Is There a Link Between Menopause and Plantar Fasciitis? Exploring the Hormonal Connection to Heel Pain
If you’ve ever rolled out of bed and winced with that first sharp step under your heel — you know plantar fasciitis. It’s one of the most common causes of heel pain, affecting about 1 in 10 people at some point in their lives. It’s especially common in runners, people who stand a lot for work, and anyone with stiff feet or limited ankle mobility.
But there’s another pattern that often flies under the radar: Plantar fasciitis disproportionately affects women — particularly those between the ages of 45 and 64.
That detail alone is enough to make clinicians and researchers pause. Why women? And why during midlife?
Let’s unpack what’s known — and what’s still hypothetical — about the link between menopause and plantar fasciitis.
The Basics: What Exactly Is Plantar Fasciitis?
Plantar fasciitis is an overuse condition of the plantar fascia, a thick, fibrous band of connective tissue that runs along the bottom of the foot from the heel to the toes. Its job is to support the arch and help absorb the load with every step.
Over time, repetitive stress — from walking, running, or even standing too long — can cause microtears in the fascia, especially near its attachment on the heel bone.
Interestingly, despite the name “-itis,” meaning inflammation, true inflammatory markers are often absent when imaging or biopsy is done. Instead, ultrasound and MRI findings tend to show:
Thickening of the plantar fascia
Microtears and small calcifications
Degenerative (not inflammatory) tissue changes
That’s why many experts now refer to the condition as plantar fasciopathy — emphasizing that it’s more of a degenerative process than an acute inflammatory one.
Who Gets Plantar Fasciitis — and Why?
Plantar heel pain is common in certain populations. Some of the biggest contributing factors include:
Repetitive strain and overuse: Common in runners and people who walk or stand for long periods.
Foot stiffness: Limited mobility in either pronation or supination can alter load through the plantar fascia.
Limited ankle dorsiflexion: When the ankle joint doesn’t bend easily, the fascia takes on more tension during gait.
Footwear: Narrow, rigid shoes or those with elevated heels can shift weight distribution and tighten the fascia over time.
Heel spurs: About 50% of people with plantar heel pain have a visible bone spur on X-ray (though the spur itself isn’t always the cause).
For physical therapists and clinicians, plantar fasciitis is a familiar face — it’s the most common cause of heel pain seen in outpatient clinics, accounting for around 15% of all foot injuries and 10% of running-related injuries.
The Gender Divide: Why Women Are More Affected
Across studies, plantar fasciitis consistently appears more common in women than men. One large-scale epidemiological study found the peak incidence in women aged 45–64, compared to a lower rate in younger women (ages 18–44) or men of any age group.
So, what changes during that midlife period that could increase risk?
One obvious consideration is footwear history — decades spent in narrow, pointed shoes or high heels can reshape foot structure over time. Elevated heels shorten the calf muscles and Achilles tendon, reducing ankle dorsiflexion and increasing tension through the plantar fascia.
But footwear alone doesn’t fully explain the trend. Many women who experience plantar fasciitis during midlife are no longer wearing heels regularly. This is where hormonal and tissue-level factors come into play — specifically, the role of estrogen.
The Menopause Connection: What Happens to Connective Tissue
During menopause, estrogen levels drop significantly. And while most people associate estrogen with reproductive health, its influence reaches far beyond that — including the musculoskeletal system.
Estrogen plays a key role in:
Collagen synthesis (the main structural protein in tendons, ligaments, and fascia)
Tissue elasticity
Muscle mass and repair
Circulation and cellular recovery
When estrogen declines, several things happen at the tissue level:
Collagen production slows, leading to stiffer, less elastic tendons and ligaments.
Muscle mass decreases, affecting the balance of tension across joints.
Recovery from micro-injury slows, making chronic overuse conditions more likely.
The plantar fascia is particularly vulnerable because it’s a dense ligamentous structure with very limited blood supply — meaning it already heals slowly under normal circumstances. Add in a decline in collagen quality and elasticity, and it’s not hard to see how menopausal tissue changes could make the fascia more susceptible to overload and degeneration.
