Foot pain with the first few steps in the morning is commonly associated with plantar fasciitis, an irritation of the plantar fascia. The condition, which is very common in runners, causes heel pain that can also radiate into the arch. It is often associated with a tight Achilles tendon and calf muscle.
When we sleep, our ankles usually rest in a flexed position, and during the night both the Achilles and plantar fascia get tighter. When you take the first step in the morning, it pulls on this contracted tissue, and this is the reason runners with plantar fasciitis have pain with their first few steps in the morning.
The good news is that plantar fasciitis usually resolves with conservative management. This includes a daily calf and plantar fascia stretching program and sometimes a dorsiflexion night splint to stretch out the tissue while you sleep. Appropriate shoes are also important, and runners should change their sneakers every 500 miles. With appropriate management, the symptoms should resolve, but it may take several months. If there is persistent pain despite these interventions you should consult your doctor.
Dr. Mark Drakos is an orthopedic surgeon specializing in disorders of the foot and ankle as well as sports-related injuries. He provides care for high school, collegiate, professional, and Olympic athletes. Dr. Drakos’s work on the effect of the shoe surface interface on ACL injuries received a regional Orthopedics Research and Education Foundation Award. He is an active member of the American Academy of Orthopedic Surgeons, the American Orthopedic Foot and Ankle Society, and the American Orthopedic Society for Sports Medicine.