The influence of body mass on foot dimensions during pregnancy

The Effect of Clinical Exercise Training on Plantar Pressure, the Subtalar Joint, and the Gait Cycle in Pregnant Women: Randomized Clinical Trial

Background/Objectives: This study aims to examine the effects of clinical exercise training on foot plantar pressure, the subtalar joint, and the gait cycle during pregnancy. Methods: The study was planned as a randomized, controlled, and single-blind study. Participants' demographic information, obstetric evaluation, physical activity level, fall history, and pain evaluation were recorded. Foot plantar pressure, the subtalar joint, and the gait cycle were measured through pedobarography at Gait Laboratory. The control group was recommended walking. Clinical exercise training was given to the study group 2 days a week for eight weeks. Evaluations were made on day 0 and the day corresponding to the end of week 8. Results: The study was completed with 50 people in the study group (age: 29.7 ± 3.8 years) and 51 in the control group (age: 29.1 ± 6.1 years). As a result of the parametric and non-parametric tests performed before and after the exercise, it was observed that there was a statistically significant difference between the two groups in weight, BMI, pain score, static plantar pressure, dynamic plantar pressure, subtalar joint flexibility, duration of the walking period, and multistep walking speed (p < 0.01). The two groups had a significant difference only in the dominant midfoot plantar pressure (p > 0.05). Conclusions: According to our research, weight control and pain relief are observed in women who engage in clinical exercise in the second trimester of pregnancy; plantar pressure and subtalar joint flexibility are preserved, the walking period does not increase, and the multistep walking speed can be maintained after eight weeks.

Plantar Fascia Thickness Difference Between Pregnant and Nulliparous in Indonesia

Background

Pregnancy is associated with distinct risks of fascia thickness compared to nulliparous. Therefore, this study aimed to compare plantar fascia thickness between asymptomatic pregnant women and nulliparous, evaluating the relationship with age, body mass index (BMI), arch height index (AHI), gestational age, and number of pregnancies.

Methods

This cross-sectional study was conducted between January and March 2023, and subjects were through a simple random sampling method. The inclusion criteria were subjects aged 18-35 years old, while those with a history of foot pain, trauma, surgery, special orthosis during pregnancy, and other complications were excluded. Fascia thickness was measured at 10 mm distal from the insertion in the calcaneus. Age, BMI, AHI, gestational age, and pregnancy history were recorded. Student's t-tests were used to compare both groups.

Results

The average plantar fascia thickness in pregnant women was 2.67 ± 0.44 mm in both feet, while in nulliparous, it was 2.24 ± 0.41 mm and 2.26 ± 0.37 mm in the right and left foot, respectively. A significant difference was observed between the two groups based on BMI category (P < 0.05). Women who had experienced more than one pregnancy showed thicker fascia (P < 0.05). In multivariate analysis, BMI (B coefficient: 0.029-0.031, P < 0.05) and number of pregnancies (0.268-0.267, P < 0.05) had a significant effect on plantar fascia thickness in pregnant women, while age and BMI affected nulliparous.

Conclusion

Pregnant women had thicker plantar fascia compared to nulliparous. Consequently, screening and prevention in pregnant women and multiparous was necessary to prevent the occurrence of plantar fasciitis.

Foot shape assessment techniques for orthotic and footwear applications: a methodological literature review

Introduction

Foot shape assessment is important to characterise the complex shape of a foot, which is in turn essential for accurate design of foot orthoses and footwear, as well as quantification of foot deformities (e.g., hallux valgus). Numerous approaches have been described over the past few decades to evaluate foot shape for orthotic and footwear purposes, as well as for investigating how one's habits and personal characteristics influence the foot shape. This paper presents the developments reported in the literature for foot shape assessment.

Method

In particular, we focus on four main dimensions common to any foot assessment: (a) the choice of measurements to collect, (b) how objective these measurement procedures are, (c) how the foot measurements are analyzed, and (d) other common characteristics that can impact foot shape analysis.

