Why do my feet hurt when I lie down at night?

Hinge Health member’s question: 

“I notice my feet hurt when I lie down in bed. Any idea why my feet hurt more at night?” 

Hinge Health physical therapist Paige Nelson’s answer:

Foot pain can happen for a lot of reasons. Common ones include nerve-related pain, circulatory issues, or foot conditions like plantar fasciitis or arthritis. When I hear about nighttime foot pain, I start by looking into underlying health factors.

Why do my feet hurt at night?

Neuropathy, especially diabetic or peripheral neuropathy, can trigger nighttime pain because reduced movement makes nerves more sensitive, causing them to relay pain signals to your brain.

Another cause could be blood circulation issues. During the day, you get good blood flow and circulation to your feet. At night when you lie still, circulation naturally slows down, which can lead to stiffness, inflammation, or heightened sensitivity in affected areas. Restricted blood flow from your legs can also be related to a condition called vascular claudication. This can cause pain or cramping, especially when you’re lying down and not moving. 

Foot-specific pain conditions like plantar fasciitis, arthritis, or Achilles tendonitis may flare up at night. Many of these conditions involve underlying inflammation. Movement — going about your daily activities — helps keep tissues mobile. But when you lie down at night, pain can increase either due to fatigue or a lack of mobility, and this can lead to stiffness or pain. You may also become more aware of discomfort from these conditions at night simply because you’re in a more quiet and relaxed state, so your body’s pain signals can feel more intense.

Note: There can be plenty of other causes of nighttime foot pain. A provider can help you identify what’s contributing to your pain. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

How can I tell what's causing my foot pain?

Identifying whether your pain stems from a nerve issue, a circulatory problem, or something else can be helpful for treatment. Here are some clues we use: 

• Nerve pain can sometimes be “global,” as seen with diabetic neuropathy — meaning it can affect a larger area of your body. However, in some cases of peripheral neuropathy, the pain might follow the path of a specific nerve. This type of pain can include sensations like tingling or numbness. With neuropathy, balance can also be affected by changes in sensation in your feet. 

• Circulation-related pain may get worse when you’re inactive or improve when you elevate your legs slightly. 

• Foot conditions often feel localized to specific areas of your foot — like the heel, arch, or ankle. For instance, plantar fasciitis pain typically centers on the bottom of the heel and often feels worse when you first get up after being off your feet. Arthritis-related pain may feel like a deep ache or stiffness in your joints, especially in your toes or ankle, and it may be accompanied by swelling. Tendonitis, particularly Achilles tendonitis, can create a burning or aching sensation around the heel or calf that’s often exacerbated after activity.

What can I do to treat nighttime foot pain?

Once we have an idea of what’s contributing to your nighttime foot pain, we can tailor your treatment plan. Here are some strategies I recommend: 

• Try nerve-mobilizing exercises before bed. Nerves need movement, blood flow, and space to stay healthy. Simple, gentle foot and ankle exercises or stretches before bed can promote mobility and may help reduce nerve-related discomfort.

• Elevate your legs or adjust your sleeping position. Slightly elevating your legs may improve circulation. If we suspect your pain is related to your back, sleeping with a pillow under your knees or trying some of the tips in this article may provide relief.

• Monitor your general health. If you have chronic conditions like heart disease or diabetes, make sure you see your primary care physician regularly. If you have diabetes, check your blood sugar as recommended and stay physically active throughout the day. Movement snacks can help improve circulation and keep your muscles and nerves healthy.

My main takeaway 

Addressing foot pain at night often involves understanding and managing underlying health conditions. A few adjustments in daily habits can often make a big difference in keeping nighttime foot pain at bay.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Daguet, I., Raverot, V., Bouhassira, D., & Gronfier, C. (2022). Circadian rhythmicity of pain sensitivity in humans. Brain, 145(9), 3225–3235. doi:10.1093/brain/awac147 

2. Weatherford, B. M. (2019, December). Arthritis of the Foot and Ankle. American Academy of Orthopedic Surgeons. Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-foot-and-ankle/

3. Francisco Javier Canca-Sanchez, Jose Miguel Morales-Asencio, Ana Belen Ortega-Avila, Gijon-Nogueron, G., Cervera-Garvi, P., Marchena-Rodriguez, A., & Jose Carlos Canca-Sanchez. (2024). Predictive factors for foot pain in the adult population. BMC Musculoskeletal Disorders, 25(1). doi:10.1186/s12891-023-07144-9

4. Halstead, J., & Munteanu, S. E. (2023). Current and future advances in practice: mechanical foot pain. Rheumatology Advances in Practice, 7(3). doi:10.1093/rap/rkad081