Why does Menopause cause foot pain?

All women will go through menopause and expect to experience on occasion low mood, hot flushes, brain fog and poor sleep, but one of the unknown and maybe less recognised issues are foot problems associated with the menopause.  Research has shown that there is a lower quality of life related to foot health problems with women who are experiencing menopause or who are postmenopausal. 11% of women aged 45 to 64 reported experiencing musculoskeletal problems and over 9% were recorded as having back pain and problems*. 

Menopause and perimenopause can occur any time from the age of 35 to 55. During this time, the body will start to produce less oestrogen. One of oestrogen’s roles in the body is to support the production of collagen. Collagen is responsible for maintaining strength, flexibility and elasticity of bone, skin, muscles and tendons. 

When oestrogen levels fall this can reduce collagen production, which affects bone density, muscle loss, flexibility in skin, tendons and muscle tissue**. All of these factors can influence the feet.  

What does this mean for your feet?

1. Lack of cushioning and sensation of burning

   The balls of your feet are cushioned by a thick pad of connective tissue that is specifically designed for shock absorption. This can thin over time, especially with the reduction of oestrogen levels and can result in a burning or bruising sensation to the soles of your feet.  You can help yourself by using cushioned supportive footwear. Options available from a Podiatrist include addressing any biomechanical imbalances and providing in shoe devices to help with cushioning and in some cases injectable fillers maybe suitable.
   

2. Corns and bunions occur or become worse
   Bunions that are already present can become worse during this time, or you may develop new callus/corn or bunion issues. All of these can be helped by wearing appropriately fitted footwear but a podiatrist is able to provide you with solutions such as removal of corns, improving foot mechanics to reduce bunion pain by addressing underlying biomechanics. Surgery is also an option in some cases.
   

3. Heel pain and Plantarfaciitis
   Plantarfasciitis is an inflammation of the tissue surrounding the band of fibrous tissue that runs along the bottom of the foot***. It can cause pain, soreness or tenderness in the sole under the heel and sometimes up into the arch. You can help yourself by doing calf stretches, taking anti-inflammatory medication, using heat packs and wearing cushion supportive footwear both indoors and outdoors.  There are more advanced therapies which can be provided by your Podiatrist, which include shockwave therapy, ultrasound, steroid injections, plantar fascia release, foot mobilisations, dry needling, night splinting, gait analysis and orthotics to correct any imbalance and surgery.
   

4. Osteoporosis and stress fractures
   Osteoporosis/osteopenia is the reduction in bone density and therefore a reduction in the strength. This can be helped by specific exercise plans such as the Onero™ program which is conducted under guidance from a physiotherapist.  Stress fractures can be managed with appropriate offloading techniques, casting and minimising high impact activity. Once the stress fracture is healed, then addressing the underlying biomechanical changes will help prevent further stress fractures from occurring.  Your Podiatrist is able to do this for you.
   

5. Tendon Pain
   Tendinopathy/tendinitis is another common foot and ankle issue which is more common in women and often present in the 5th and 6th decade.  Adult acquired flat foot has a peak prevalence at 55 years old****. Early intervention is vital to reduce damage to tendons and get back to pain free activity.
   

A Podiatrist should be your first contact when foot pain is present as they are the foot and ankle experts and will be able to diagnosis, plan and execute a course of treatment for you.  They may also refer on to Podiatric Surgeons or Foot and Ankle Orthopedic Surgeons.

Sources

* Australian Institute of Health and Welfare (2016). Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011. https://www.aihw.gov.au/reports/burden-of-disease/abds-impact-and-causes-of-illness-death-2011/contents/highlights 

** Nkechinyere, C-O., Baar, K. (2018). Effect of estrogen on musculoskeletal performance and injury risk. Frontiers in Physiology, 9: 1834. Published online 2019 Jan 15. doi: 10.3389/fphys.2018.01834 

*** Planter heel, pain and fasciitis. Landorf, KB, Menz HB.  BMJ Clin Evid. 2008 Feb 5;2008:1111PMID: 19450330. Free PMC article

**** Deland, JT (2008).  Adult Acquired Flat Foot Deformity. Journal of American Academy of Orthopaedic Surgeons 16:7 p399-406