Plantar fasciitis: foot pain and menopause

How menopause can affect your feet

• Plantar fasciitis is a painful condition affecting the feet
• Age, footwear, activity and weight can all play a part – as well as hormone changes during perimenopause and menopause
• Advice and tips on how to manage this condition

We all know the familiar aches and pains being on your feet all day can bring, as well as the toe-curling pinch from wearing a too-tight pair of shoes.

But what about when foot pain becomes more troublesome and frequent – and why can this happen?

Menopause is so often framed in terms of hot flushes and night sweats, when in fact hormone changes at this time can trigger a range of symptoms, including aches and pains throughout the body. And one issue where menopause can play a part is plantar fasciitis, a condition which causes pain on the bottom of your foot, and around your heel and arch [1].

RELATED: Perimenopause, menopause, aches and pains

Here, balance looks at the causes of this condition, the link to hormone changes in menopause – plus advice on what you can do to bring some relief to your feet.

Plantar fasciitis explained

Up to one in ten adults are thought to be affected by plantar fasciitis, which is the inflammation of the plantar fascia – a tough, fibrous band of tissue that runs along the sole of the foot and used during foot movement and walking [2, 3].

The plantar fascia attaches to your heel bone and to the base of your toes, helping to support the arch of your foot, and acts like a ‘bow string’ to stiffen your foot when you walk. When the plantar fascia becomes inflamed, it can lead to pain, stiffness and tenderness.

According to NHS.uk, the cause of your foot pain is more likely to be plantar fasciitis if:

• Pain is much worse when you start walking after sleeping or resting
• Pain feels improves while during exercise, but returns after resting
• You find it difficult to raise your toes off the floor [1].

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Risk factors

Plantar fasciitis is more common between the ages of 40 and 60 and is more common in women than men [4]. Other risk factors can include:

• An increase in your activity level, such as embarking on a new fitness programme
• The structure or shape of your foot – people with high arches, flat feet or other arch problems are more likely to develop plantar fasciitis  
• Ill-fitting footwear
• Weight.

RELATED: Chronic pain and menopause: what’s the link?

What’s the link between plantar fasciitis and menopause?

Plantar fasciitis is also linked to fluctuating and falling hormone levels during perimenopause and menopause.

‘Many women complain of foot pain, especially first thing in the morning when they get out of bed,’ explains balance founder Dr Louise Newson.

‘During perimenopause and menopause, levels of hormones oestradiol [a type of oestrogen], progesterone and testosterone decline and then stay low forever. These three hormones have numerous beneficial effects throughout your body: they reduce inflammation everywhere, including in the musculoskeletal system.

‘This means when women have low levels of these hormones there is often more inflammation in the muscles, joints and soft tissues. This can lead to symptoms of muscle and joint pains and stiffness, and for some women conditions such as plantar fasciitis, carpal tunnel syndrome, frozen shoulder or more generalised arthritis.’

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Low levels of oestradiol can reduce the elasticity of the plantar fascia. Plus, oestradiol is also important in creating collagen, a protein which provides structure and flexibility to your skin, bones, muscles and tendons. Degeneration of collagen in the sole of your foot can also lead to plantar fasciitis occurring.

Changing hormone levels during perimenopause and menopause can also contribute to weight gain, which is another risk factor for plantar fasciitis. During perimenopause and menopause, your body looks to combat falling oestradiol by trying to obtain it elsewhere – chiefly a different form of the hormone produced by fat cells called oestrone. Oestrone is less effective than oestradiol, the most potent type of oestrogen, and it’s also inflammatory in your body.

This can lead to weight gain, and you might also have strong cravings for foods high in sugar or unhealthy fats, which your body will, in turn, lay down as oestrone-producing abdominal fat.

RELATED: How the Mediterranean diet can help menopausal symptoms

Managing plantar fasciitis

If you suspect your foot pain may be due to plantar fasciitis, here at some strategies recommended by NHS.uk that you can try at home. They include:

• Rest: avoid walking or standing for long periods, and rest and raise your foot on a stool when you can
• Ice: place an ice pack (or bag of frozen peas) in a towel and apply it to the painful area for up to 20 minutes every two to three hours
• Try regular stretching exercises
• Think about your footwear: look for shoes with cushioned heels and good arch support, or use insoles or heel pads in your shoes – and avoid anything too tight-fitting or high
• Switch up your exercise routine: try exercises that don’t involve putting pressure on your feet, such as swimming
• Try to maintain a healthy weight
• Over the counter painkillers such as paracetamol can help

Hormone replacement therapy (HRT), the first-line treatment for management of menopause-related symptoms is also worth considering [5].

‘Many women who take HRT, often with testosterone, find that their muscle and joints pains, as well as symptoms related to their plantar fasciitis, really improve,’ Dr Newson adds.

RELATED: Read more articles on HRT here

When to see a healthcare professional

You should see your GP if your foot pain is severe and is preventing you from doing normal activities, if your pain is getting worse or hasn’t improved after self-treating for two weeks. In addition, if you have any tingling or loss of feeling in your foot, or you have diabetes and foot pain, then you should seek medical advice.

If your plantar fasciitis does not improve, your GP may refer you to a physiotherapist or a podiatrist for further treatment.

References

1. NHS.uk (2022), ‘Plantar Fasciitis’
2. National Institute for Health and Care Excellence (2020), ‘Plantar fasciitis: how common is it?’
3.  Johns Hopkins Medicine ‘Plantar Fasciitis’
4. Nahin, R.L. (2018), ‘Prevalence and pharmaceutical treatment of plantar fasciitis in United States adults’, The Journal of Pain, vol.19,8, pp.885-96. doi:10.1016/j.jpain.2018.03.003
5. National Institute for Health and Care Excellence (2015), ‘Menopause: diagnosis and management’