Nicki Quigley is a Podiatrist at OPSMC and the Hawthorn Football Club, and explains how to keep your feet most comfortable during pregnancy.

Towards the end of the second and throughout the third trimester, there are hormonal, postural and anatomical changes that lead foot discomfort.

What are the most common foot complaints?

The most common foot complaints presenting to this clinic during pregnancy are ingrown toenails, callouses, cracked heels, and generalised foot and ankle pain.

What causes these problems to occur?

During pregnancy, there is an increased level of the hormone relaxin in the body, which is needed to loosen the ligaments of the birth canal and pelvis, in preparation for child birth. This hormone also causes an increased laxity in the ligaments of the feet, which may cause flattening of the arch of the foot. This can lead to increased loading of the structures that normally support the arch, particularly a band of tissue that runs along the sole of the foot called the plantar fascia. There may also be increased loading through the metatarsal bones of the feet, causing pain along the top of the foot, and the balls of the feet.

Ligamentous laxity also leads to pelvic instability. This can change the walking pattern of a pregnant woman, again causing a different loading pattern through the feet, which can lead to discomfort.

Most women experience fluid retention in their feet and ankles towards the end of their pregnancy, which causes footwear to be too tight. This can lead to ingrown toenails and corns/callouses.

Increased weight gain during pregnancy also contributes to foot discomfort, as there is more loading through all the structures of the feet.

How can I avoid these common foot complaints during my pregnancy?

The right type of footwear :

Correct footwear choice is the biggest factor in avoiding and treating foot complaints during pregnancy.

Footwear should have laces or another type of adjustable fastening mechanism, to avoid clawing of the toes, and also to allow the shoe to be adjusted according to foot width, which can change each day depending on fluid retention.

Very flat shoes and high-heeled shoes should both be avoided. Ideally footwear should be ‘pitched’, which means a small gradient in the shoe from the heel to the toe. Shoes should be approximately 1cm higher at the back of the shoe compared to the front. Thongs and ballet-flats should be avoided, as they can lead to arch, ankle and forefoot pain, plus cracked heels and callouses. Pointed-toe shoes are not appropriate during pregnancy, they lead to ingrown toenails and callouses.

Shoes should be cushioned, to allow greater shock absorption. This can compensate for the weight gain associated with pregnancy. Ensure that your shoe has a ‘midsole’.

Although not always appropriate, athletic footwear is the best choice for pregnant women, especially if most of the day is spent walking or standing. Shoes may also need to be purchased slightly larger, to accommodate foot changes. Some women need to buy a couple of pairs of larger shoes to wear towards the end of their pregnancy.

Minimising fluid retention :

Legs should be elevated at the end of the day. Pregnant women should also have regular breaks during the day to sit down with their feet up. Calf and foot exercises can reduce fluid retention in the feet, ankles and lower legs.

Exercise:

At the end of the second trimester and during the third trimester, swimming and pilates may be better activities than walking. Swimming is non-weightbearing, so reduces foot load, and can reduce fluid retention. Pilates taught by a qualified Physiotherapist can improve strength around the pelvic girdle, which can reduce pelvic instability.

Can orthotics help?

Foot orthoses may be beneficial during pregnancy, as they improve foot function during walking and redistribute load away from pressure areas. They support the medial longitudinal arch of the foot, which can reduce loading through the plantar foot structures, by reducing flattening of the arch during standing and walking. Padding can be added to the orthoses, to more specifically alter foot loading patterns for pregnant women.

It is normally most appropriate for a pregnant woman to be issued a pair of off-the-shelf orthoses, rather than custom-made orthoses, as often they only need to be worn short-term. These devices are practitioner-only, and can be specifically altered by a Podiatrist to be made more customised for a patient’s foot. They are much cheaper than custom-made orthoses, but only last up to 12 months.

After delivery if foot discomfort is ongoing, there may be a need for further biomechanical assessment, as often ligamentous laxity remains, and orthoses are required long term.

For additional help and advice about caring for your feet during pregnancy, make an appointment to see Podiatrist Nicki Quigley or contact the OPSMC podiatry department.