Muscle and joint pain, or musculoskeletal symptoms, are among the most common complaints during menopause, affecting 65% of women. These aches and pains can be generalised across all joints and muscles or localised to specific areas.
I frequently meet women in our clinic who suffer from conditions such as plantar fasciitis or frozen shoulder without an obvious cause, and effective treatment often relieves them of these issues.
Learn more about the link between hormones and common musculoskeletal conditions, including plantar fasciitis
Introduction
Plantar fasciitis is one of the most common causes of heel pain, affecting up to 10% of people at some point in their lives. It is characterised by inflammation of the plantar fascia, a thick band of tissue that runs along the sole of the foot, connecting the heel to the toes. The condition typically presents as a sharp, stabbing pain in the heel, particularly when taking the first steps in the morning or after periods of inactivity.
While plantar fasciitis is often associated with athletes or individuals who spend long periods on their feet, research and clinical observations suggest a potential link between plantar fasciitis and menopause. Hormonal changes, particularly the decline in oestrogen levels, may contribute to the onset or worsening of plantar fasciitis in menopausal women. Understanding the relationship between these factors is crucial for effective management and prevention.
The Role of Hormones in Musculoskeletal Health
Menopause is marked by significant hormonal changes, most notably a reduction in oestrogen and progesterone levels. Oestrogen plays a key role in maintaining the health of connective tissues, including tendons, ligaments, and cartilage. It aids in the production of collagen, which provides strength and elasticity to these tissues, and also possesses anti-inflammatory properties. As a result, the decline in oestrogen during menopause can have a negative impact on musculoskeletal health, including the structures within the feet.
Oestrogen and the Plantar Fascia
The plantar fascia is a fibrous band that supports the arch of the foot and absorbs shock during movement. Like other connective tissues in the body, it relies on collagen for its elasticity and tensile strength. Oestrogen helps regulate collagen production and ensures that the tissue remains flexible. With the drop in oestrogen levels during menopause, the plantar fascia may become less pliable and more susceptible to microtears and inflammation, increasing the risk of plantar fasciitis.
Risk Factors for Plantar Fasciitis in Menopausal Women
Along with hormonal changes, several other factors common during midlife can increase the risk of developing plantar fasciitis in menopausal women:
Weight Gain: Weight gain is a frequent occurrence during menopause, partly due to changes in metabolism and lifestyle. Increased body weight places additional stress on the plantar fascia, leading to overloading and strain. The extra pressure on the heel can trigger inflammation and lead to plantar fasciitis.
Changes in Foot Structure: Age-related changes in foot biomechanics, such as a reduced arch height (fallen arches) and altered gait patterns, can contribute to plantar fasciitis. These changes may be exacerbated by hormonal shifts during menopause, further straining the plantar fascia.
Decreased Activity Levels: Many women experience joint discomfort, muscle stiffness, or fatigue during menopause, leading to a reduction in physical activity. This can weaken the muscles supporting the arch of the foot, placing more strain on the plantar fascia.
Bone Health and Osteopenia/Osteoporosis: Menopausal women are at a higher risk of bone density loss due to reduced oestrogen. While plantar fasciitis is primarily a soft tissue condition, weakened bones in the feet, as seen in osteopenia or osteoporosis, may aggravate symptoms by altering foot mechanics or causing compensatory movement patterns.
Diagnosis and Management of Plantar Fasciitis in Menopausal Women
Diagnosis
Plantar fasciitis is usually diagnosed based on clinical symptoms, such as heel pain that worsens after rest. In some cases, imaging techniques such as ultrasound or MRI may be used to assess the plantar fascia and rule out other causes of foot pain, such as stress fractures or heel spurs.
Management
Treating plantar fasciitis in menopausal women should focus on relieving symptoms and addressing the underlying factors that contribute to the condition, such as hormonal changes and lifestyle factors.
Footwear and Orthotics: Wearing supportive, properly fitted footwear and using custom orthotics can help distribute pressure evenly across the foot, reducing strain on the plantar fascia. Shoes with cushioned soles and adequate arch support are particularly beneficial.
Physiotherapy: Stretching exercises targeting the Achilles tendon, calf muscles, and plantar fascia can improve flexibility and reduce strain. Strengthening exercises for the foot and lower leg muscles can also help support the foot’s arch, lowering the risk of recurrence.
Weight Management: Maintaining a healthy weight can reduce excess pressure on the plantar fascia. A balanced diet, regular physical activity, and addressing any metabolic changes associated with menopause can assist with weight management.
Hormone Replacement Therapy (HRT): While HRT is not a primary treatment for plantar fasciitis, it may help mitigate the musculoskeletal effects of oestrogen deficiency during menopause. Body-identical HRT, which provides regulated doses of oestrogen and progesterone, may help maintain connective tissue health, including that of the plantar fascia, and reduce inflammation. However, the decision to use HRT should be made on an individual basis and after thorough discussion of the risks and benefits with a healthcare professional.
Other Interventions: In severe cases, treatments such as corticosteroid injections or shockwave therapy may be considered. However, caution is advised in menopausal women, especially those with weakened bones, as these interventions may increase the risk of tissue or bone damage.
Conclusion
Plantar fasciitis can be a painful and disabling condition, and its incidence may rise in women going through menopause due to hormonal changes, weight gain, and age-related alterations in foot structure. Recognising the potential link between menopause and plantar fasciitis can help guide more effective prevention and treatment strategies. Incorporating lifestyle modifications, appropriate footwear, physiotherapy, and hormone replacement therapy where appropriate can help menopausal women manage plantar fasciitis and improve their overall foot health.
By addressing the unique challenges faced by menopausal women, healthcare providers can offer a comprehensive approach to managing plantar fasciitis and other musculoskeletal conditions associated with hormonal changes.
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