Why does my heel hurt so much with the first steps in the morning?

Question

Many people describe heel pain (aedi ka dard) that is worst when they get out of bed and eases after a few minutes of walking. They ask whether it is a heel spur, and what actually helps.

DoctorOS Team · Answer

Heel pain that is worst with your first steps in the morning, or after sitting for a while, is the typical pattern of plantar fasciitis. This is irritation of the plantar fascia, the strong band of tissue under the foot that supports the arch (AAOS). Most people get better without surgery, and AAOS says more than 90% improve within 10 months of starting simple treatment.

Is it a heel spur?

If an X-ray shows a heel spur (aedi ki haddi barhna), it is usually not the cause. AAOS says heel spurs do not cause plantar fasciitis pain, and most people with heel spurs have no heel pain. The pain can be treated without removing the spur.

What helps

Rest and raise your foot when you can, and hold ice wrapped in a towel on the sore area (NHS).
Wear shoes with cushioned heels and good arch support, or add insoles or heel pads. Try not to walk barefoot on hard floors (NHS).
Stretch every day. AAOS describes a calf stretch against a wall, and a sole stretch where you sit, cross the sore foot over your other knee and pull your toes back towards you. Hold each stretch for 10 seconds and repeat it 20 times on each foot. Do the sole stretch in the morning before you stand up.
Switch to low-impact exercise such as swimming for a while, and lose weight if you are overweight (NHS).
Painkillers such as paracetamol or ibuprofen can help (NHS). Follow the label, and AAOS advises not taking anti-inflammatory painkillers for more than a month without talking to your doctor.

When to see a doctor or physiotherapist

See a physiotherapist or doctor if the pain has not improved after 2 weeks of self-care, is severe or stops your normal activities, keeps getting worse or coming back, or if you have tingling or numbness in the foot (NHS). If you have diabetes (sugar), get any foot pain checked, because foot problems can be more serious with diabetes (NHS). Our guide to diabetic foot care explains why.

What treatment involves

A physiotherapist can teach exercises, and a podiatrist can advise on insoles, shoes or night splints (NHS). If these don't help, doctors may offer steroid injections or shockwave therapy (NHS). AAOS notes that doctors limit steroid injections because they can weaken the plantar fascia and make it tear. Surgery is usually considered only after 12 months of non-surgical treatment has not helped (AAOS).

Sources

General health information from the DoctorOS Team, not a diagnosis. For advice about your own situation, see a doctor.