Foot topic of the month: Your feet
during pregnancy
A
ship under sail and a big-bellied woman, are the handsomest two things that can
be seen common.
–Benjamin Franklin
As this topic is currently quite relevant to a
number of our friends and patients, we chose it to begin our monthly discussions
on foot and ankle health. A number of changes take place in the structure and
function of a woman’s body during pregnancy, which help her carry a baby for
nine months. These changes have direct or indirect consequences on the health
of our lower extremities.
Natural
weight gain during pregnancy increases the stress on the feet when walking. The
increase in midsection mass also shifts the body’s center of gravity forward and
requires certain postural adjustments to maintain stability. These changes include an increased curvature
of the lower back, forward tilt of the pelvis, genu valgum (knees positioned closer
together), foot pronation and flattening, and relocation of pressure to the
front and middle of the foot when walking. 1,2 These changes
increase the demand on the muscles, tendons, and ligaments of the back, hips,
and lower extremities predisposing women to certain injuries. 1,2
Many women complain of pain in the feet and ankles
during and after pregnancy. The pain is
likely due to over-pronation and excessive stress on the soft tissue structures
of the foot, such as joints, ligaments, tendons, and the plantar fascia. 1,2
To manage and prevent these symptoms,
Dr. Dukarevich recommends avoidance of barefoot walking and use of shock-absorptive
supportive walking shoes. Certain stretching exercises and icing may also help.
Occasionally, if symptoms persist, Dr. Dukarevich will prescribe custom
functional orthoses. These custom devices go inside your shoes and are made
from a mold of your foot, based on the doctor’s prescription. They help to
support the arch of the foot, prevent excessive foot pronation, and relieve
tension on the soft-tissue structures.
Women’s feet actually increase in size, both in
length and in width, during pregnancy. 1,2,5 The feet are not
actually “growing”. The increase in size is due to the spreading and lowering
of the bones of the foot during pregnancy. These changes are secondary to an increase
in elasticity of the joints and ligaments and are likely permanent. Dr. Igor Dukarevich
recommends appropriately-sized supportive walking shoes and either
over-the-counter or custom orthotic devices. You can get your feet measured at
most shoe stores. You can also stop by Advanced Podiatry Clinics and we’ll be
happy to measure you, as well as advise you on a proper shoe size, style, and
fit.
Swelling or edema of the lower extremities during
pregnancy is also a common complaint. This is a common occurrence and can be especially
bothersome at the end of the day and in the summer months. The lower extremity
swelling is usually due to an increase in your body’s fluid volume, weight
gain, as well as the baby’s pressure on the inferior vena cava (which is a
large artery that returns blood back to the heart). 3,4
To relieve
the swelling in the legs and feet, Dr. Igor Dukarevich advises avoidance of
prolonged sitting or standing, elevation on the lower extremities, frequent short
walks, use of well-fitting comfortable shoes, use of light support stocking, intake
of enough plain water, and limitation of caffeinated and salty food products. A
recent study also demonstrated improvement in swelling with regular foot and
leg massage. 3,4 We do provide
copies of this latest article for the father of your child in our office.
Edema of the lower extremities is usually a
temporary condition and resolves rapidly after birth. Swelling of the face,
neck, or upper extremities can a sign of a dangerous condition called pre-eclampsia
and you should certainly consult your obstetrician. 3,4
Many women also report skin and nail changes. There
is usually an increase in the rate of nail growth and a roughening of the nail
texture. The skin also becomes dryer and often cracks, necessitating regular
use of emollient lotions. 5
If you have any further questions on this topic, you
are welcome to leave them on our Facebook page, e-mail Dr. Igor Dukarevich
through our website at www.advpod.com, or call Advanced Podiatry Clinics at (708)
450-0705.
References:
1.
Ribeiro AP, Trombini-Souza F, de Camargo Neves Sacco I,
Ruano R, Zugaib M, João SM. Changes in the plantar pressure
distribution during gait throughout gestation. J Am
Podiatr Med Assoc. 2011 Sep-Oct;101(5):415-23.
2.
Bird AR, Menz HB, Hyde CC. The effect of pregnancy on footprint parameters. A prospective investigation.
J Am Podiatr Med Assoc. 1999 Aug;89(8):405-9.
3. Bamigboye AA, et al. Interventions for varicose veins and leg oedema in pregnancy.
Cochrane Database of Systematic Reviews. 2007:CD001066.
4.
Coban A, Sirin A. Effect of foot massage to decrease
physiological lower leg oedema
in late pregnancy: a randomized
controlled trial in Turkey. Int J Nurs Pract.
2010 Oct;16(5):454-60.
5.
Ponnapula P, Boberg JS. Lower
extremity changes experienced during pregnancy.
J Foot Ankle Surg. 2010 Sep-Oct;49(5):452-8.