Results

For each dimension, we summarize the most commonly used techniques and identify additional considerations that need to be made to achieve a reliable foot shape assessment.

Discussion

We present how different choices along these two dimensions impact the resulting foot assessment, and discuss possible improvements in the field of foot shape assessment.

Suitable Heel Height, a Potential Method for Musculoskeletal Problems during the Third Trimester: A Pilot Study

BACKGROUND

The treatment options for third-trimester musculoskeletal issues are limited. This study aims to examine how heel height affects gait biomechanics and provides heel height recommendations for various musculoskeletal problems.

METHODS

Five third-trimester gravidas were recruited wearing uniform footwear with four heel heights (0 mm, 15 mm, 30 mm, and 45 mm). Lower-limb muscle forces, joint angles, joint torques, joint contact forces, and ground reaction forces (GRF) at specific moments (the first peak, valley, and second peak of GRF) were collected for one-way analysis of variance with repeated measures.

RESULTS

The soleus, gastrocnemius, tibialis posterior, plantaris, obturator externus, gluteus maximus, gemellus superior, and obturator internus were the smallest at heel heights of 45 mm and 15 mm at the valley of GRF. Hip extension and knee flexion displayed the smallest joint angle and joint torques at a height of 15 mm. Ankle joint contact force decreased with increased heel height.

CONCLUSIONS

The height of the heel significantly impacts muscle force, joint angles, joint torques, and joint contact force. A heel of 15 mm might be the most suitable heel height to potentially avoid or alleviate musculoskeletal problems during the third trimester.

Changes in Foot Biomechanics during Pregnancy and Postpartum: Scoping Review

(1) Background: During pregnancy, changes in foot biomechanics affect structural stability and gait. (2) Objective: To map the available evidence for changes in foot biomechanics during pregnancy and the postpartum period. (3) Methods: Scoping review according to the methodology of the Joanna Briggs Institute through the relevant databases via EBSCO, MEDLINE with full text, BioOne Complete, CINAHL Plus with full text, Academic Search Complete, and SPORT Discus with full text. The search was conducted in SCOPUS and PubMed. (4) Results: Eight studies were included in the scoping review. Two independent reviewers performed data extraction and synthesized data in narrative form. We found that changes in the length and volume of the foot occur during pregnancy and remain in the postpartum period. (5) Conclusions: During pregnancy, anatomical and biomechanical changes occur in the pregnant woman's foot, potentially contributing to the risk of musculoskeletal disorders. However, more research is needed to determine whether these biomechanical changes can lead to the risk of musculoskeletal disorders.

Methodological and statistical approaches for the assessment of foot shape using three-dimensional foot scanning: a scoping review

OBJECTIVE

The objectives of this study were to: (i) review and provide a narrative synthesis of three-dimensional (3D) foot surface scanning methodological and statistical analysis protocols, and (ii) develop a set of recommendations for standardising the reporting of 3D foot scanning approaches.

METHODS

A systematic search of the SCOPUS, ProQuest, and Web of Science databases were conducted to identify papers reporting 3D foot scanning protocols and analysis techniques. To be included, studies were required to be published in English, have more than ten participants, and involve the use of static 3D surface scans of the foot. Papers were excluded if they reported two-dimensional footprints only, 3D scans that did not include the medial arch, dynamic scans, or derived foot data from a full body scan.

RESULTS

The search yielded 78 relevant studies from 17 different countries. The available evidence showed a large variation in scanning protocols. The subcategories displaying the most variation included scanner specifications (model, type, accuracy, resolution, capture duration), scanning conditions (markers, weightbearing, number of scans), foot measurements and definitions used, and statistical analysis approaches. A 16-item checklist was developed to improve the consistency of reporting of future 3D scanning studies.

CONCLUSION

3D foot scanning methodological and statistical analysis protocol consistency and reporting has been lacking in the literature to date. Improved reporting of the included subcategories could assist in data pooling and facilitate collaboration between researchers. As a result, larger sample sizes and diversification of population groups could be obtained to vastly improve the quantification of foot shape and inform the development of orthotic and footwear interventions and products.

