Why Does Plantar Fasciitis Hurt Worse In The Morning?

Do the first few steps out of bed each morning cause intense, sharp pain in your foot and heel? Plantar fasciitis might be the cause.

Morning foot and heel pain is a distinctive feature of the presence of plantar fasciitis. Many sufferers wonder, why does plantar fasciitis hurt worse in the morning?

The reason is because while we are sleeping, our feet and ankles naturally shift into a plantar flexed position (toes pointed downward) and this shortens the calf, Achilles tendon, and plantar fascia overnight.

This happens due to the long period of inactivity while you sleep and causes the plantar fascia ligament to tighten up and contract.

So, when you awake in the morning and put your feet down to the ground to take your first step, it's a sudden deep stretch of the calf, Achilles tendon and plantar fascia in order for you to get your heel to make contact with the ground.

This rapid change in tendon and fascia length causes an immediate sharp, unrelenting pain response with the symptoms lessening as walking continues

The best way to prevent this debilitating morning event is to begin elongating and stretching the plantar fascia before you take that first step.

Dr. Angela Walk

Natural Physician

Specializing in Foot & Ankle Mechanics

What Are The Best Morning Stretches For Plantar Fasciitis?

Experiencing heel/foot pain in the morning is a telltale sign on plantar fasciitis. One of the best ways to relieve morning pain is to use these stretching and massage techniques before you take your first steps.

1.) Straighten you leg completely, then pull your toes toward your knee. Contracting your shin muscles and quadriceps muscle (the muscles on the front of your upper and lower leg).

Best morning stretches for plantar fasciitis ~ Dr. Angela Walk

When you contract these 2 muscles, that naturally releases and stretches the calf and hamstring muscles. Hold each stretch/contraction for 2 seconds and perform 10 repetitions.

This type of stretching is called Active Isolated Stretching (AIS) and is more effective than static stretching (holding a stretch for 20-30 seconds).

2.) Stretch the plantar fascia by using a belt or towel to gently pull the ball of your foot into a flexed position. Hold each stretch for only 2 seconds, and complete 10 repetitions.

Active isolated stretching for plantar fasciitis - Dr. Angela Walk

3.) Self Massage or Self Myofascial Release with a massage tool or handle of a table spoon:

Using a massage tool or handle of a table spoon, find areas that feel impinged, tight or tender.
Apply a light layer of emollient balm or essential oils over the treatment area.
Using the edge of the tool, apply unidirectional strokes using moderate pressure.
Continue for 15-20 seconds in a single area before moving onto another area.
Repeat 2-3 times per week on each of these soft tissues: Gastrocnemius, Soleus, Achilles Tendon & Plantar Fascia

Dr. Angela Walk, Natural Physician & Author of The Plantar Fasciitis Home Recovery Guide, recommends these stretches and massage techniques to try at home.

What Is The Main Cause of Plantar Fasciitis?

There are (3) primary causes of plantar fasciitis:

(1.) Limited Dorsiflexion and Ankle Immobility - Tight Calves

(2.) Weak Intrinsic Foot Muscles

(3.) Fascial Adhesions - Scar Tissue/"Knots" in The Plantar Fascia, Achilles & Calf Muscles

When these main causes of PF are ignored, missed, or just plain misunderstood, the injury isn’t rehabilitated properly and never fully heals.

(1.) Limited Dorsiflexion (tight calves):

Do Tight Calves Cause Plantar Fasciitis?

One of the more common causes of plantar fasciitis is tight calf muscles. If there is not enough motion in the ankle joint due to a lack of flexibility then there will be extra strain on the fascia which may lead to this injury.

Calf tightness alters walking and running gaits, leading to a tremendous amount of knee, ankle, and foot injuries.

When the ankle is limited in its ability to dorsiflex, it causes excessive stretching of the plantar fascia.

That means with every step up the stairs and every squat, limited ankle mobility and tightness of your calves could be putting excess tension on the plantar fascia.

