Why Plantar Fasciitis Hurts in the Morning, After Sitting and on Runs

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. Today we're covering with a running expert about plantar fasciitis.

We're going to see these three questions you guys submitted. The three questions are, why does it hurt more in the morning? Why does it hurt more after sitting? And are trails better or worse than roads? Hi everybody, this is Dr. Mandy Riehl and we are covering more plantar fasciitis today. And the first question is going to be about time of day for plantar fasciitis. Why do you think, is there a reason why it hurts more in the morning for people? Yeah, there's a pretty clear two reasons that it could be. And it depends on what your actual diagnosis is. If it's true plantar fasciitis, like itis meaning inflammation in the plantar fascia itself or a nerve-referred plantar fascia, we've gone over this a ton.

So go dig in our other videos. The description, there'll be some probably. So for those two, if it is a true plantar fasciitis and you have inflammation in the fascia, there's a swelling effect. So when swelling stays there, gravity sucks down. So if you have swelling in the foot, it likes to stay in the foot. It typically stays there when you're asleep because you're not pushing it around at all. When you're walking around in the day, you kind of squish it out of there and it warms up. But when you're asleep, it just kind of pools there and sits there. And then when you wake up in the morning, it hurts kind of your first step because you're putting pressure on that irritated area.

But then it kind of warms up, right? So it loosens up, so to speak, but more you're pumping the fluid out of that area. So is there like something people could do to not have the first step in the morning? Is there like they move their foot in the bed or? Yeah, moving your foot in the bed helps. I actually find that the sock, I forgot what the clinical name is. We're going to cover those later too. On a different video. Yeah, so the sock doesn't seem to help with that because it doesn't move your foot at all. So move your foot, you can light massage it. But the thing I found the most benefit in for my patients with true plantar fasciitis is toe threading, which we've done in another video.

It's kind of like shaking hands with your foot. It's a foot mobility routine. Yeah, we have it in the ebook at the bottom too or in the corner. But I think we've done probably quite a few videos on toe threading. It's very simple to do, right? Yep, yep. And you'll know it when you see it. It looks weird. Yeah. But for, so that's for true plantar fasciitis. If you're nerve referred, then there is a phenomenon particularly with lumbar discs where in the morning it is typically worse. And it's a similar concept of fluid in the, like how those fluids are moving or not. So for true plantar fasciitis, if you're squishing the fluid out of there by stepping or moving the foot around, the pain kind of warms up, goes away.

If it is coming from the spine and it's referred down, same concept applies. It's usually just in the disc space rather than in like a fascia tissue. So it's kind of like just stagnant time for six to eight hours and then, but they can get rid of it preemptively. And it could be less than six to eight hours too. This is for both of them. This is where people run into problems if they're at work and they sit for a couple hours and then they stand up and it hurts again. That was our next question. Oh, well. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity.

The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. So I guess, well, before we go on to the next question then, what if they had problems more in the afternoon? Yeah, typically that, it depends on what you're doing before that. So if you're going to work, you're going to your office and you're sitting and then you have problems, it's probably the same effect. If you are on your feet, say you're like a farmer or something like that, or a coach or a doctor, you're on your feet for a while and it starts getting irritated after a lot of activity.

Same deal with after a run or towards the end of a run. That can be from the mechanical pressure on it. If you have an inflamed area and you're just smashing it over and over, or you're overloading something that doesn't want to be overloaded. So that's either the plantar fascia itself, right? You're putting stress on that all day by walking or running or standing for a long time. Or if, again, if it's spine referred, then same deal. You're putting stress on usually extension of the spine more commonly. In the afternoon. Yeah. If you're... Like older people. Yeah. And people who are, yeah, mostly on their feet a lot or moving around a lot.

So running, walking. For the, in another area, we talked about mechanical sensitivity too. And I'm guessing that would lend to that as you put more pressure on it in the day, it's just going to hurt a little bit more sometimes. Yeah. I have had a few cases, actually one right now who we're just finishing up. He works in a hospital and is on his feet all day, but it wasn't that painful in the morning. It was only in the afternoon, in the evening. And he shifts between being on his feet a lot and then sitting, like for surgeries, works in the OR. So they notice that when they're walking around, it feels fine, even if they're walking around for the whole day.

But even at the end of the day, if they're sitting for a long time, if they have done a lot of activity before that, he had issues when he would get up from sitting. So more commonly, this is someone who works on their feet all day. They feel pretty good. It's warmed up. And then they go home and they eat dinner and they're sitting in front of the TV and they get up to use the restroom and then it hurts again. That is another concept. And it can happen with either of those two types of plantar fasciitis. So the true plantar fascia or an upper fur. Okay. So that question too about when it hurts after sitting.

Yeah. We're all done there. Yeah. Do you have anything to add to that? Yeah. It's super common. It's usually nothing to worry about. If it was a, say like a traumatic plantar fasciitis where you took a step and it feels like it just tore, it's going to hurt all the time and it may hurt a little bit more after sitting or sleeping, but in plantar fasciitis in general, both for true and nerve referred, it's super common. It's like the most common symptom I hear. Yeah. I think I've met a lot of people that they, like when the pain comes back, they're more concerned of did they damage something? You know, but sometimes time of day, circumstantial, mechanical sensitivity is all part of it.

Yeah. And, and damage is, it's usually a little easier to parse out than sensitivity. So damage, damage, like I tore something, there's usually swelling or bruising or it hurts at all times. So it may hurt a little bit more after you wake up or sit, but it, it's going to hurt like pretty much no matter what you do. Yeah. It usually creates like just immediate, like disability. Like you can't like put bare weight on the foot. Yeah. Like I had a case who had a, a plantar fascia rupture, which is like worst nightmare stepped on their cross country runner. So stepped down during a race, ruptured the plantar fascia, couldn't walk like immediate ER.

So if you're thinking you tore your plantar fascia and it's more than just like a little tiny tear, it's going to hurt. And you're going to know you're going to be on crutches. I heard the analogy one time about like they, they were, they were talking about like, like someone being sick enough to go to work or not. And like, if you wake up and you're like, well, I think I'm sick. I'm maybe, maybe I could do it. Or you're like, I am sick. Like, you know, you can't. And that's the difference between like a little tiny or like full rupture. Yeah. It's like, it's not a question anymore. Yep. So last question is going to be about different trails or, sorry, trails or roads, which would be more useful if you were trying to recover from plantar fasciitis or run even despite having it?

Right. It depends on your goal. So if your goal is to do a trail race with 10,000 feet of vert, then obviously you need hills. So you do as much as is tolerable on trail. But if trails specifically like the surface hurts, you can recreate that on roads. If you have road hills nearby in another vein, if you're training to qualify for the Boston Marathon and you just like trail running on the side, you go to the roads as long as that feels fine. But for most people, if you have more pain going fast, roads are usually not as good because your pace can increase. And that's also where most people do speed work or tempo runs.

So if you're doing that and you have pain when you're going faster, that's not a good combination. It's because of the road, the lack of road or like obstacles in the way slows them down automatically. Like you don't have to like tell them go slower. Right. Yeah. So if you're on trail and it's super steep and you have no problems going uphill, but you are someone who has issues going faster, hills are great because you're going slower, but you're still getting a ton of work in. Okay. Get the ebook at the bottom. Mandy spent a lot of time writing it. There's a lot of pictures and videos in it. It covers it with plantar fasciitis.

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