Why This Hypothesis Makes Sense
Let’s connect the dots.
Plantar fasciitis peaks in women between 45–64 years old — the same window as perimenopause and menopause.
Estrogen directly affects collagen production and tissue elasticity.
The plantar fascia is collagen-dense connective tissue — meaning any decline in collagen quality could affect its mechanical resilience.
Post-menopausal women often experience muscle loss (sarcopenia) and reduced lower limb strength, which can shift load distribution through the feet.
Footwear history and changes in activity during this stage of life can add layers of mechanical stress.
From a physiological perspective, the connection tracks.
While there isn’t yet definitive research confirming that menopause causes plantar fasciitis, the mechanistic overlap between hormonal changes, tissue properties, and mechanical load is strong enough to warrant more investigation.
The Current Research Landscape
As of now, research directly linking menopause and plantar fasciitis is sparse. Most existing studies focus on:
Epidemiology: showing higher incidence rates in midlife women
Biomechanics: examining how reduced ankle mobility or altered foot mechanics contribute to stress
Hormonal effects on tendons: revealing estrogen’s protective role in tendon and ligament health
In fact, a 2021 review in Frontiers in Physiology highlighted that estrogen deficiency is associated with decreased collagen turnover and increased tendon stiffness, particularly in load-bearing tissues like the Achilles tendon.
If the Achilles is affected, it’s logical that the plantar fascia — which functions as part of the same posterior chain — may be influenced in similar ways.
Some clinicians have begun to explore this overlap in practice, noting higher rates of chronic plantar heel pain, Achilles tendinopathy, and other connective tissue issues in postmenopausal women. But large, controlled studies are still lacking.
How This Insight Can Guide Prevention and Treatment
Even if we can’t yet prove causation, understanding this potential link opens up meaningful opportunities for prevention and care — especially for women in or approaching menopause.
Here are several strategies I emphasize with clients in this stage of life:
1. Prioritize Foot Strength and Mobility
Gentle strengthening for the intrinsic foot muscles, combined with mobility work for the ankle and calf, can help restore natural load distribution.
Pronation drills and short-foot exercises strengthen the arch.
Calf stretching and ankle dorsiflexion drills improve fascial flexibility.
2. Choose Footwear That Supports Natural Function
Shoes should allow the toes to splay and the foot to move freely. Avoid narrow toe boxes or elevated heels that keep the fascia under tension.
(If you’re unsure where to start, my Footwear for Pain-Free Feet Guide walks through key considerations for fit, toe box width, and bunion-friendly options.)
3. Load the Fascia Gradually
Controlled loading — like heel raises or eccentric calf work — helps stimulate collagen remodeling. Progress slowly, especially after periods of inactivity or hormonal transition.
4. Support Systemic Health
Adequate protein, vitamin C, and collagen precursors support connective tissue integrity. Discuss hormone replacement therapy (HRT) with your physician if appropriate, as emerging research suggests it may help preserve tendon health in some women.
5. Don’t Ignore Early Symptoms
Morning heel pain is an early red flag. Addressing it early with targeted movement, footwear modifications, and load management can prevent months of chronic pain.
The Bottom Line
Right now, the evidence connecting menopause and plantar fasciitis is correlational, not causal — but the pieces fit together compellingly.
Declining estrogen levels lead to reduced collagen production and tissue elasticity, both of which affect how the plantar fascia handles repetitive load. Combine that with biomechanical changes, footwear history, and lifestyle shifts in midlife, and it’s no surprise that women in the menopausal transition represent the highest-risk group for plantar fasciitis.
Future research will need to explore this connection in depth — ideally comparing pre- and post-menopausal tissue changes and recovery rates in plantar fascia injuries. But even now, this hypothesis helps clinicians and women alike understand why midlife heel pain might not just be “bad luck” or “overuse” — it could be part of a broader systemic shift.
So, if you’re in your 40s, 50s, or beyond and noticing new heel pain creeping in — you’re not alone, and it’s not in your head. Your tissues are changing, but your capacity to move, adapt, and heal remains. With the right movement strategies, footwear choices, and awareness, your feet can stay strong and pain-free through every phase of life.