Pregnant patients and podiatry

Pregnancy causes a range of complications for the lower extremities. The weight gain experienced during pregnancy places an enormous amount of unexpected pressure on the feet. It’s common for pregnant women to suffer from foot pain, swelling, leg cramps and varicose veins. In addition to weight gain, stretched ligaments in the feet and ankles cause stability problems and flat feet can cause irreparable damage. A podiatrist may be able to relieve these symptoms through proper foot care and advice during pregnancy.

Treatment options for foot pain during pregnancy are often overlooked as other medical aspects of the pregnancy are prioritised. However, many of treatments chosen by podiatrists do not use pharmacological interventions, so they are very safe and effective during pregnancy. The following five podiatric complications are common during pregnancy and should be observed as part of an overall pregnancy support plan:

1. Weight gain can have a biomechanical impact on the feet and occurs as the centre of gravity shifts as a pregnancy progresses. Weight gain can cause or exacerbate foot pain, bursitis and neuromas, along with corns and calluses. Patients should be advised to avoid wearing high heels or any shoes without adequate support.

2. Production of the hormone relaxin during pregnancy will also relax ligaments of the feet and ankles. This can cause instability and discomfort through overuse of the muscles in the foot to maintain support and may lead to long-term, irreversible changes to the feet. Some women will also continue to have these issues whilst breastfeeding.

3. Increased force to knees and ankles can cause injury and pain. Added force on the feet combined with biomechanical changes cause over-pronation and can result in irreparable arch collapse. Arch height is usually reduced during pregnancy and may become worse with future pregnancies.

4. Oedema is common in the feet and, as well as causing discomfort, may result in problems getting into shoes and shoe sizes will probably need to be larger than what the patient is used to. Professional fitting is recommended. Patients should be advised to keep feet elevated while sitting down, to avoid crossing the legs, and to avoid sitting or standing for long periods of time, recommend short walks to improve circulation. Compressions garments should be considered to aid in the reduction of oedema.

5. Foot and leg cramps are common during pregnancy due to altered calcium levels, muscle fatigue and increased pressure on nerves and blood vessels. Massage and exercises are recommended to alleviate symptoms.

Patient education should include advice on appropriate footwear during pregnancy, avoidance of socks or shoes that restrict blood flow and patients should be encouraged to exercise regularly and eat a healthy, balanced diet.

Consider referring to a podiatrist for pain relieving interventions for conditions that are easily treated such as corns, calluses and ingrown toenails.

Severe pain and discomfort can be treated with the fitting of orthotics, which are proven to realign unstable gait, relieve pressure on tendons, ligaments and muscles and reduce pain in the knees, hips and lower back. Orthotics can be custom fitted via referral to a podiatrist.

This resource has been provided by an Australian Podiatry Association (APodA) member podiatrist as part of Foot Health Month 2014

Pregnancy and podiatry

Nobody told you that your feet would hurt as well! The weight gain experienced during pregnancy places a huge amount of unexpected pressure on your feet. Your centre of gravity shifts as your baby grows, and it’s common for pregnant women to suffer from foot pain, swelling, leg cramps and varicose veins. The good news is that you may feel better after receiving proper foot care.

With extra weight and force placed on your feet, one of the main problems during pregnancy is flat feet. Increased weight causes the bone structures in your arches to flatten and your feet to roll inwards. This can be incredibly painful as other parts of your feet and legs — your tendons, ligaments and muscles — are all working harder to keep you upright.

Another issue during pregnancy is swelling. As your uterus grows to accommodate your baby, the flow of blood and fluids to your extremities can be compromised. Fluid can build up around your feet and ankles, and this can lead to painful swelling. As long as the swelling is the same in both feet, this is normal. If you have sudden swelling, swelling that is noticeably different between your feet, or that appears in your hands or face, contact your maternal caregiver immediately.

There are treatments available to relieve foot pain. Nine months is a long time to be uncomfortable and remember – your feet shouldn’t hurt!

1. Wear comfortable, supportive shoes with a cushioned innersole; your feet will thank you for them as they won’t have to work so hard to keep you stable. You may find that with swelling you will need a shoe size bigger that what you are used to. Get your feet professionally measured and avoid wearing shoes that are too tight.

2. Wear socks without an elastic cuff and avoid anything that will restrict circulation to your feet.

3. Take in regular exercise to keep the blood circulating around your body. Walking, swimming and yoga are good options as they are low impact and will be easy on your feet while giving you the workout your body needs. Swimming is particularly recommended because the force of the water on your body actually helps to bring swelling down. If you are sitting for long periods of time (e.g. at work) be sure to stand up and have a walk around throughout the day.

4. Stretch! If you notice cramps in your feet or calves stand up and have a good stretch to relieve the pain. Remember that your muscles and ligaments are working really hard, so show them some TLC by stretching just as you would after exercising.

5. Elevate your feet as much as possible to minimise swelling. Keep a footrest or a box under your desk at work so you can keep your feet up at the office.

6. Avoid crossing your legs as that will restrict blood flow and increase swelling.

7. Drink plenty of water. Drinking more water won’t make you retain more water, so keep up fluids.

8. Eat healthy! Make sure you’re eating loads of healthy foods and a well-balanced diet. Lay off the salt as it will cause you to retain more water.

9. Sleep on your left side; this opens up your blood vessels and will encourage more fluid to flow upwards from your feet.

10. Ingrown toenails can be a risk resulting from tight shoes that push the skin around nails cut too short. Keep your nails healthy and check them regularly for signs of injury.



11. Consider the use of compression stockings which may help prevent or lessen varicose veins.