There are so many changes the body undergoes duringpregnancy that it becomes easy to ignore the changes in thefeet. During pregnancy the body releases hormones that allowthe ligaments to relax in the birth canal. The ligaments in the feetalso relax, causing the foot to lengthen and widen. Many willcomplain of a shoe size increase by one or two sizes. In mostcircumstances, this flattening and widening of the foot is benignand no problems result. In the diabetic, this change in foot sizeis important to recognize. Despite the increase in foot size, manymoms will continue to wear the same size shoes. As a diabetic,properly fitting shoes are of utmost importance. Increasedpressure on the foot can cause areas of rub or irritation andpotentially result in ulceration. Once there is an ulceration, one isat risk for infection, delayed healing and further diabetic footcomplications.
Diabetic neuropathy is the single greatest risk factor fordeveloping foot ulcerations. Neuropathy is the loss of sensationin the feet commonly caused by diabetes. Many individuals willdevelop neuropathy before they are diagnosed with diabetes.Others will develop neuropathy years after being diagnosed withdiabetes. Luckily, gestational diabetes is not typically associatedwith neuropathy. Unfortunately, type I diabetics developneuropathy much earlier than type II diabetics and may haveneuropathy during their pregnancy. Regardless of the type ofdiabetes, it is still extremely important to have the feet evaluatedto assess the status of the nerves. Even mild neuropathyincreases the risk of ulceration. Wearing shoes which are toosmall causes an increase in friction and an increased risk ofskin breakdown.
Wearing properly fitting shoes during and after pregnancy is ofparticular importance. Although the ligaments relax in the footduring pregnancy, they do not stay relaxed. The post-pregnancyfoot is at higher risk for developing foot problems. There aremultiple reasons contributing to the increased risk. The flattenedfoot places excess stress on the ligament that holds up the arch.The weight gain from pregnancy places excess stress on thefeet. Moms are also carrying their baby, added weight whichtransmits to the feet. Moms are staying at home more often andwalking around in slippers and flexible shoes which aregenerally not supportive.
To decrease your chances of foot problems during and afterpregnancy follow these steps:
1. Check your feet everyday: This is an absolute necessity if youare a type I diabetic or if you have diagnosed neuropathy. It is agood habit to practice. Look for cuts, sores, bruises, openings orareas of irritation. Remember, if your nerves are not functioningproperly, then you may not feel everything in your feet. If youcannot reach your feet, have a family member check your feet orplace a mirror on the floor and put your feet over it.
2. Check your shoes before you put your foot in them.
3. Don't walk around barefoot: Wear a supportive shoe, one thathas a rigid sole and bends only where the foot bends (at thetoes). If a shoe seems too confined, find a slipper which has asemi-rigid sole, or try a clog or slip-in shoe with a more rigidsole. The remaining aspect of the shoe can be soft and flexibleand allow for swelling, but the sole should be rigid from the heelto the ball of the foot.
4. Buy shoes that fit your feet: Be aware of the changes your feetare going through. The feet are most likely widening andlengthening. Make sure the shoes don't cramp the toes. Yourfeet will not shrink after the birth.
5. Watch out for folds in your socks: A simple fold can cause rubor irritation on your feet. Swelling will be greater by the end ofthe day and the small crease that didn't bother you in themorning can rub an open sore or blister on the toes. Seriousconsequences in diabetics can include ulceration and infection.
6. Dry your feet and between toes after showers: Increasedmoisture between your toes can lead to skin breakdown andeventual ulceration.
7. Don't be a victim of fashion: Most moms will avoid highfashion during pregnancy, but many try squeezing into thatstrappy heel after. Wearing high heeled shoes puts excessstress on the ball of the foot, cramps the toes and increases thechances of ankle sprains. Tight shoes will increase the chanceof ulceration for those with neuropathy.
8. Test the bath water before stepping in: If you have neuropathy,you will not recognize when the temperature is too hot. Check thewater by inserting your hand into the water to wrist depth.
9. Don't use a heating pad on your feet: Although the idea of heaton your feet may sound soothing after a long day, the heat willincrease swelling and inflammation. Sore feet respond better toice. Roll your foot over a frozen sports water bottle to help easethe achiness in the arch. Wear a sock while doing this and don'tput ice directly on your feet. The heating pad can cause burns inthose who have neuropathy.
10. Don't use any medication on the skin: Be careful of topicalmedications during pregnancy and during breast-feeding.Consult your doctor before use. Don't use medicated corn padsfrom the local drug stores if you have neuropathy.
11. Visit your podiatrist: At the first sign of a problem, make anappointment with your podiatrist. Prevention is much easier thantreatment.
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Christine Dobrowolski is a podiatrist and the author of ThoseAching Feet: Your Guide to Diagnosis and Treatment ofCommon Foot Problems. To learn more about Dr. Dobrowolskiand her book visit http://www.skipublishing.com/ or athttp://www.northcoastfootcare.com./
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