
If your symptoms persist, make an appointment with your podiatrist.