ÜÇÜNCÜ TRİMESTERDA AYAKKABI UYGUNLUĞU, DÜŞME KORKUSU VE FİZİKSEL AKTİVİTE ARASINDAKİ İLİŞKİ

Purpose: Pregnancy is a time of intense physiologic and physical changes, especially in third trimester. The aim of this study was to investigate the relationship between the footwear suitability, fear of falling and physical activity in third trimester of pregnancy. Methods: One hundred twenty-three pregnant women aged between 18-40 years and a gestational age of 28 weeks and above were included the study. The Footwear Assessment Score was used to assess the suitability of the footwear. The fear of falling of the participants was measured using the Falls Efficacy Scale-International, and the physical activity level was measured using the International Physical Activity Questionnaire - short form. Results: A low negative correlation (r = -0.215; p < 0.05) was found between physical activity and fear of falling, and a low positive correlation (r = 0.256; p < 0.01) was found between footwear suitability and physical activity in pregnant women. There was no statistically significant relationship (r = -0.120; p = 0.185) between footwear suitability and fear of falling. Conclusion: According to the findings of the current study, it can be concluded that a more appropriate choice of shoes as the level of physical activity increases among pregnant women, and physical activity may reduce the fear of falling during pregnancy. Future studies are needed to investigate footwear suitability during pregnancy in more detail.

The Pregnant Patient - Why Do My Feet Hurt?

Although hormonal and anatomical changes that occur during pregnancy have been well documented, how these changes affect foot and ankle function are less understood. Changes during pregnancy in body mass, body-mass distribution, joint laxity, and muscle strength can all contribute to alterations in gait pattern that can lead to pain or injury to the foot and ankle. This review provides an overview of the various foot and ankle anatomic, biomechanic, and kinematic changes that occur during pregnancy. In addition, this article presents the most common causes of foot and ankle symptoms expressed by the pregnant patient population and discuss the management and treatment of each condition.

Effects of Jump-Rope-Specific Footwear Selection on Lower Extremity Biomechanics

Footwear is among the most important equipment in sports to decrease injuries and enhance performance during exercise. In this study, we investigated differences in lower extremity plantar pressure and muscle activations during jump rope activities. Ten participants performed jump rope under two landing conditions with different footwear. A force platform (AMTI, 1000 Hz), a Novel Pedar-X system (Nove, 100 Hz), and a wireless electromyography (EMG) system (Noraxon, 1500 Hz) were used to measure biomechanical parameters during the jump rope exercise. Vertical ground reaction forces (vGRF), plantar pressure, and lower extremity muscle activations were analyzed. One-leg landing resulted in a significantly greater vGRF and shorter fly time than two-leg landing (p < 0.05). A significantly higher peak pressure and lesser toe (LT) area pressure was shown with the jumping shoe (all p < 0.05), but lower plantar pressure resulted in the middle foot area (p < 0.05). The EMG results of tibialis anterior (TA) were significantly greater with one-leg landing (all p < 0.05) during the pre- and background activity (BGA) phases. The results suggest that plantar pressure distribution should be considered when deciding on footwear during jump rope exercises, but care should be taken with regards to recovery after repeated collisions and fatigue. The jumping shoe provides benefits in terms of decreased plantar pressure sustained during jump rope exercises.

Influence of pregnancy related anthropometric changes on plantar pressure distribution during gait—A follow-up study

Background

As foot constitutes the base of support for the whole body, the pregnancy-related anthropometric changes can result in adaptive plantar pressure alterations. The present study aimed to investigate how pregnancy affects foot loading pattern in gait, and if it is related to body adjustments to growing foetus that occur in the course of pregnancy.

Methods

A prospective longitudinal study included 30 women. Three experimental sessions in accordance with the same procedure were carried out in the first, second and third trimesters of pregnancy. First, the anthropometric measures of the body mass and waist circumference were taken. Then walking trials at a self-selected speed along a ~6-m walkway were registered with the FreeMED force platform (Sensor Medica, Italy). Vertical foot pressure was recorded by the force plate located in the middle of the walkway.

Findings

The correlation of individual foot loading parameters across different trimesters was relatively high. Nevertheless, our results revealed a longitudinal foot arch flattening with the strongest effect in late pregnancy (P = 0.01). The anthropometric characteristics also influenced the foot loading pattern depending on the phase of pregnancy. In particular, arch flattening correlated with the body mass in all trimesters (r≥0.44, P≤0.006) while the medial-lateral loading index correlated only in the first (r = 0.45, P = 0.005) and second (r = 0.36, P = 0.03) trimesters. Waist circumference changes significantly influenced dynamic arch flattening but only in the late pregnancy (r≥0.46, P≤0.004). In the third trimester, a small though significant increase in the right foot angle was observed (P = 0.01).

Interpretation

The findings provided the characteristics of the relative foot areas loading throughout pregnancy. Growing abdominal size increases the risk of medial arch flattening, which can result in less stable gait. The observed increase in foot angle in late pregnancy may constitute a strategy to enhance gait stability.

Morphological and Postural Changes in the Foot during Pregnancy and Puerperium: A Longitudinal Study

The aim of this study is to observe the morphological and postural changes to the foot that take place during pregnancy and the puerperium. Method: In this descriptive, observational, longitudinal study, we analysed 23 pregnant women, with particular attention to morphological and postural aspects of the foot, at three time points during and after pregnancy: in weeks 9-13 of gestation, weeks 32-35 of gestation and weeks 4-6 after delivery. The parameters considered were changes in foot length, the Foot Posture Index (FPI) and the Hernández Corvo Index, which were analysed using a pedigraph and taking into account the Body Mass Index (BMI). The same procedure was conducted in each review. Results: The statistical analyses obtained for each foot did not differ significantly between the three measurement times. A pronator-type footprint was most frequently observed during the third trimester of pregnancy; it was predominantly neutral during the postpartum period. Statistically significant differences between the measurement times were obtained in the right foot for cavus vs. neutral foot type (between the first and third trimesters and also between the first trimester and the puerperium) (in both cases, p < 0.0001). Conclusions: Foot length increases in the third trimester and returns to normal in the puerperium. According to FPI findings, the third trimester of pregnancy is characterised by pronation, while the posture returns to neutrality during the postpartum period. During pregnancy, the plantar arch flattens, and this persists during the puerperium. The incidence of cavus foot increases significantly in the third trimester and in the puerperium.

Special footwear designed for pregnant women and its effect on kinematic gait parameters during pregnancy and postpartum period

During pregnancy, an array of changes occurs in women body to enable the growth and development of the future baby and the consequent delivery. These changes are reflected in the range of motion of trunk, pelvis, lower limbs and other body segments, affect the locomotion and some of these changes may persist to the postpartum period. The aim of this study was to describe the changes affecting the gait during pregnancy and to determine the effect of tested footwear on kinematic gait characteristics during pregnancy as previous studies indicate that special orthopaedic insoles and footwear might be useful in prevention of the common musculoskeletal pain and discomfort related to pregnancy. Participants from the control group (n = 18), without any intervention, and the experimental group (n = 23), which was wearing the tested shoes, were measured at their 14, 28 and 37 gestational weeks and 28 weeks postpartum to capture the complete pregnancy-related changes in gait. The gait 3D kinematic data were obtained using Simi Motion System. The differences between the control and experimental group at the first data collection session in most of the analysed variables, as well as relatively high standard deviations of analysed variables indicate large individual differences in the gait pattern. The effect of tested footwear on kinematic gait pattern changes may be explained by its preventive effect against the foot arches falling. In the control group, changes associated previously with the foot arches falling and hindfoot hyperpronation were observed during advanced phases of pregnancy and postpartum, e.g. increase in knee flexion or increase in spinal curvature. For the comprehensive evaluation of the tested footwear on pregnancy gait pattern, future studies combining the kinematic and dynamic plantographic methods are needed.

