Morning Heel Pain


Morning Heel Pain


Morning Heel Pain

Do you have pain in your heel that is most painful in the morning or after an extended period of rest off your feet? If so, you may be experiencing an injury commonly known as plantar fasciitis. Although the pain is usually felt at it’s worst on the heel, sometimes pain is also felt radiating along the arch of the foot, as the plantar fasciitis tissue makes up the arch under the foot. In some cases, heel pain resulting from a heel spur or bruised heel can be mistaken for plantar fasciitis. In children, heel pain is more commonly as a result of Sever’s disease (swelling of the growth plate in the heel, with pain usually at the site of the achilles tendon attachment).

What are the causes and symptoms of morning heel pain?


  • Plantar fasciitis: Degeneration of the plantar fasciitis tissue under the foot
    • Cause: Overuse injury of the plantar fasciitis tissue that worsens over time. It can develop over time due to a variety reasons. The most common being as a result of sport that use the feet in bounding movements frequently. Some other factors that contribute include:
      • Poor footwear
      • A previous injury
      • Excessive overpronation
      • Muscle imbalances
      • Being overweight or obese; and
      • Naturally high arches
      • Pes planus otherwise known as flat feet
  • Symptoms:
    • Pain under the heel and arch of the foot
    • Pain that is worse in the morning or after extended rest
    • Tenderness to touch
    • Inflammation and degeneration of the tissue
  • Heel Spur: Excessive bone growth commonly occurring with plantar fasciitis
    • Cause: A heel spur is caused by a bone growth protruding from the heel, the calcaneus bone.
      • Being overweight or obese
      • Poor footwear
      • Genetics
      • Repetitive impact to the heel
      • Incorrect locomotion technique
  • Symptoms:
    • Pain at the heel
    • Tenderness to touch
    • Difficulty to bear weight and locomote without pain
    • Note: In many cases patients experience no pain or other symptoms and a heel spur is detected through an x-ray.  While it may not be possible to get rid of the heel spur on the x-ray, most of our heel spur patients are treated very successfully with a range of Physiotherapy treatments.
  • Bruised heel / Policeman’s Heel: Degeneration of the fat pad tissue causing bruising of the heel, the calcaneus bone.
  • Cause: A bruised heel is caused by sudden impact or more commonly due to a gradual overuse of the heel, the calcaneus bone. In this case, overuse can be defined in one of three ways:
    • Running for a long distance
    • Placing a great amount of weight on the heel when locomoting
    • Movements that incur repetitive bounding on the heel
  • Symptoms:
    • Pain under the heel
    • Pain when locomoting
    • Tenderness and pain to touch

Treatment for morning heel pain:

Initial treatment advised is a combination of the PRICE principles:

  • Protection: Avoid locomoting and aggravating exercises if possible. For bruised heels, using a fat pad – in both shoes to avoid leg length discrepancies – is advised to reduce the pain by acting as an extra shock absorber. Wearing shoes that are more supportive – not too tight or too loose and support the natural arch – are also advised.
  • Rest: Rest is paramount to a fast recovery of all heel pain. In the case of a bruised heel, taking the time to rest the heel properly can be the difference between an acute injury and a chronic long-term injury.
  • Ice: Apply ice for 10 minutes every hour up to 24-48 hours, especially after exercising. Chronic injuries may benefit more so from heat to reduce pain and inflammation.
  • Compression: Wearing a compression sleeve may help to reduce pain by increasing blood flow to the area, preventing the plantar fascia from getting ‘cold’ and tightening up.
  • Elevate: To reduce any swelling that may have occurred.

Physiotherapy Treatments for morning heel pain

To reduce pain and rehabilitate the injury back to pre-injury state, a physiotherapist will be use a combination of the below treatments. A gait analysis is also often conducted to assess if there are any underlying factors such as excessive overpronation, excessive supination or muscle imbalances that are contributing to the occurrence of the heel pain.

  • Shockwave Therapy – strong sound waves help to break down adhesions and stimulate healing where the plantar fascia attaches to the heel bone.
  • Laser therapy – helps to reduce inflammation, and promote healing of tissue.
  • Ultrasound therapy – to relieve pain and enhance recovery.
  • Taping – to reduce pressure on the injured part of the foot.
  • Gua sha massage – stainless steel tools are  used to relieve pain and relax the plantar fascia tissue.
  • Night splint – a night splint is used predominantly overnight, to prevent the plantar fascia tissue from tightening up overnight.
  • Custom orthotics – used to support the arch of the foot and correct any biomechanical gait abnormalities commonly associated with foot pain.
  • Stretches – used gradually to relieve pain and symptoms associated with the injury. These stretches commonly used for plantar fasciitis and heel spurs are:
    • Dorsiflexion stretch – pulling the toes up towards the shin for 30 seconds 5 times, repeating this 3 times a day. This stretch is best completed after walking and before bed to prevent the tissue tightening up.
    • Calf stretches – the two muscles of the calf are stretched to prevent the plantar fascia tightening up more so. This can be done by placing the foot on part of a ledge and gradually squatting into the stretch with more weight. To target the soleus muscle, bend the knee slightly, and to target the gastrocnemius muscle, keep the leg straight.
  • Strengthening exercises – if muscle imbalances are the cause or a contributing factor of heel pain, strengthening exercises can be used to prevent further issues by strengthening those weak muscles.  Examples of strengthening exercises for flat feet can be seen below.

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About the Author

Brad SaltzBrad is a Registered Physiotherapist at Ace Physio, a highly respected Physiotherapy clinic in downtown Toronto. Ace Physio provides high quality one on one Physiotherapy that combined state-of-art technology such as; Shockwave Therapy, Laser Therapy, and Spinal Decompression with traditional Physiotherapy.View all posts by Brad Saltz