Why Your PTTD Hurts More in the Morning: Understanding Morning Stiffness
You wake up, put your feet on the floor, and that familiar ache shoots through your inner ankle. If you’ve noticed your PTTD symptoms are worse in the morning, you’re not imagining it. There’s a real physiological reason your posterior tibial tendon feels stiffer and more painful after sleep.
Why mornings are harder
When you sleep, your feet are typically in a relaxed position—often pointing slightly downward, which shortens your Achilles tendon and calf muscles. This position allows the tissues around your posterior tibial tendon to tighten.
Then when you stand up, your full body weight lands on your arches. Your posterior tibial tendon suddenly has to stretch and support your weight after being relatively relaxed all night. That mismatch between the relaxed state of sleep and the demands of standing is what creates that sharp morning pain.
Fluid buildup plays a role too. When you’re inactive for hours, fluid can pool in your lower extremities. This slight swelling makes your tendons and joints feel stiffer than usual.
The good news is that this pattern is common and doesn’t necessarily mean your condition is worsening. It’s a characteristic of many foot and ankle conditions, not just PTTD.
What helps
A few simple strategies can ease the transition from bed to standing.
Night splints keep your foot in a gentle dorsiflexion position while you sleep, preventing your calf and Achilles from tightening too much. Many people with PTTD find that night splints significantly reduce their morning pain.
Gentle stretching before you get out of bed helps. While still lying down, rotate your ankles, flex your toes, and do gentle heel raises. A few minutes of this circulation-boosting movement makes a difference.
Warm water therapy works for some people. Dip your feet in warm water for 5-10 minutes before standing. The warmth increases blood flow and loosens tight tissues.
Building a morning routine
Start your day on the right foot—literally. Keep your orthotics or supportive slippers right next to your bed so you put them on before you walk anywhere.
Avoid walking barefoot on hard floors first thing. Even a few steps on tile or hardwood can aggravate your tender tendon. Slides or supportive sandals are better than bare feet.
Give yourself extra time in the morning. Rushing means you don’t do your stretches and you walk too quickly, both of which stress your tendon.
When to worry
Some morning stiffness is normal, but watch for changes. If your morning pain is getting progressively worse, lasting longer, or not responding to the strategies above, it might indicate progression of your PTTD.
Also pay attention to pain that starts occurring at rest or at night. That’s different from morning startup pain and warrants a discussion with your doctor.
This article is for informational purposes only and is not a substitute for professional medical advice. Always consult with a healthcare provider before starting any exercise program.