The best way to elongate and increase range of motion of your calf muscles is to use Active Isolated Stretching with a foot rocker. Perform stretches 3 times a day for best results.

2.) Weak Intrinsic Foot Muscles

Does your foot have a core? Yep! Weakness of these core intrinsic muscles of the foot are one of the most common causes of plantar fasciitis, Achilles tendinosis, and other lower extremity disorders.

Short foot exercises, also called foot doming, is the exercise I recommend the most to strengthen your arch muscles.

I have found over the years, that giving patients fewer exercises and simple homework increases compliance. So, this is ONE simple exercise that makes a huge difference in foot health!

First, stand on one foot, and evenly distribute your body weight over the plantar foot.
Then, spread the digits. Make sure all toes are in touch with the ground.
Press the toes into the ground, and contract the arch of that foot.
Hold the short foot exercise for about 10 seconds and repeat this 5 times. Perform daily!

(3.) Removing Fascial Adhesions & Scar Tissue For Plantar Fasciitis

How Do You Remove Scar Tissue From Plantar Fasciitis?

Scar tissue is also referred to as fascial adhesions, fascial restrictions, or simply “knots.” Think of scar tissue as the body’s duct tape.

When you walked too far in bad shoes, you overwhelmed the structural integrity of the plantar fascia and created small injuries. The body uses scar tissue like duct tape to create a quick “patch.”

Before the body can properly heal, you overwhelm the scar tissue patch, causing more scar tissue to be laid on top.

If fascial adhesions are present as in the case of PF, results from stretching may only be temporary. It would be similar to having a knot in a rope.

Pulling on the end of the rope does not release the knot, it only tightens the knot and makes it even more difficult to remove.

The same is true for muscles. If a knot (fascial adhesion) is present, stretching only makes the problem worse.

These fascial adhesions MUST be released before stretching is effective. Adhesions remain until they are removed. Rest, ice, stretching, and ibuprofen will not make them go away!

You may get some temporary relief, but once you resume your activities, the issue will make itself known once again. The best method to remove fascial adhesions in with a specific instrument.

I have used Instrument Assisted Soft Tissue Mobilization (IASTM) in my practice for many years with great success. I have extensive training in these techniques including Graston Technique and Gua Sha.

It involves the use of a stainless steel instrument or stone to "scrape" away scar tissue adhesions. These tools greatly assist in soft tissue mobilization and improve blood ow to the affected area and in turn, release adhesions in the muscle tissue and create healing.

Many PF rehab protocols involve using a lacrosse ball, tennis ball, frozen bottle of water, or foam roller to release fascial adhesions, but these objects are just not as effective.

Can I Treat Plantar Fasciitis At Home?

As a chiropractor and foot specialist, I often see patients with plantar fasciitis after they’ve tried everything. Cortisone shots, night splints, ineffective stretching, and rolling on a frozen water bottle are a few of their failed remedies.

If you’re wondering how to treat plantar fasciitis at home, I want to share a few insights that have worked for my patients. The solution for most of my patients is through addressing multiple factors.

Improving limited ankle mobility and dorsiflexion
Strengthening weak intrinsic foot muscles
Strengthening weak calf, soleus, and peroneal muscles

Rarely is there a quick fix for PF. Identifying areas of weakness in the foot and ankle and restoring proper foot function is the most important piece of the puzzle.

I have created a step-by-step comprehensive guide on how to resolve Plantar Fasciitis at Home. Take a look at my FREE GUIDE here.

Other Helpful Tips To Treat Plantar Fasciitis:

In addition to these stretching, strengthening, and fascial recovery protocols, these tips can help to avoid pain and stiffness of the plantar fascia:

Wear footwear that are shaped like your feet with a wide toe box and no elevated heel. Minimalist shoes is ideal
Running or walking on softer surfaces
Walking barefoot daily
In the acute phase, an orthotic insert can be helpful (not for long term correction)
Stay properly hydrated. It is critical for healing of muscles, joints, and fascia

I've written extensively on the topic of Plantar Fasciitis. Take a look at these other related blog posts: