I wore a night splint every single night. I stretched before my feet even touched the floor every single morning. I iced, I exercised, I modified my shoes. I did everything right. And nothing worked.
Here is the part that still gets me. I am an occupational therapist with decades of clinical experience. Treating musculoskeletal conditions is literally my job. And I could not fix my own plantar fasciitis no matter what I tried.
That is because I was missing the underlying cause.
My plantar fasciitis was one of my first symptoms of menopause. At the time, I had no idea my ovaries had stopped functioning following my hysterectomy. I was estrogen deficient, and my body was telling me in one of the most persistent and painful ways it could. No amount of night splints was going to fix a hormone problem.
What Estrogen Has to Do With Your Feet
Here is what was actually happening inside my body, and what may be happening inside yours.
Estrogen has receptors in your tendons, your ligaments, and your connective tissue throughout your entire body, including the tissue in your feet. It plays a direct role in collagen production, which is the structural protein that keeps your tendons and connective tissues strong, flexible, and resilient. When estrogen begins to decline during perimenopause and menopause, collagen synthesis slows. Tissues that were once strong and elastic become less hydrated, less flexible, and far more vulnerable to inflammation and injury.
The plantar fascia is a thick band of collagen-rich connective tissue that runs along the bottom of your foot from your heel to your toes. It absorbs impact with every step and supports the arch of your foot. When estrogen drops and collagen production slows, that tissue becomes stiffer, more prone to microtears, and much harder to heal. The result is that stabbing heel pain that is worst with your very first steps in the morning, the hallmark symptom of plantar fasciitis.
For me, no matter how diligently I followed the standard treatment protocol, the underlying hormonal driver meant my tissue simply could not recover the way it should have.
The Musculoskeletal Syndrome of Menopause
What I was experiencing has a name: the Musculoskeletal Syndrome of Menopause. This is a framework that recognizes the profound and wide-ranging effect that estrogen decline has on the entire musculoskeletal system. Joint pain, muscle aches, tendon problems, frozen shoulder, body stiffness that seems to appear out of nowhere. These are not simply signs of getting older. For millions of women, they are signs of estrogen decline.
Estrogen also has natural anti-inflammatory properties, so as levels fall, systemic inflammation rises. This creates a double hit: connective tissues are losing structural integrity at the same time the body is running hotter with inflammation. It is a perfect storm for the kind of persistent, treatment-resistant musculoskeletal pain that so many women experience during this transition and cannot get answers about.
Plantar fasciitis is one piece of this picture. Frozen shoulder, or adhesive capsulitis, is another. Tendinopathies across the body, including the rotator cuff, the Achilles, and the hip, are also increasingly recognized as part of this syndrome. Women in their 40s and 50s are disproportionately affected by all of these conditions, and the hormonal connection is rarely made.
I know this not just from my own experience, but from the clinical work I have been doing. I recently gave a lecture on the Musculoskeletal Syndrome of Menopause to Physical Medicine and Rehabilitation residents at the University of Pennsylvania Hospital. These are physicians training in a specialty where musculoskeletal conditions are central to their work every single day. And most of them had never encountered this framework before. Not because they are not exceptional clinicians, but because this simply is not taught in medical school. That gap in knowledge has real consequences for women who are suffering and being told that what they are experiencing is just aging or overuse.
What Finally Worked for Me
When I finally started replacing my estrogen, my plantar fasciitis disappeared. Almost immediately. After months of doing everything right and getting nowhere, the symptom that had been stopping me in my tracks every single morning was gone.
I also have herniated discs in my cervical spine that have caused me significant nerve pain for years. Since starting hormone therapy, that pain has decreased so substantially that I have been able to stop taking my nerve pain medication entirely.
I share this not to suggest that hormone therapy is the answer for everyone, but because I think women deserve to know that a hormonal connection exists and that it is worth exploring with a knowledgeable provider. If you have been suffering from plantar fasciitis, joint pain, or other musculoskeletal symptoms and hormone therapy has never come up in conversation, it is absolutely worth asking about.
What You Can Do
Beyond hormone therapy, there are things you can do to support your musculoskeletal health during this transition. Regular movement is at the top of the list. I know it feels counterintuitive when your body hurts, but motion is lotion. Walking, swimming, strength training, tai chi, whatever you will actually do consistently helps keep your joints lubricated, supports collagen synthesis, and reduces inflammation. Adequate protein intake supports both muscle maintenance and collagen production. Staying well hydrated matters more than most people realize, because estrogen helps your tissues retain water and when it drops, so does tissue hydration. And working with a provider who understands the hormonal drivers of these symptoms, rather than just treating each one in isolation, can change everything.
You Deserved to Know This Sooner
No one taught us any of this. Not our mothers, not our doctors, not our health teacher. The connection between estrogen decline and musculoskeletal health is real, it is well supported by research, and it affects millions of women who are quietly suffering and wondering why their bodies suddenly feel so foreign.
If any of this sounds familiar, you are in the right place.
Want to understand more about what is happening in your body during the menopause transition? Download my free audio series, "Menopause Doesn't Have to Suck." It is five parts, about 30 minutes total, and covers the stages, the symptoms, and the solutions of the menopause transition in plain language. Because you deserve the information you never got.
And if you are ready to build a real, personalized plan for navigating your symptoms, I would love to work with you one on one. You can book a Menopause Empowerment Session with me here.
Julie Parana, MS, OTR/L, CWHS is an Occupational Therapist, Certified Women's Health Specialist, and Certified Menopause Coach. She runs The Menopause OT, a virtual practice dedicated to helping women understand and navigate the menopause transition. She went through surgical menopause herself at 42, which drives her passion for making sure no woman has to figure this out alone.