Why Does Heel Pain Get Worse After Rest?

If you’ve ever noticed that your heel pain is worse with those first few steps after waking up or sitting for a while, there’s a clear reason why.

When you rest, tissues such as the plantar fascia and Achilles tendon shorten, stiffen, and cool down. When you suddenly load your body weight onto those tight structures after sleep or prolonged sitting, they are rapidly stretched. This sudden tension can trigger pain, increase sensitivity, and cause symptoms to flare.

Simple stretches, gradual loading, icing after activity, and wearing supportive shoes can help reduce these painful episodes.

Triggering Activities and What to Do About Them

What Occurs During Rest?

Several tissues in the heel bear your body weight, including the plantar fascia, Achilles tendon, calcaneal fat pad, bursae, and small joints.

After sitting for 30 to 60 minutes or sleeping overnight, several physiological changes occur. The plantar fascia shortens. The calf muscles tighten and lose flexibility. Tissue temperature drops. Fluid may accumulate locally, increasing stiffness. Microtears and previously irritated tissue become less pliable.

When you stand after this period of rest, the plantar fascia is suddenly stretched as the leg straightens. This rapid increase in tensile load leads to what is commonly called “first-step pain.”

Clinically, many patients report the worst pain in the first one to three steps after getting up from bed or rising from a seated position. Pain often improves after five to ten minutes of walking.

Movement warms the tissues, restores ankle dorsiflexion, improves circulation, and reduces viscoelastic stiffness.

As you push off the ground and your toes bend upward, the plantar fascia tightens and contracts.

This is known as the windlass mechanism.

If the plantar fascia has been shortened overnight or during prolonged sitting, it is more vulnerable to this windlass tension during your first steps. The result can be sharp pain along the medial, or inner, heel.

This explains why the first few steps can feel intense, while walking several minutes later feels more tolerable.

Conditions Related to Heel Pain That Flares After Rest

Plantar FasciitisPain is typically sharp and located in the medial heel. It is usually worst with the first steps after waking or sitting and improves with light activity. This is the most common reason heel pain worsens after rest.

Achilles TendinopathyStiffness and discomfort are located in the back of the heel. Pain is worse after rest and often increases with uphill walking. Symptoms usually improve once the tendon is warmed up.

Stress FractureThis is less common. It causes deep, focal bone pain that is worse with weight bearing and may not improve after warming up.

Nerve EntrapmentPain may feel burning, tingling, or electric in nature. Symptoms can worsen at night or when lying on your side.

If your pain is sharp and improves after walking for several minutes, excessive strain on the plantar fascia is often the primary cause.

Why Does It Improve With Movement?

When you begin moving, your body increases circulation, raises local tissue temperature by approximately one to two degrees Celsius, loosens stiff tissues, restores ankle dorsiflexion, and activates natural pain inhibition mechanisms.

These changes explain why heel pain often improves after five to ten minutes of walking. However, symptoms may return after sitting again because the tissues tighten repeatedly.

Tips to Prevent Painful First Steps

Stretch Prior to Standing

Perform ankle pumps and calf stretches before getting out of bed. This reduces the sudden tensile load placed on the plantar fascia during your first steps.

Wear Night Splints

Night splints keep the ankle in neutral dorsiflexion or slight upward flexion, limiting overnight shortening. Consistent use for four to eight weeks has been shown to significantly reduce morning pain.

Warm Up Before Activity

Walk briskly or cycle for five to ten minutes before exercising. Heel raises and ankle circles can also help warm the calf muscles. Warm tissues tolerate mechanical load more effectively.

Wear Supportive Shoes

Avoid walking barefoot indoors, wearing flat sandals, or using unsupportive training shoes. Choose footwear with arch support and moderate cushioning. A slight heel raise of about one to one and a half centimeters is often beneficial. Replace shoes after 300 to 500 miles of use to maintain support.

Take Frequent Breaks From Sitting

If you work at a desk, stand and walk for one to two minutes every 30 to 60 minutes. Perform ankle pumps before standing after long sitting periods to reduce tissue tightening.

When to Seek Medical Attention

Most individuals improve with stretching and appropriate footwear. However, you should consult a medical professional if pain persists for more than six to eight weeks, you are unable to bear weight, or you experience swelling, redness, fever, numbness, weakness, or deep persistent pain that could suggest a stress fracture.

A thorough evaluation may include assessment of biomechanics, calf flexibility, and footwear. Patients who do not improve with at-home care may benefit from custom orthotics, structured physical therapy, shockwave therapy, or injections depending on the underlying cause.

The Bottom Line

Heel pain worsens after rest because the tissues of the foot tighten during periods of inactivity. When you place weight on the foot again, the sudden stretch increases strain and triggers pain. As the tissues warm and circulation improves, discomfort typically decreases.

Consistent daily strategies such as gentle pre-movement stretching, wearing supportive footwear, using night splints when indicated, strengthening the foot and calf, and breaking up prolonged sitting can help interrupt the cycle of recurrent flare-ups.

FAQ

Does heel pain feel better as I walk because inflammation is decreasing?

It can. During rest, mild fluid accumulation and inflammatory chemicals can increase stiffness and pain sensitivity. Activity helps reverse these changes.

Are tight calves the cause?

Tight calves limit ankle dorsiflexion and increase strain on the plantar fascia during the first steps, which can worsen symptoms.

Do night splints actually work?

They can be effective for many patients, particularly in reducing morning pain when used consistently.

Can heel pain worsen after rest without plantar fasciitis?

Yes. Achilles tendinopathy and certain nerve conditions can also cause pain with the first few steps, although the location and quality of pain typically differ.