Women’s Foot Health Part 1: Athletes

WOMEN’S FOOT HEALTH PART I: considerations for a female athlete

An Article Written by Yen-Chii Wong
Podiatrist – New Step Podiatry

Over four articles we will explore women’s health considerations in podiatry. We will discuss considerations for a female athlete in the article, bone health for women here, foot changes during pregnancy here and foot changes during menopause here. Click on the links to access these articles.

Training around the menstrual cycle

Understanding the menstrual cycle and hormone activity for female athletes can really help in knowing when and what to train that best suit the body. Most women’s menstrual cycles last for 25-40 days. This diagram gives a good run down of performance in the menstrual cycle with information from Dr Stacy Sims, a leading expert in female athletic performance.

Period: hormone levels are at their lowest meaning physiologically the body is more like that of a male’s. Starts at the beginning of the follicular phase.

Training: more force and more strength can be produced and training may feel easier. Training can increase in intensity.

Follicular Phase: a gradual increase is estrogen levels with low progesterone.

Training: continue with higher intensity or heavier strength training with a taper as you approach ovulation and the luteal phase.

Ovulation: estrogen levels are at their highest.

Training: you may feel flat or sluggish so don’t push it too much. This can be a recovery day.

Luteal Phase: estrogen and progesterone are high. PMS (prementrual syndrome) can occur with mood changes.

Training: decrease endurance capacity. Switch to low to moderate intensity exercise with more recovery. Coordination and reaction time may be reduced.

597701- TK Ways to Make Your Period Work for You
Kuikman, M. (2021). Nutrition across the menstrual cycle. https://megankuikmanrd.ca/menstrualcycle/

The Female Athlete Triad

The Female Athlete Triad consists of three main symptoms that can lead to a decrease in physical performance and general health. These symptoms are:

– Low energy availability

This occurs when the amount of food being eaten (energy input) isn’t enough to sustain the level of physical activity (energy output)

– Menstrual disturbance

Big changes in your period – in some cases complete loss of your period – is bad news. It means the body isn’t getting enough energy and is taking energy from functions it deems ‘non-essential’, like the reproductive system.

– Low bone density

This can occur from low energy availability, high levels of activity, and deficiencies in certain nutrients. Having low bone density can predispose you to injuries like stress fractures and can lead to bone pathologies like osteopenia and osteoporosis.

More recently, The Female Athlete Triad has been modified and is now known as RED-S (relative energy deficiency in sport), which recognises that this condition can affect both females and males.

Statuta SM, Asif IM, Drezner JARelative energy deficiency in sport (RED-S)British Journal of Sports Medicine 2017;51:1570-1571.

Physiological Differences

It’s no surprise that female and male bodies are physiologically different. Some of these differences can alter athletic performance.

– Females have a higher proportion of body fat, which means there is more reliance on fat over carbohydrates for fuel.

– Females have larger type 1 muscle fibres which are used mostly in endurance sports. Type 2 muscle fibres are used more for power output. This means females may have a higher capacity for endurance-based or ‘long and slow’ sports.

– Females have smaller heart and lung volume with less oxygenated blood pumped out per beat, which means respiratory muscles have to work harder and use more energy.
– Females tend to sweat later into a vigorous activity and retain more heat. It may take longer for females to cool down after sport.


Beck, B., & Drysdale, L. (2021). Risk Factors, Diagnosis and Management of Bone Stress Injuries in Adolescent Athletes: A Narrative Review. Sports (Basel, Switzerland), 9(4), 52. https://doi.org/10.3390/sports9040052

Kuikman, M. (2021). Nutrition across the menstrual cycle. https://megankuikmanrd.ca/menstrualcycle/

Statuta SM, Asif IM, Drezner JA
Relative energy deficiency in sport (RED-S)
British Journal of Sports Medicine 2017;51:1570-1571.

Sims, S. T., & Yeager, S. (2016). Chapter 2: Demystifying and Mastering your Menstrual Cycle. In ROAR (pp. 24-41). Rodale Books.

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