How Menopause Affects Your Feet

Foot pain becomes more common during the menopause transition. Here’s how to avoid aching, painful feet.

By Selene Yeager

 *** This article was originally posted in June 2022. It has since been updated. ***

Bunions and bone spurs and heel pain. Oh my, midlife can usher in a host of conditions that seem to conspire to (literally) knock us off our feet. Foot pain comes in many forms, is extremely common, and becomes more so as we enter the menopause transition.

What does menopause have to do with our feet? Estrogen affects our collagen production, which is the building block of structural and connective tissues. As our levels decline, our tendons become less supple. That’s important because our feet are a hotbed of the body’s connective tissues. Each foot has 26 bones, 33 joints, and 100 tendons!

Combine hormonal changes with the general wear and tear we put our feet through as active and athletic women, and we’re more vulnerable to joint and foot maladies like plantar fasciitis and hallux limitus (rigid big toe joints), and if we don’t act, can find ourselves with aches and pains further up the chain. 

“Unless you’ve got your feet on track, your knees, your hips, your core, everything is not going to function well,” explained Karen Langone, DPM, in Hit Play Not Pause episode 56 Feet First. “It’s no different from the foundation on your house. If your foundation is shaky, you’re not going to function at your optimum.”

As part of the medical team for many athletic events including the 7-Day Race, the Boston Marathon, and the New York City Marathon, Langone specializes in the medical and biomechanical treatment of the foot, ankle, and lower extremities caused by faulty foot mechanics. Here’s what she recommends.

Know Your Feet

Many of us have been told that flat feet or high arches can be a problem. But they’re just a variation of the many normal foot shapes. It’s only a problem if your foot doesn’t move well because of it. For instance, if your flat foot is functioning well and not causing issues, there’s nothing to be addressed. But if your flat foot is moving in such a way that those 33 joints are not staying aligned, but are moving and dislocating as you walk or run, then it’s going to cause you problems down the road. 

You can do a simple assessment yourself. Stand in your athletic shorts and look at your feet, knees, and hips in the mirror. Is your ankle stable and straight over your foot? Are your feet pointed relatively symmetrically or is one foot doing one thing and the other doing something else? (Asymmetric function is a concern). Are your knees pointing forward? Have someone take a phone video of you as you walk or run to see if your movement is stable and symmetrical. 

Check your shoes, too. Take an old pair of running shoes and put them on the floor and look at them from behind. Do they list to one side or the other? Check the soles. Is one wearing differently than the other? Are you wearing one particular spot on your shoes more than another? If you have asymmetries and/or pronounced wear on your shoes in particular spots, those are signs that your foundation could use some stabilizing. 

You can take all this information to a podiatrist who can perform a gait analysis and help you get more balanced from the ground up before you run into pain and/or injury. And if you already have pain and/or injury, it’s important to get it checked out, because even small issues with your feet can become magnified into larger issues over time. 

For example, many women in the Hit Play Not Pause audience have hallux limitus, a progressive arthritic condition that limits the motion and function of the big toe joint. The root of this is foot function and stability. That first metatarsal is not functioning as well as it should, so it is jamming against the base of the big toe joint. Bones respond to stress by building and enlarging, which is good when you’re exercising to maintain bone health, but not in this circumstance because you end up with a bone spur. Imperfections in biomechanics get magnified during accumulated stress like marathons and Ironman triathlons. Address them as early as you can.

Make Sure the Shoe Fits & Works for You

Langone estimates that 90 percent of the people she sees are wearing the wrong-sized shoes. That’s because though we’ve all had our shoe size measured on a standard device at some point, shoe manufacturers do not use that standardization for their sizing. So if you just buy a size 8, it may or may not be the correct size.

It’s particularly important that athletic shoes fit well. You want a thumb’s-width space between the tip of your longest toe, which for most people is the second toe and the front of the shoe. You also want the widest part of your foot to correspond to the widest part of the shoe, so your foot is fully supported and not constricted. Note, athletic shoe lifespan is shorter than it used to be. The standard lifespan used to be 450 to 500 miles. Now that shoes have become lighter, there’s much more foam, gel, and other proprietary material that breaks down more quickly. So, you should replace your running shoes about every 350 miles. 

You know this, but it bears repeating, wear heels sparingly. Wearing heels day in and day out can put undue stress on the front of your foot and shorten your Achilles tendon, making you more prone to plantar fasciitis and foot problems like hammertoes and bunions. You can help your feet by keeping your heels to no more than two inches, preferably in a wedge or stacked heel, which provides more stability than a spiked heel.

Finally, mixing up your footwear is crucial for foot health. If you wear the same shoe all the time, you’re using your foot muscles in the same way. The more you mix up your footwear, including going barefoot sometimes, the more you distribute the stress and strain on your feet in different ways. Think of it like cross-training for your feet. 

Practice Proactive Foot Care

Many of us overlook our feet until they demand our attention. A better strategy is a little proactive care, including:

Exercise your feet. 

Strong feet are healthy feet. Train your foot muscles the way you train the rest of your muscles, with specific exercises. One of the easiest exercises is the towel scrunch. Place a towel under your foot. Scrunch it up with your toes and lift it off the ground. Hold, release and repeat 10 times. You can find other foot exercises at Dr. Langone’s online library.  

Try yoga toes.

Langone gives out yoga toes (flexible toe separators like you wear when you get a pedicure) to her patients who have bunions and hammertoes, because they help stretch out the constricted tissues that are pulling their bones out of alignment. Wearing them when you’re watching TV or working at your computer can help your feet from further deforming out of alignment.

Massage those muscles. 

Just as foam rolling helps work out the kinks in your quads and hamstrings, massaging your feet can break up the adhesions and tight spots in your feet. Langone likes to use supple therapy balls, which compress and conform to your foot as you roll on top of it. 

Stretch your lower legs.

Plantar fasciitis may hurt in your feet, but it generally involves the whole chain of muscles down the back of your body. So stretch your hamstrings and calves regularly, especially after running or after you’ve been on your feet an unusual amount. 

Invest in recovery footwear.

Take the stress off your muscles and joints with recovery footwear, like Oofos. “Oofos are really great,” Langone says. “They have a nice, supportive platform, a lot of cushion, and a little bit of a rocker on the bottom, which does some of the forward propulsive movement for you, taking a bit of stress and strain off your feet.” And they feel amazing at the end of a long run or ride.

Consider glucosamine supplements. 

Glucosamine is a chemical compound that naturally occurs in our body and helps form cartilage. There is some evidence that it might provide relief for arthritic conditions. “In this case, it’s functioning as a building block,” Langone says. (This is not a paid advertisement, but Previnex is a sponsor of Hit Play Not Pause and offers their own Joint Health product that includes glucosamine. If you choose to try this route you can get 15% off your first order with code HITPLAY at previnex.com.)