Heel pain and Plantar Fasciitis

Does taking those first few steps out of bed each morning feel like stepping on glass? Or do you have to take a moment for that heel pain to settle after sitting for a prolonged period?

Plantar fasciopathy (the correct medical term for plantar fasciitis) is common among middle aged women. Menopause certainly plays a role, but it may not be entirely due to reduced estrogen. Let’s talk about what is plantar fasciopathy and what you can do about it.


The plantar fascia is a broad band of fibrous tissue located from the heel and inserts into base of toes, assisting in stability of the arches during walking and exercise. Weight bearing causes the plantar fascia to stretch but sometimes, it becomes overloaded around the heel during sudden increased activity levels. Pain is usually felt either under the heel or on the inside of the heel by the arch area.

Plantar fasciopathy (heel pain that is usually worse in the morning) is common among middle-aged women as the loss of estrogen affects our collagen production. Collagen is the building blocks of our musculoskeletal system mainly our ligaments, tendons and skin. With less collagen synthesis during menopause, this certainly affects the elasticity of the plantar fascia which makes it less adaptable to load and our day-to-day physical activities. The same can occur during pregnancy with an increase in body weight and estrogen mediated softening of the plantar fascia. However, other factors not directly due to estrogen loss can also cause plantar fasciopathy:

  • Age: More common in between the age of 40-60 years old
  • Sudden increase in intensity of weight bearing activities/exercises
  • Weight gain: Obesity, pregnancy
  • Reduced ankle mobility/flexibility due to tight calf muscles or joint ankle joint stiffness
  • Weakness in muscles about the foot, ankle or lower limb
  • Foot posture: those with low/high arch
  • Footwear that provides poor cushioning and support through the arch of the foot
  • Occupations that require long periods of standing


The treatment of plantar fasciopathy depends on whether you are in the pain dominant phase or the load dominant phase. Feel free to speak to your women’s health physiotherapist to know where you are at to tailor your treatment to suit you better.

Plantar fasciopathy in the pain dominant stage focuses on reducing tissue stress temporarily to allow more tolerable pain levels. Some initial strategies to help treat plantar fasciopathy in this pain dominant stage may include:

1. Lifestyle Modification

  • Try to avoid barefoot walking. Wear footwear with good thick but flexible soles at home. Footwear should be supportive and have cushioned soles, especially in the heel area.
  • Reduce long periods of standing.
  • Omit high impact exercise i.e. running, jumping, aerobics. You can still maintain your fitness through other forms of aerobic exercises that does not aggravate your symptoms. Try opting for light impact aerobics like (cycling, swimming, aqua jogging)
  • Continue to do your daily activities but try to pace yourself! You can still do your regular activities each day but break it up in to shorter and more manageable load.

2. Footwear

  • Wear a soft cushioned sole that is well-fitted and wide enough to allow the toes to comfortably spread out
  • Some people find wearing a shoe that has a short heel more comfortable than flat shoes (pumps or very flat flip flops)
  • Heel pads/Gel heel cups: Use a thick and soft foam or gel heel pads in your shoes to improve comfort especially taking your first few steps in the morning so as to avoid barefoot walking on hard floors.

3. Ice massage

  • Gently (and not punish) roll your barefoot back and forth from toes to heel over a frozen plastic bottle or can. This may help gently desensitize symptoms and can be comforting at the end of a long day

4. Stretching Exercises

5. Strengthening (to commence during the load dominant phase)

  • A graded strengthening exercise programme improves calf muscle strength, normalise plantar fascia tissue structure and its ability to better tolerate mechanical loads

6. Other treatment options

  • Medications – NSAIDs
  • Taping
  • Podiatry referral for assessment for shoe inserts
  • Extracorporeal shockwave therapy to stimulate healing
  • Surgery

You may feel some discomfort during and after these exercises which should only last for a short while. However, if you feel a lasting increase in your symptoms, seek advice from your women’s health physiotherapist before continuing. If you are an active woman in menopause, don’t let this heel pain stop you from staying active! What you need is just some guidance on a graded exercise programme to manage load, restore your strength and flexibility!




James L. Thomas et al. The Diagnosis and Treatment of Heel Pain: A Clinical Practice. Guideline–Revision 2010. The Journal of Foot & Ankle Surgery 49 (2010) S1–S19.

Rathleff et al 2014 Page 5 of 5 Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Spor 2014:n/a-n/a doi: 10.1111/sms.12313 [published Online First: Epub Date]|.

Sullivan et al. 2015. Musculoskeletal and Activity-Related Factors Associated With Plantar Heel Pain

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