Plantar Fasciitis in Women

Numerous studies have confirmed that there is a gender difference whereas the appearance of plantar fasciitis is concerned. For example, this condition has been identified as more common in middle-aged women, as well as in young men (runners in particular). Today, we are going to discuss this condition from the perspective of the female gender, providing useful information on prospective causes, gender particularities, and modalities of keeping plantar fasciitis under control.

What are the factors that lead to plantar fasciitis in women?

At a simple glance, the factors that lead to plantar fasciitis in women do not differ tremendously from the ones in men. However, women’s footwear has been incriminated as a main risk factor; inadequate footwear, whether high-heeled or flat, places a lot of strain on the arch of the foot and keeps the plantar fascia in a tense position. In time, this leads to micro-tears, with the body compensating by calcifying the affected tendon.

If women are engaged in occupations that require prolonged standing, such as waitressing or being a maid, it is highly likely they will suffer from plantar fasciitis. The condition is also seen in women who are often involved in weight-bearing activities, as well as in those who train or run on a regular basis.

As it was already mentioned above, inadequate footwear can be responsible for the appearance of plantar fasciitis, including in female athletes or professional runners. When one wears athletic shoes that are too light or have minimal cushioning, the risk of developing plantar fasciitis is higher. Other risk factors, equally present in women as in men, include overpronation, leg length discrepancy, and rigid Achilles tendons.

Are there any specifics related to plantar fasciitis in women?

Plantar fasciitis is diagnosed in both men and women, of all ages and occupations. When it comes to women, the condition seems to reach a peak incidence between the ages of 40 and 60. As a percentage, plantar fasciitis is twice as common in women, in comparison to the male gender.

Inadequate footwear is one of the most important risk factors to take into consideration, with regard to diagnoses such as one plantar fasciitis. It is highly likely that the regular wearing of flat shoes can lead to such conditions. These are often worn by women who are afraid that high-heels might damage their feet; however, many of them are unaware of how damaging shoes that do not offer the necessary arch support can be.

The plantar fascia suffers tremendously from the regular wearing of flat shoes, such as flip-flops. The more rigid the soles of the shoes are, the higher the risk of developing plantar fasciitis. Oftentimes, female patients visit the doctor for a burning or stabbing pain; upon performing a thorough anamnesis and ordering medical imaging studies, the diagnosis will most certainly be plantar fasciitis.

What happens when you wear flat shoes? Well, whether you wear flip-flops or athletic shoes that are inadequately cushioned, the result is the same. In time, the arch of the foot will begin to drop, with the ligaments and tendons in the area being placed in a tense position. This will lead to inflammation and micro-tears, with symptomatology characteristic of plantar fasciitis.

What do studies have to say?

In 2010, a study[1] regarding the epidemiology of plantar fasciitis was published in the Lower Extremity Review Magazine. The study discussed this condition being more common in women than men, especially in those who also presented an increased incidence of tears at the level of the anterior cruciate ligaments.

In the same study, it was also presented that female athletes with low estrogen levels have a higher risk of developing such conditions. Due to the estrogen levels being low, the overall elasticity of the collagen is reduced and thus the risk for plantar fasciitis is higher.

Another study[2], published in 2009, in The Foot and Ankle Online Journal, discussed the gender role in the development of plantar fasciitis. The study confirmed that women were most often diagnosed with this condition, but not due to the differences in footwear, as it was commonly believed. The study drew attention to the fact that women diagnosed with plantar fasciitis, actually presented a considerable decrease in their ankle joint dorsiflexion (knee extended).

In the book[3] Musculoskeletal Injuries in Military Women, written by Springer & Ross, we are informed that plantar fasciitis is one of the most common overuse injuries, affecting military women (lower extremity injuries). The authors of the book state that the condition might be associated with the wearing of boots in the Brigade Combat Team, even though no evidence exists in the present to confirm such risks. However, it is highlighted that women who present overpronation (pes planus) or over supination (pes cavus), present a higher risk of developing plantar fasciitis (due to the constant stress placed on the plantar fascia).

The book[4] Sex Differences in Sports Medicine, written by Casey, Rho & Press, discusses plantar fasciitis as being a common condition diagnosed in US military recruits. According to the authors of the book, female military recruits are more often diagnosed with plantar fasciitis; in fact, 1.96 times more than men. The authors also draw attention to the fact that women present a predisposition towards developing heel spurs, in comparison to men.

Final word of advice

From what you have read in this article, you have probably understood that plantar fasciitis is more common in women than men (especially middle-aged ones). It is possible to control certain risk factors, by maintaining a healthy weight, wearing adequate footwear, and avoiding walking or running barefoot. The occupational hazard must be taken into consideration as well, as weight-bearing activities and prolonged standing can wreak havoc on the plantar fascia.

It is recommended to visit the doctor for a thorough assessment, in order to confirm/infirm the existence of such problems; the doctor can also guide you toward the best treatment/conservative measures. Do not forget to inquire about custom orthotics, night splints, and compression sleeves, as these can really improve your overall functionality.

[1] The Epidemiology of plantar fasciitis, 2010, Scher et al., Lower Extremity Review Magazine.
[2] Prevalence of Equinus in Patients Diagnosed with Plantar Fasciitis, 2009, Wenzel et al., The Foot and Ankle Online Journal.
[3] Musculoskeletal Injuries in Military Women, 2011, Springer & Ross, Borden Institute.
[4] Sex Differences in Sports Medicine, 2016, Casey, Rho & Press, demosMedical.