My Feet Hurt When I Wake Up and Walk

Several conditions can cause foot pain when you wake up in the morning, but each condition has a slightly different location and pattern of pain. We will explain each of these in summary throughout this article with links to more in-depth articles that you can explore, including pages on exercises to alleviate each condition. 

My Feet Hurt When I Wake Up and Walk

Outer Foot in the Morning

If you have pain in your outer foot when you wake up, it can be the result of Peroneal Tendonitis. The peroneal tendons run along the outside of the foot and if they become overloaded through a sudden increase in activity levels or changes in footwear, they can become tendinopathic. The classic symptoms of Peroneal Tendonitis include pain on the outer ankle first thing in the morning or when walking after long periods of sitting. Symptoms often improve with activity but are worse the following morning. 

Back of the Foot in the Morning

Pain around the back of the heel bone first thing in the morning is most often caused by Insertional Achilles Tendonitis. The Achilles Tendon runs along the back of the heel and attaches to the very bottom of the heel bone. Unlike the more Achilles Tendonitis, which causes pain in the middle of the Achilles Tendon, Insertional Achilles Tendonitis is painful on the heel bone. It is associated with pain first thing in the morning that eases within the first few steps when walking. 

We have articles on the best exercises for Insertional Achilles Tendonitis and the best Shoes for Insertional Achilles Tendonitis. 

Inner Foot Pain in the Morning

Posterior Tibial Tendonitis is a common cause of pain in the medial arch that can be misdiagnosed as Plantar Fasciitis. Along with pain on the medial arch of the foot, there may also be pain along the inner ankle bone. It is often painful to hop, walk on uneven surfaces or run and worse the following morning. It is painful when you wake up and walk in the morning, and it eases within a few steps. 

We have articles on exercises, shoes and insoles for Posterior Tibial Tendonitis. 

Heel Pain in the Morning

The most common cause of heel pain first thing in the morning is Plantar Fasciitis, where the pain is usually located on the inner aspect of the heel bone on the underside of the foot. Pain is often worse in the morning and improves within 10-15 steps; however, severe cases may last 10-15 minutes. Pain can improve with physical activity but is often worse the following morning. It is important to remember that Plantar Fasciitis can also cause pain in the middle of the foot first thing in the morning. 

Strengthening exercises, stretches, insoles, and the correct footwear are the best treatment for this condition. 

Midfoot Pain in the Morning

An uncommon cause of pain on the underside of the midfoot is Peroneal Longus Tendinopathy. There are 3 Peroneal Tendons all assisting with turning the foot outwards and the Peroneal Longus also assists with pointing the foot downwards as it attaches to the base of the 1st metatarsal. If the Peroneal Longus becomes overloaded, it can cause pain on the side of the foot or on the middle of the underside of the foot. 

Flexor Hallucis Tendinopathy is a condition affecting the Flexor Hallucis Tendon, which assists with the flexion of the big toe joint. It is a common condition that affects ballet dancers and sports that involve a lot of hopping. Pain can also be located on the inner ankle where the tendon attaches. Treatment is in the form of strengthening exercises and the correct footwear. 

Midfoot arthritis can cause vague pain across the midfoot in the morning when you wake up that eases within a few steps or when you wear cushioned trainers. Morning stiffness can be worse the morning after a physically active day, and we would expect the pain to ease with non-weight-bearing activities. 

Forefoot Pain in the Morning

Morton’s Neuroma is a condition causing inflammation of the interdigital nerves of the forefoot. Patients describe symptoms of Morton’s Neuroma as a burning sensation or as if there is a pebble in their shoe. There may be a sharp pain in the forefoot first thing in the morning. 

Big Toe Joint arthritis can cause pain first thing in the morning, and this condition is known as Hallux Rigidus. A typical presentation of arthritis is stiffness first thing in the morning that eases within a few minutes of walking. The pain is located in the joint of the big toe, and it is common to have a reduced range of motion within the joint that can be red or inflamed after walking.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments.