Some of the unexpected effects of pregnancy and your feet.

Complaints in the feet, knees and hips are often deemed secondary and dismissed in the hope that the problem will resolve spontaneously after birth. This may be because many clinicians are concerned that the treatment protocols for these problems in non-pregnant women are inappropriate and even dangerous in pregnant women. This may often lead to a treatment strategy of benign neglect.
Two of the most common foot problems experienced by pregnant woman are over-pronation and edema. These problems can lead to pain at the heel, arch, or the ball-of-foot. Many women may also experience leg cramping and varicose veins due to their increased weight gain.

Causes:
Over-Pronation, also referred to as flat feet, is caused when a person's arch flattens out upon weight bearing and their feet roll inward when walking. This can create extreme stress or inflammation on the plantar fascia, the fibrous band of tissue that runs from the heel to the great toe.
Over-pronation can make walking very painful and can increase strain on the feet, calves and/or back. The reason many pregnant women suffer from over-pronation is the added pressure on the body as a result of weight gain.
Edema, also referred to as swelling in the feet, normally occurs in the latter part of pregnancy. Edema results from the extra blood accumulated during pregnancy. The enlarging uterus puts pressure on the blood vessels in the pelvis and legs causing circulation to slow down and blood to pool in the lower extremities. The total water fluid in the body remains the same as before pregnancy, however it becomes displaced. When feet are swollen, they can become purplish in color.
Additionally, with all the fluid retention the hormone relaxin is released primarily in the third trimester to relax the pelvic ligaments for childbirth, flattening and lengthening foot ligaments.

How can we Help?
There are effective ways to treat both over-pronation and edema during pregnancy.
Over-Pronation can be treated conservatively with an OTC orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to correct the over-pronation. Proper fitting footwear is also very important in treating over-pronation. The choice of comfortable footwear that provides extra support and shock absorption are recommended.

Custom Foot Orthotics
The over-pronation associated with pregnancy may be best treated with a truly custom, biomechanically correct foot orthotic. In fact, pregnancy provides an opportunity to address foot problems while the foot is malleable and able to adapt to a new position. Using the time while pregnant to support the foot in a new corrected position will allow proper functioning and decreased pain for years to come.
A foot orthotic calibrated to your weight and foot flexibility is crucial to the foot during pregnancy and beyond. A premium custom orthotic will support your arch. This raising will cause a shortening of the foot as it is placed in its optimal position and may actually reduce the need for bigger shoes. Improving your foot posture can also help unwanted postural changes in the knees and lower back.
It is important to treat over-pronation for pain relief but also to prevent other foot conditions from developing such as Plantar Fasciitis, Heel Spurs, Metatarsalgia, Posterior Tibial Tendonitis and/or Bunions.

Treatment and Prevention:
Edema in the feet can be minimized by the following methods:

Elevate your feet as often as possible.
Wear proper fitting footwear.
Footwear that is too narrow or short will constrict circulation.
Have your feet measured several times throughout your pregnancy.
They will probably change sizes.
Wear seamless socks that do not constrict circulation.
If you are driving for a long period of time, take regular breaks to stretch your legs to promote circulation.
Exercise regularly to promote overall health; walking is the best exercise.
Drink plenty of water to keep the body hydrated.
This helps the body retain less fluid.
Eat a well-balanced diet and avoid foods high in salt that can cause water retention.
Swelling is normally similar in both feet. If swelling is not symmetrical in both feet, this may be a sign of a vascular problem.

Shoe Selection:
The first step in addressing your foot pain is to remove any potential interference with your changing foot. To help with the swelling, soak your feet in cold water and prop them up to help with drainage. Buy a few new pairs of roomy comfortable shoes. Be aware that your feet may continue to change with each pregnancy. Avoid the use of shoes with heels as these only accentuate the problems in your foot at a time when it is at its weakest structurally.

Shoe buying tips:
Shop late in the day, your feet tend to swell as the day goes on.
Make sure the shoes fit before you leave the store-It's a myth that you can ‘break into them'.
Choose shoes with a square or round toe, avoid pointy-toed shoes.
When buying boots, ensure they have room in the calf area, as your calves may swell. Also choose boots with a side zip as they're easier to get on and off than the pull-on style boots.
Replace worn out heels regularly as uneven heels can throw you off balance.

Finally, our pregnant patient should take advantage of having their feet massaged! The foot has a complex structure of 26 bones, 33 joints, layered with an intertwining web of over a 120 muscles, ligaments and nerves. A great foot massage can do wonders for tired and aching feet, so make the most of this excuse and encourage your patients to have their feet massaged regularly.