Plantar pressure and foot pain in the last trimester of pregnancy

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.

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.

Assessment of physical fitness during pregnancy: validity and reliability of fitness tests, and relationship with maternal and neonatal health - a systematic review

Objectives

To systematically review studies evaluating one or more components of physical fitness (PF) in pregnant women, to answer two research questions: (1) What tests have been employed to assess PF in pregnant women? and (2) What is the validity and reliability of these tests and their relationship with maternal and neonatal health?

Design

A systematic review.

Data sources

PubMed and Web of Science.

Eligibility criteria

Original English or Spanish full-text articles in a group of healthy pregnant women which at least one component of PF was assessed (field based or laboratory tests).

Results

A total of 149 articles containing a sum of 191 fitness tests were included. Among the 191 fitness tests, 99 (ie, 52%) assessed cardiorespiratory fitness through 75 different protocols, 28 (15%) assessed muscular fitness through 16 different protocols, 14 (7%) assessed flexibility through 13 different protocols, 45 (24%) assessed balance through 40 different protocols, 2 assessed speed with the same protocol and 3 were multidimensional tests using one protocol. A total of 19 articles with 23 tests (13%) assessed either validity (n=4), reliability (n=6) or the relationship of PF with maternal and neonatal health (n=16).

Conclusion

Physical fitness has been assessed through a wide variety of protocols, mostly lacking validity and reliability data, and no consensus exists on the most suitable fitness tests to be performed during pregnancy.

PROSPERO registration number

CRD42018117554.

Foot health status in pregnant women

BACKGROUND

Pregnancy is associated with physiological changes such as increased body mass index, postural changes, hormonal imbalance and changes in foot morphology. Due to an increased uterus and body mass, the centre of gravity is displaced anteriorly and superiorly as a means to produce and maintain stability and balance. An influx of relaxin mostly in the third trimester leads to ligament laxity which in turn causes the feet to become longer, flatter and broader. This structural change may remain permanent in some women. Structural changes, increased body weight and increased pressure in the lower limbs may also lead to lower limb oedema which makes it harder to find adequate fitting shoes and may be associated with causing or exacerbating foot pain in pregnant women. The purpose of this study was to determine the overall Foot Health Status (FHS) in pregnant women and also to compare the foot health status in the different trimesters.

METHODS

A quantitative approach, using a descriptive cross-sectional study design was utilized and a validated foot health status questionnaire was used. Data was analysed using a Statistical Package for Social Sciences (SPSS) version 1.04 program and presented in the form of tables.

RESULTS

All pregnant women had a poor foot health status in the area of vigour, particularly in the third trimester. In the third trimester, women's physical activity was diminished and they appeared to have greater footwear difficulties. However, it was found that despite having minimal foot pain, pregnant women maintained good foot function and good social capacity. The least amount of foot pain was felt in the second trimester.

CONCLUSION

As a woman progresses in her pregnancy, her foot health status declined in the areas of footwear, physical activity and vigour.

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.

Relationship of the mobility of the sacroiliac joint with foot plant pressure

[Purpose] To evaluate mobility of the sacroiliac joint and plantar pressure changes. [Participants and Methods] This was an analytical study comprised of 300 participants, using a functional kinetic evaluation involving the test of standing flexion (SFT), the test of Downing, the test of Gillet, and the analysis of baropodometry. [Results] There was an association between mobility of the sacroiliac joint and the standing center of gravity. However, the mobility of this joint was not associated with plantar pressure and the plantar contact area. [Conclusion] These data suggest that sacroiliac mobility is linked to the center of gravity. This connection may precede sacroiliac dysfunction and may help to improve the accuracy of the tests.

Mechanisms of Gait Adaptation in Overweight Pregnant Women

BACKGROUND

Pregnancy is a period when a woman's body undergoes changes. The purpose of this study was to analyze the mechanisms of gait adaptation in overweight pregnant women regarding spatiotemporal gait parameters, ground reaction forces, and plantar pressure distribution.

METHODS

The tests were performed in 29 normal-weight pregnant women and 26 pregnant women who were overweight before pregnancy. The measurements included spatiotemporal gait parameters, in-shoe plantar pressure distribution, and ground reaction forces during gestation.

