Changes in estrogen and progesterone levels during perimenopause and menopause may make some women more prone to a painful foot condition called plantar fasciitis. It occurs when the collagen fibers of the plantar fascia — a strong band of tissue that connects the heel bone to the base of the toes — begin to degenerate, often causing microtears.(1)(2)
Plantar fasciitis, also known as plantar fasciopathy, differs from tendinopathies, such as tendonitis, because it’s not characterized by inflammation. People with plantar fasciitis experience sharp heel pain. The condition has been shown to affect women more than men and is most common among people ages 40 to 60.(2)(3)(4)
Hormonal fluctuations can affect women’s musculoskeletal health as they age. For this reason, menopause may trigger or worsen foot problems like plantar fasciitis. Understanding the influence of hormones on the body’s connective tissues can help women seek effective treatment for this condition and other types of musculoskeletal pain that may emerge during this phase of life.
The Connection Between Menopause and Plantar Fasciitis
Declining levels of estrogen and progesterone can impact the structure and function of the body’s connective tissues, including the plantar fascia, which is essential for arch support, shock absorption, and overall foot health.(1)(2)(5)
The body’s ligaments, tendons, and muscle tissues all have estrogen receptors. Estrogen promotes collagen production and tissue elasticity. One study found that the elasticity of the plantar fascia changed throughout women’s menstrual cycle, suggesting a connection with the sex steroid hormones. It’s believed that a loss of estrogen may cause increased rigidity in the body’s connective tissues, potentially leading to musculoskeletal pain.(1)
Studies have also found joint pain and body aches to be associated with the use of aromatase inhibitors, a medication that blocks estrogen production in postmenopausal women with breast cancer.(1) The researchers proposed that sudden decreases in estrogen levels may increase nociception, which is the system of neural communication between the brain and the sensory neurons responsible for detecting potential threats to the body’s tissue. These studies further illustrate a connection between hormonal imbalances and musculoskeletal pain, which may include cases of plantar fasciitis during menopause.
Symptoms of Plantar Fasciitis During Menopause
The primary symptom of plantar fasciitis is sharp, stabbing heel pain. The pain tends to be most intense when patients first wake up and begin walking. The discomfort typically improves as the patient continues to walk but returns as physical activity increases throughout the day. Pain symptoms may also flare up after extended time spent sitting or standing.(2)(3)
Some patients may also present with high arches, flat feet, or tightness of the Achilles tendon. Diagnostic imaging tests may reveal symptoms of swelling or thickening of the plantar fascia.(2) Because foot pain and body aches are common symptoms of menopause, it can be difficult to distinguish these symptoms from symptoms of plantar fasciitis.
Plantar Fasciitis Risk Factors
The following factors may increase the risk of plantar fasciitis in menopausal women:(2)(3)
Physical Risk Factors
Obesity
Thinning of the heel pad
High foot arches
Flat feet
Overpronation (the foot rolls inward)
Underpronation (the foot rolls outward)
Reduced ability to flex the ankle
Tight foot or calf muscles
Different leg lengths
Lifestyle Risk Factors
A sedentary lifestyle
Jobs involving a lot of walking or standing
Can HRT help plantar fasciitis?
Research findings are mixed, but hormone replacement therapy (HRT) can help preserve skeletal muscle function and tendon elasticity as women age. A study found that postmenopausal women who used oral estrogen replacement therapy (ERT) displayed higher collagen turnover and reduced tendon stiffness compared to women who did not use HRT. Findings suggest that replenishing declining hormone levels during menopause may help maintain the health of women’s connective tissue later in life. While HRT may alleviate musculoskeletal pain, it’s not a direct treatment method for plantar fasciitis.(1)(6)
Treatment Options for Plantar Fasciitis
Up to 80% of individuals treated for plantar fasciitis experience improvement in symptoms within one year.(2)(3) A podiatrist may recommend the following non-operative treatment methods for women with plantar fasciitis:(2)(3)(4)(7)(8)
Rest from Physical Activity
It’s recommended to avoid or reduce any physical activity that may aggravate foot pain. Applying ice or a cold compress to the heel after the activity can help reduce pain.
Plantar Fascia Stretches
Stretching techniques for plantar fasciitis used to focus on strengthening the Achilles tendon to increase ankle flexibility and consequently reduce the risk of the condition. However, research suggests that stretches involving the plantar fascia, such as heel drop exercises, may be more effective.
Low-Dye Taping
A treatment known as low-dye taping may be recommended for people with overpronation. It involves wrapping the foot with athletic tape to reposition it in a way that reduces pain. Taping is most effective as a short-term treatment method.
Supportive Shoes
Wearing shoes that don’t fit properly can exacerbate heel pain. Hard shoes that lack cushioned insoles or adequate arch support can also worsen plantar fasciitis symptoms. Some research suggests that high-heeled shoes may help reduce pain by taking pressure off the heel and placing it more towards the front of the foot. However, some experts caution that heels that are too high may have the opposite effect. Supportive shoes with padded insoles and proper arch support are recommended for symptom management.
Shoe Inserts and Night Splints
Wearing footwear designed to reduce foot problems can help improve symptoms. Prescription orthotics support the foot arches, reduce pronation, and relieve pressure on the plantar fascia. Prefabricated silicon heel inserts may also reduce foot pain. Some research indicates that using orthotics in combination with night splints, which are designed to keep the ankle in place overnight, may be more beneficial for pain relief than only wearing orthotics.
Deep Friction Massage
Deep friction massage focuses on the body's muscles, ligaments, and tendons. It has been used for the management and treatment of tendinopathies. Using deep friction massage to target specific areas of the foot may help alleviate pain.
Acupuncture Treatment
Research supporting the efficacy of acupuncture treatment for plantar fasciitis is limited. However, it may help reduce heel pain by stimulating the nerves in specific areas of the feet and legs.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Oral or topical NSAIDs can be used to reduce mild pain symptoms.
Advanced Treatment Options for Plantar Fasciitis
For cases of plantar fasciitis that do not improve with traditional treatment approaches, a doctor may recommend the following:(2)(3)(4)
Extracorporeal Shock Wave Therapy
Extracorporeal shock wave treatment involves the administration of low-energy waves through vibration to increase blood flow.
Injections
Different types of injections may be used to help treat plantar fasciitis. Corticosteroid injections can provide short-term pain relief and reduce swelling. Botulinum toxin injections have been shown to reduce pain and increase foot function in plantar fasciitis patients. Alternatively, platelet-rich plasma injections are believed to stimulate tissue regeneration.
Surgery
Surgery is not a common treatment method for plantar fasciitis. However, a fasciotomy procedure may be recommended if symptoms persist for six to 12 months following non-operative treatment. The surgery involves cutting through the fascia to alleviate tension. Complications can occur, including fascia rupture, nerve injury, or collapse of the foot arch.
Managing Plantar Fasciitis During Menopause
While injury and overuse are common causes of plantar fasciitis, aging and hormonal fluctuations can also influence its development. However, menopausal women don’t have to live with musculoskeletal pain. There are various treatment options available to help manage plantar fasciitis and other common body aches that may occur during menopause.
Taping, the use of orthotics, and targeted stretching are a few of the many non-operative treatment methods a doctor may recommend as part of an individualized treatment plan. In more severe cases, advanced or operative treatments may be advised.
It’s crucial for perimenopausal or menopausal women who are experiencing foot problems to consult with a podiatrist. A healthcare provider can offer treatment recommendations depending on the cause, which may include HRT, physical therapy, or other pain management strategies.
