Guest Article, first published November 2022.
Link to original: https://www.pilates44.com/post/menopause-plantar-fasciitis-plan-tur-fas-e-i-tis
The majority of clients that I see dealing with Plantar Fasciitis are women that have gone through the hormonal changes of menopause.
They can experience heel and or foot pain on varying levels, from chronic flare ups to light heel pain when getting out of bed in the morning. It got me thinking about the loss of oestrogen directly impacting the flexibility throughout the female body. In this particular instance it was in relation to the pelvis, which all lower extremity muscle fibre either directly or indirectly connects to.
The plantar fascia serves as an elastic cushion for weight applied to the foot and also helps increase stability in the ankle. It is a thick fibrous connective tissue that originates at the heel and inserts at each of the 5 toes.
Research has shown that: “Women have significantly higher rates of anterior cruciate ligament (ACL) injuries and anterior knee pain than men. Previous studies have shown that ACL injuries are associated with changes in anterior and posterior cruciate ligament laxity due to changes in body temperature during the menstrual cycle and the effect of beta oestrogen receptors on these two ligaments. Investigations into the effect of oestrogen on the knee ligaments and the Achilles tendon raise questions about how the ligaments in the foot, such as the plantar fascia, might be altered during the menstrual cycle. It stands to reason that, if these same oestrogen receptors are found in the plantar fascia, the ligament will be most flexible at ovulation. This, combined with the known effects of oestrogen on more proximal aspects of the kinetic chain, should have the added effect of impairing postural control at ovulation.” 1
In laymen’s terms, our hormones influence collagen and elasticity within the ligaments of the body throughout stages of the menstrual cycle and menopause. Ovulation is the point when these ligaments are at their softest and most pliable. Therefore, when women move in to and then through menopause, or have had a Hysterectomy, which places the body in to early menopause, the laxity associated with the hormones is no longer there. We begin to feel ‘rigid and tight’ in the pelvic region. We tend to lose those fat pads from under our muscle tissue that helps to give our muscle form (*important to keep up resistance training) and as this happens we lose our bums; our biggest pelvic stabilizers. Our shape changes, our posture changes, the muscle synergy between quadriceps and hamstrings is interrupted and we can perhaps tend more towards a quad dominant movement pattern with short tight hamstrings and zero glute muscle = imbalance.
So what has that got to do with sore feet? Imagine you walking around all day on the balls of your feet. I am sure many of us have or do were raised to very high heeled shoes and feel that ‘tightness’ under the foot once we remove those shoes. That shortening and tightening of the plantar fascia can and does cause inflammation leading to varied levels of pain or chronic plantar fasciitis and even tears in the fascia.
What can we do?
Controlled resistance training, like Pilates. Either floor or equipment based. To build up and maintain glute muscles and strengthening the pelvic and hip muscles. As very simple exercise that can be done at home is Bridging with so many wonderful variations and benefits for the whole body. See our blog about Bridging.
Calf stretches and fascia release using a roller or even massaging your calves throughout the day. Our calves are very often forgotten and have such an important role to play with lymphatic drainage of the lower extremities. They are often called “The Second Heart” of the body. The body is engineered so that when you walk, the calf muscles pump venous blood back toward your heart.
Toe stretches. As easy as it sounds.
Sensible foot-ware (now I know I am getting older saying that) and going bare foot.
Foot strengthening and mobilisation exercises (did I say Pilates is great for this)
Simmone Cser-Pratzky, PAA Committee member
 The female ACL: Why is it more prone to injury?2016 Jun; 13(2): A1–A4. Published online 2016 Mar 24. doi: 10.1016/S0972-978X(16)00023-4