Most women, nor their Practitioners, never give the ageing of the feet and legs a thought during the perimenopause to post-menopause transition … that is until the client’s mobility becomes affected.
Positioning the menopause transition in health and ageing physiology during my doctoral studies, gave me incredible insight about why it is that over 80% of the 500,000 women globally, who have completed the MyMT™ Menopause Symptoms Quiz, report that they have sore joints.
Feet suffer significant stress throughout a lifetime and undergo ageing-associated problems.
According to researchers in Greece (Kakagia et al, 2023), this may be due to gradual tissue degeneration affecting the skin, connective tissue, and nerves, along with diminished oxygen supply to the tissues and structural changes to the joints, ligaments and tendons as women age.
Menopause may be the stage of life when many of these changes occur, especially the menopause to post-menopause transition.
Is Plantar Fasciitis the problem for aching feet?
The plantar fascia ligament forms the arch under the sole of your foot. It carry’s around 10% to 14% of the total load of the foot.
This means that it plays a dynamic role in walking, running and jumping. If you have clients who want to continue these activities as they get older, then it pays to have a focus on looking after this important structure in ageing feet.
Declining oestrogen during menopause plays a role in making the feet feel hot and sore and this is because the plantar ligament and the fascial sheath are changing with age, and can become inflamed – a condition called plantar fasciitis.
The plantar fascia is known as the ‘spring ligament’ for a reason. It is a strong ligament that runs from your heel to the metatarsal heads in the front of the foot.
This powerful ligament helps absorb the shock that occurs when the foot strikes the ground – walking, running, jumping, jogging, dancing – whatever your clients are doing with their exercise, the plantar ligament is helping them to do it. It helps them to ‘take-off’.
Plantar fasciitis is a relatively common condition in runners, walkers, and many others who spend considerable time on their feet, especially in jumping-type exercise and sports.
If your clients have hobbled out of bed in the morning, they may not fully understand that plantar fasciitis is characterized by pain at the bottom of the foot in front of the heel, and that this is typically worse with the first steps in the morning or after a long period off the feet, prolonged standing, or following hard exercise.
The pain may then reduce with movement or warming up.
When I reached my menopause transition, I remember hobbling out of bed every morning because I couldn’t walk properly.
The soles of my feet were tight, painful and my heels often used to ache, which I attributed to very dry, hard skin on my heels. I’ve talked to numerous women who experience this as well.
I just thought that after years, of teaching aerobics and running, that this was ‘normal’ ageing.
Hundreds of dollars later, having paid for orthotics, sports medicine advice and goodness knows how many anti-inflammatories and turmeric supplements, my feet weren’t all that better. Not one Practitioner mentioned menopause, nor the inflammatory and structural changes that arrive in the fascia and feet as women age.
It was only when I began to understand that the decline in oestrogen during menopause was the issue and the pain I was feeling, wasn’t completely due to plantar fasciitis.
Instead, inflammatory changes to the plantar fascia (see in the diagram how broad this is underneath the foot) was caused by increased drying-up and thickening of the fascial sheath, due to declining oestrogen.
A Focus on Feet is Important During Menopause
When I heard New York Podiatrist and ‘Foot Doctor’, Dr Emily Splichal, talk at a conference many years ago, I had another one of my ‘lightbulb moments’.
As the plantar ligament is ageing, the foot is one of the most important structures to focus on and strengthen. I teach this to all my client’s now via my exercise programme called ‘Rebuild My Fitness‘ – especially those clients who want to run, jump and hike as they get older.
Dr Splichal can be found on You Tube, and her presentation changed my focus towards looking after my feet. They call her the ‘The Barefoot Doctor‘ for a reason.
In my 12 week Rebuild My Fitness programme, I talk about Dr Splichal’s work in more depth. I like her rationale for focusing on feet as women get older.
She helped my understanding of the ageing feet. This includes the fact that many knee and hip problems may be associated with changes to the soles of the feet.
This completely opened up my mind to the possibilities of women managing their feet better during menopause.
After-all, it’s fascinating that 26 small bones are able to carry our body weight throughout our life. And we don’t really focus much on our feet do we?
We all take our feet for granted, but a generation of women are entering menopause, having been exercising for decades, unlike our mother’s generation. As such, if women are going to hike, walk, ski, jog or dance, as they get older, then encouraging them to reduce inflammation in the plantar ligament and to visit a Physiotherapist or Podiatrist if they are having problems, is important advice.
But there are also some strategies that Dr Splichal promotes for ageing feet and a plantar ligament that has lost some of its pliability due to dryness.
Gentle Trigger-Point Release for the Plantar Ligament
Gentle trigger-point release for the plantar fascia is promoted by Dr Splichal for all ageing feet!
She promotes a small ball rolling exercise for the sole of the foot, following the pattern in the image above.
This pattern helps to stimulate the small muscles of the foot to receive signals again from the fascia.
As women get older, this neural feedback mechanism may be lost, not only due to all the type of exercise women may engage in, or the exercise that they’ve engaged in, in the past, but also due to the declining oestrogen during menopause and the thickening of the fascia, which also contributes to neural desensitization in the sole of the foot.
This is just one way you can help your clients to improve their mobility and to move more freely, including the prevention of plantar fasciitis. If they already have plantar fasciitis, then obviously this needs to be referred to a Physiotherapist or Physical Therapist.
Dr Wendy Sweet (PhD), Member: Australasian Society of Lifestyle Medicine/ REPS registered Exercise Specialist (New Zealand)
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References:
Kakagia DD, Karadimas EJ, Stouras IA, Papanas N. The Ageing Foot. Int J Low Extrem Wounds. 2023 Sep 26:15347346231203279. doi: 10.1177/15347346231203279.
Menigoz W, Latz TT, Ely RA, Kamei C, Melvin G, Sinatra D. Integrative and lifestyle medicine strategies should include Earthing (grounding): Review of research evidence and clinical observations. Explore (NY). 2020 May-Jun;16(3):152-160. doi: 10.1016/j.explore.2019.10.005.
Wilke J, Macchi V, De Caro R, Stecco C. Fascia thickness, aging and flexibility: is there an association? J Anat. 2019 Jan;234(1):43-49. doi: 10.1111/joa.12902.
Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024 Jul 30:1-7. doi: 10.1080/13697137.2024.2380363.