Changes in lower extremity blood flow during advancing phases of pregnancy and the effects of special footwear

Background

During pregnancy, a number of changes affecting venous blood flow occur in the circulatory system, such as reduced vein wall tension or increased exposure to collagen fibers. These factors may cause blood stagnation, swelling of the legs, or endothelial damage and consequently lead to development of venous disease.

Objectives

The aim of this study is to evaluate the effect of special footwear designed to improve blood circulation in the feet on venous blood flow changes observed during advancing phases of pregnancy.

Methods

Thirty healthy pregnant women participated in this study at 25, 30, and 35 weeks of gestation. Participants were allocated at random to an experimental group (n = 15) which was provided with the special footwear, or a control group (n = 15). At each data collection session, Doppler measurements of peak systolic blood flow velocity and cross-sectional area of the right popliteal vein were performed using a MySonoU6 ultrasound machine with a linear transducer (Samsung Medison). The differences were compared using Cohen's d test to calculate effect size.

Results

With advancing phases of pregnancy, peak systolic velocity in the popliteal vein decreased significantly in the control group, whereas it increased significantly in the experimental group. No significant change in cross-sectional area was observed in any of the groups.

Conclusions

Findings in the experimental group demonstrated that wearing the footwear tested may prevent venous blood velocity from reducing during advanced phases of pregnancy. Nevertheless, there is a need for further investigation of the beneficial effect on venous flow of the footwear tested and its application.

Do Structural Changes of the Foot Influence Plantar Pressure Patterns During Various Stages of Pregnancy and Postpartum?

BACKGROUND

The foot of a pregnant woman undergoes morphological changes with the advancement of pregnancy. It is important to understand the structural changes of the foot during pregnancy and postpartum because any such change may alter the plantar pressure pattern and the entire foot biomechanics.

METHOD

Primigravidae with a gestational age of 12 weeks or less, aged between 18 and 35 years were included in the study. They were prospectively studied across 5 time periods during pregnancy and postpartum. The measures recorded were length, width, navicular height, truncated foot length and normalized navicular height, truncated ratio of the foot, and the static plantar pressure pattern. Repeated-measures ANOVA was done to analyze the changes across various time periods.

RESULTS

All the foot parameters, except foot length and truncated foot length, showed significant differences across various time periods of pregnancy and postpartum (P < .001). It was found that the static plantar pressures also varied significantly (P ≤ .001).The maximum pressure was recorded at the hindfoot of the dominant leg.

CONCLUSION

The feet of pregnant women tend to get pronated as pregnancy advances but do not reach baseline values even at 6 weeks postpartum. Pregnant women tend to bear more weight on the dominant foot with an increased static hindfoot pressure as pregnancy progresses.

LEVELS OF EVIDENCE

Prognostic study, Level I: Prospective.

Relation between foot pain and plantar pressure in pregnancy

Background/aim: Hormonal and structural changes that occur during pregnancy cause alterations in body biomechanics. These alterations reach their peak in the last trimester. Adaptive changes that appear in the foot result in pain in the foot and ankle. Pedobarography is a noninvasive measurement method that can be used to understand the origin of such pain. Materials and methods: One hundred and thirty-one pregnant women who did not have a foot or ankle problem prior to pregnancy volunteered to take part in the study. Pain was quantified by a visual analog scale (VAS). A cut-off value of 2.95 was taken to divide the subjects into two groups: Group 1 (n = 70) with VAS scores of <2.95 and Group 2 (n = 61) with VAS scores of ?2.95. Plantar pressure measurements were taken by Tekscan HR Mat using midgait protocol. Results: Forces experienced by the total right foot area, right forefoot, and the midfoot for both feet were significantly higher in Group 2 (P < 0.05). Contact area was significantly larger in Group 2 (P < 0.05). Conclusion: Results indicate that presence and severity of foot pain during pregnancy are related to the force distribution along the foot, especially at midfoot and the contact area.