Anthropometric Changes of The Foot and Pregnancy-Related Musculoskeletal Pain

So many physiological changes occur to the body during pregnancy, it is no wonder that during pregnancy people have back and lower extremity aches and pains. It is common to experience hormonal changes, weight gain, and reduced abdominal strength during this time, not to mention the anterior shift in their center of mass.

These physiological changes result in altered spinal and pelvic alignment, and increased joint laxity. Also, many individuals report increases in size of their feet and a tendency to have flatter arches during and after pregnancy. Alignment changes may influence pain, and altered alignment could change the physical stresses placed upon different tissues of the body, which that specific tissue was not adapted to, therefore, causing pain or injury to that tissue.

A study published in 2016, in the Journal of Women’s Health Physical Therapy¹, investigated if there may be a relationship between anthropometric changes of the foot that occur with pregnancy and pregnancy-related musculoskeletal pain of the lower extremity. The study included 15 primigravid women and 14 weight-matched controls. This study was a repeated-measurements design study, where the investigators measured foot length, foot width, arch height index, arch rigidity index (ARI), arch drop (AD), rear foot angle, and pelvic obliquity during the second and third trimesters and post-partum. The subjects were surveyed on pain in the lower back, hips/buttocks, and foot/ankle.

The author’s findings were that measures of arch flexibility (ARI and AD) correlated with pain in the lower back and the foot and ankle and that medial longitudinal arch flexibility may be related to pain in the lower back and foot. The more flexible arches were associated with more pain in the study participants. They reported the participants in their study did not have very high pain levels in general and recommended further studies to compare pregnant individuals who experience severe pain with those who do not while comparing their alignment factors.

This article is a good reminder for physical therapists to consider the changes that occur to the foot including changes in arch height, arch flexibility, and foot size, and how that influences the pelvis and lower extremity for prevention and treatment of musculoskeletal pain during pregnancy.

Educating our pregnant patients on shoe wear seems even more important now. Making recommendations, unique to each patient based on their objective data, foot type, and arch flexibility status seems like an appropriate addition to a well-rounded treatment plan.

Doesn’t it seem prudent to wear shoes that provide some arch support to hopefully reduce musculoskeletal pain associated with pregnancy changes?

I have observed some patients who are pregnant arrive at their physical therapy appointment wearing unsupportive flip-flops and other poor shoe-wear choices. I understand there are barriers for pregnant patients, I remember from when I was pregnant that reaching your feet to put shoes on can be very difficult, and sometimes your feet are swelling so it may be near impossible to physically get shoes on your feet. You might even need a new pair of shoes, as your shoes may no longer fit.

However, an article such as this one seems like something I could easily share with a patient to help persuade them of the importance of good shoe wear or at least proper arch support. Being able to discuss a recent scientific study with a patient can be powerful and motivating to a patient.

Additionally, an article such as this reminds a practitioner of specific objective data to monitor such as arch height and flexibility as it changes throughout the patient’s pregnancy.

• How does the patient’s changing arch height and flexibility influence their specific pelvic, hip, knee, and ankle alignment?
• How does swelling play a part in the patients’ foot anthropometrics day to day, trimester to trimester?
• Ask more questions about their daily activities, are they ‘barefoot and pregnant’?
• Could something as simple as having them wear appropriate, arch-supportive shoes while in the home reduce their lower extremity or back pain?"

Join us at the next Pregnancy Rehabilitation course scheduled for July 20-21 to learn more about pregnancy-related topics.

Reference:

1. Harrison, K. D., Mancinelli, C., Thomas, K., Meszaros, P., & McCrory, J. L. (2016). The Relationship Between Lower Extremity Alignment and Low Back, Hip, and Foot Pain During Pregnancy: A Longitudinal Study of Primigravid Women Versus Nulliparous Controls. Journal of Women’s Health Physical Therapy, 40(3), 139-146.

AUTHOR BIO

Rachel Kilgore, DPT, OCS, COMT, PRPC, PPCES

Rachel Kilgore, DPT, OCS, COMT, PRPC, PPCES graduated from Central Washington University with a Bachelor of Science (BS) in exercise science and a minor in nutrition in 2004 where she also captained the collegiate soccer team. Rachel completed her Doctor of Physical Therapy (DPT) at University of Washington in 2007. She has worked in out patient orthopedics and pelvic health since 2007. She furthered her physical therapy training earning Certified Orthopedic Manual Therapist (COMT), Physical Therapy Board-Certified Specialist in Orthopedics (OCS), and Pelvic Rehabilitation Practitioner Certification (PRPC). She is a member of the American Physical Therapy Association (APTA), Section of Orthopedics and Section of Women’s Health, and the Physical Therapy Association of Washington (PTWA).

Currently, Rachel practices in Seattle at Flow Rehab in the Freemont Neighborhood with Holly Tanner and Jake Bartholomy. Her patient care focuses on orthopedics, female athletes, and women’s health conditions for bladder & bowel dysfunctions, pelvic, pain, pregnancy and post-partum issues.