WOMEN’S FOOT HEALTH PART IV: Menopause and 4 Ways it can Impact Feet

An Article Written by Cecilia Brennan
Podiatrist – New Step Podiatry

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

The Stages of Menopause

Further information outlining the stages menopause and about menopause can be found at the Australian Menopause Society’s What is Menopause – Information Sheet here

Perimenopause

– 8-10 years before menopause

– Lasts right until menopause

– The ovaries gradually produce less oestrogen (sex hormone). This decline accelerates in the 1-2 years prior to menopause.

– Symptoms of menopause can occur and menstrual cycles can occur

– Pregnancy can still occur.

– Usually diagnosed clinically on the basis of new onset vasomotor or other symptoms and a change in the pattern of menstrual bleeding.

– Measuring oestradiol or FSH is generally not indicated because of marked daily fluctuations (unless early age menopause is suspected).

Menopause

– Refers to the time when menstrual periods have stopped for 12 months.

– It is not diagnosed until you’ve gone 12 months without any period at all. Once you’ve passed through menopause, you’re in postmenopause.

– The point when the ovaries stop releasing eggs and producing most of their estrogen.

– Average age is 51 and normal range is 45-55 and can even occur in 60s.

Postmenopause

– Commences 12 months after menstrual periods have ceased / when a woman has had no periods for 12 consecutive months.

– This stage continues for the rest of life.
 

What are some changes to the feet and legs that can occur with menopause?

Dry & Thin Skin

Collagen is a protein in our body found in bones, muscles, skin and tendons. Think of it like scaffolding that provides strength and structure. There is a strong correlation between a decline in oestrogen and skin collagen loss due to menopause (Calleja-Agius & Brincat 2015).

Furthermore, changes in oestrogen and other hormone levels at menopause decrease the water content, elasticity and thickness of skin. Basically, the skin’s scaffolding isn’t as strong. This means more dry, thin, easily bruised & wrinkle prone skin. Healing for grazes and cuts can take longer.

For the feet you may notice dry cracks around the heels that are prone to splitting. Not only are these painful but are at risk of bacterial and fungal infections. Podiatrists recommend applying a moisturiser to improve the moisture content of your skin and you must check our blog on heel cracks here for further explanation and care.

Dry skin can be itchy. If you scratch itchy skin, the skin will be damaged, irritated and possibly inflamed which will make it even more itchy. It’s a good idea to regularly apply a calming moisturiser to your skin to prevent dry itch.
 

Foot Pain

The relationship between menopause and foot pain is quite multifaceted. Let’s outline some:

1. Weight gain and/or difficulty reducing body mass increases the amount and time period the additional kgs are placing on your lower limb joints, muscles, ligaments and bones. This increased loading can contribute to pain and injuries.

2. The foot shape of a women who is postmenopausal and has a high Body Mass Index (BMI) is more likely to be a flat footed / have a lower arch. Flat feet are a risk factor for certain lower limb and foot injuries.

3. Fat weight gain is more likely to occur around the abdomen and for some reason (researchers don’t fully understand this yet) the fact that it’s fatty weight as opposed to leaner muscle it more likely to cause lower limb pain. Furthermore, the location increases the risk of lower limb pain i.e. if someone puts on weight but it’s more on the thighs, they are less likely to have lower limb pain than someone who puts weight on around the abdomen (Peiris et all, 2001). Perhaps the fat around the gut affects the vital organs and causes adverse biochemical changes?

4. A lack of energy and reduced physical activity can increase body mass compounding the points above.

5. A lack of sleep is associated with increased risk of injuries (Huang & Ihm, 2001), however, this research result is based upon athletes.

6. Bone health is impacted by menopause. Oestrogen plays a role in bone maturation and development. The density/strength of bones decreases during menopause because of a decline oestrogen. This decline increases risk of bony injuries such as stress fractures in the foot metatarsals.

7. Changes to muscles, tendons and ligaments due to a reduction in oestrogen and other hormones. As we discussed above, collagen levels decline with declining oestrogen. With collagen being the scaffolding of these structures, a decline in collagen increases risk of pain and injury.

All of the above factors in addition to many other contributing factors increase risk for foot, ankle and leg pain. Please consult your Podiatrist for assessment and a management plan. Don’t just blame menopause and suffer in pain! There are many things Podiatrists can do and suggest to reduce your pain to make life a little easier.

Increased Risk of Injury

As mentioned above, there are bone, muscle, tendon and ligament changes that occur with menopause. A reduction in muscle mass, muscle strength and bone strength increase the risk of falls and associated injuries. An overall reduction in flexibility will also increase falls risk. Other musculoskeletal injuries are more likely to occur due to increased tendon stiffness.

A reduction in bone strength/density means that when a fall happens there is an increased risk of bone injury i.e. a fracture. Bone density scans can help you and your doctor determine if you have low bone density i.e. osteopenia or osteoporosis and what management is required. Check out the article on bone health for more information. 

If you are wanting to decrease your falls risk during and after menopause, consider targeting the quadriceps and hip abductors as weaknesses in these muscles cause a decline in balance.

Random Symptoms

Menopause brings along many symptoms due to hormone fluctuations and changes. These symptoms vary from person to person. The longer-term impacts of menopause are poorly understood and under researched. For these reasons ‘random’ symptoms have made it to this article.

Those random aches and pains or altered sensations such as burning may be associated with your menopause. We just don’t have enough evidence to prove all the symptoms are associated with menopause. If you have a ‘random’ foot pain, consider talking these symptoms over with your Podiatrist or General Practitioner so they can rule out other causes and determine what action can be taken.

References

Australian Menopause Society (2021). What is menopause – information sheet. https://www.menopause.org.au/images/infosheets/AMS_What_is_menopause.pdf

Calleja-Agius, J. & Brincat, M. (2015) The urogenital system and the menopause. Climacteric 18:sup1, pages 18-22. Accessed from https://www.tandfonline.com/doi/abs/10.3109/09513590.2011.613970

Fu, S., Choy, L., & Nitz, J. (2009). Controlling balance decline across the menopause using a balance-strategy training program: a randomized controlled trial. Climacteric, 12: 165-176. DOI: 10.1080/13697130802506614

Huang, K., & Ihm, J. (2001). Sleep and Injury Risk, Current Sports Medicine Reports. Volume 20. Issue 6 – p 286-290.

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

Peiris, W., Cicuttini, F., Hussain, S., Estee, M., Romero, L., Ranger, T., et al. (2021) Is adiposity associated with back and lower limb pain? A systematic review. PLoS ONE 16(9): e0256720. https://doi.org/10.1371/journal. pone.0256720

Robertson, C. (2021). Impact of menopause on foot health, structure and function. ApodA Stride Magazine July 2021. ApodA member access.

Thamile Luciane Reus, Carla Abdo Brohem, Desiree Cigaran Schuck, Marcio Lorencini. Revisiting the effects of menopause on the skin: Functional changes, clinical studies, in vitro models and therapeutic alternatives, Mechanisms of Ageing and Development. Volume 185, 2020, 111193, https://doi.org/10.1016/j.mad.2019.111193.

 

Book an Appointment at Our Canberra Clinic for a biomechanical assessment to help you with your foot pain and injuries

Our podiatrists are here to ensure those in Canberra have access to quality services that can help individuals get the treatment they deserve. Easily book an appointment at our clinic online or give us a call on 02 6198 4818.