Morning heel pain is pain experienced at or around the heel of the foot that is most pronounced when one first gets out of bed in the morning. It may be felt at the heel bone, radiating toward the arch of the foot, or toward the back of the ankle along the Achilles tendon. Such pain may be exacerbated in the morning by one’s sleeping position, particularly by a face-down sleeping position in which the foot remains pointed downward for prolonged periods. Common causes of morning heel pain include such conditions as plantar fasciitis, neuromas, and Achilles tendinitis.
Plantar fasciitis is a condition in which the fascia on the plantar surface, or sole of the foot, becomes irritated and inflamed. The fascia is a band of dense fibers that connect the calcaneus, or heel bone, to the phalanges of the toes, essentially forming the arch of the foot. Plantar fasciitis is a common affliction that can occur as a result of repetitive weight-bearing exercise, particularly among obese individuals, and it is typically experienced as pain in the heel and arch of the foot. Morning heel pain stemming from plantar fasciitis is a consequence of remaining in a fixed position overnight, such that the tissue becomes stiff and inflamed, making standing and moving about difficult when one first gets out of bed.
Another common cause of morning heel pain is Achilles tendinitis. This is a condition in which the Achilles, or calcaneal, tendon, which links the gastrocnemius and soleus muscles of the calf to the heel bone, becomes similarly irritated and inflamed. Achilles tendinitis is common among recreational and professional athletes as a type of overuse injury, in which frequent running or jumping movements create excessive friction between the tendon and the bone. This leads to a gradual wearing of the tissue that is felt as pain, tenderness, swelling, and stiffness along the back of the heel and ankle. As with plantar fasciitis, remaining in a prolonged position while sleeping can bring about morning heel pain, especially when the foot is plantarflexed and the tendon shortened. Stretching the heel upon waking may help ease the pain and stiffness felt there and make walking more bearable.
A less common cause of morning heel pain is a neuroma. Neuromas involve inflammation and swelling of nervous tissue. In this case, it involves the nerves that cross the heel bone. Nerves most likely to be afflicted at this site are the medial calcaneal branches of the tibial nerve, which innervate most of the skin on the underside of the heel.
This condition is caused by various neuropathies, or nerve disease, or by a nerve-damaging injury, such as a surgery that creates scar tissue at the site. Less often, a neuroma of the heel can be caused by a tumor of the nerve. Remaining in any position that places pressure on a neuroma, as during sleeping, can exacerbate the pain felt here.