RESULTS

The results indicate that both normal-weight and overweight pregnant women make use of the same spatiotemporal gait parameters to increase body stability and safety of movement during pregnancy. The double-step duration in the third trimester of pregnancy was higher in normal-weight and overweight pregnant women compared with in the first trimester (P < .05). A significant change in pressure amplitude was found under all anatomical parts of the foot in the third trimester (P < .05). The results also suggest a higher increase in the maximum amplitude of force in overweight pregnant women in the third trimester compared with the normal-weight group.

CONCLUSIONS

This study suggests that both normal-weight and overweight pregnant women use different mechanisms of gait adaptation during pregnancy. In practice, understanding the biomechanical changes in women's gait can protect the musculoskeletal system during gestation.

Changes in center of pressure velocities during obstacle crossing one year after bariatric surgery

Adults with obesity have atypical gait with poor balance leading to an increase in fall risk. After massive weight loss, their gait improves. However, we know little about changes in postural stability after massive weight loss. The present study aimed to examine how massive weight loss after Roux-en-Y bariatric surgery affected adjustments in center of pressure (COP) velocities during flat ground walking and obstacle crossing. Before and one-year post-bariatric surgery, nineteen female adults walked under four conditions: baseline walking on flat ground and obstacle crossing with three different obstacle heights for a total of 20 trials. COP data were obtained from raw pressure time series data extracted from a gait carpet. Massive weight loss increased anteroposterior COP velocities under the midfoot of both trailing and leading legs (ps<.01) and decreased mediolateral COP velocities under the forefoot of trailing leg (p < .05). Decreased BMI from pre- to post-surgery was correlated with an increase in anterior-posterior and decrease in medial-lateral COP velocities and with increased velocity (ps<.05). Massive weight loss not only improved gait but also facilitated effective balance control strategies. Examining how massive weight loss affects adjustments in COP velocity may help create ways to better understand why individuals with obesity have atypical gait with poor balance and how we can facilitate participation in physical activities.

Does the first trimester of pregnancy induce alterations in the walking pattern?

Introduction

From among many studies observing the walking pattern throughout pregnancy, only two items monitor the influence of pregnancy on the movement system during gait considering the period before gestation.

Research question

Does the women’s gait pattern at the end of the first trimester undergo changes in comparison to body movement pattern before pregnancy?

Methods

All subjects who met the inclusion criteria gave signed and informed consent before the study. Two experimental sessions were arranged according to the same protocol: (P0) before pregnancy and (P1) at the end of the first trimester of pregnancy (12^th week of gestation). At first the anthropometric measures were taken. Then, walking trials at a self-selected speed along a walkway were registered with Vicon 250 (Oxford Metrics Ltd.; Oxford, UK) and FreeMED force platform (Sensor Medica, Italy).

Results

An analysis of anthropometric parameters in 12^th pregnancy week demonstrated significant changes in mean values of waist circumference and waist to hip ratio as well as waist to height ratio indexes compared to the results before pregnancy. No significant differences were found in the basic kinematic gait parameters between experimental conditions. Significant increase of mean inter—ankle distance during double support phase occurred during the first trimester of pregnancy. Also, the ratio of the ankle separation width to the pelvic width was noticeably higher in gestation. Then, angular changes of the pelvis in coronal and transverse planes throughout gait cycle during pregnancy demonstrated significant differences compared to those measured before pregnancy. At the same time in the first trimester of pregnancy no adaptive changes in the pattern of feet loading take place.

Significance

Since our study is of longitudinal character, in the course of pregnancy we expect compensatory mechanisms more clearly demonstrated. Therefore, we hope to identify a strategy of the gravid body progression in space.

Changes in foot plantar pressure in pregnant women

BACKGROUND

During pregnancy, the body undergoes many hormonal and anatomical changes causing several medical problems as the musculoskeletal system problems.

OBJECTIVE

To investigate the plantar pressure distribution during pregnancy.

SUBJECTS

Twenty two pregnant and non-pregnant females were selected from the King Abdulaziz University in Jeddah.

METHODS

All females were evaluated by inspection regarding their deformities of the spine, pelvis, lower extremities and feet. Pain was assessed by the Visual Analog Scale (VAS), and the weight and height were recorded using a calibrated weighing scale. Finally, the plantar pressure distribution was examined by a Global Postural Analysis device (GPA).

RESULTS

The results revealed significant asymmetry of weight bearing in the study group (pregnant) compared to the control group (non-pregnant) (p< 0.05). In addition, there was a significant increase in pain intensity in the study group (p= 0.02). On the other hand, the results showed a non-significant difference between study and control groups regarding the three points of pressure (calcaneus, 1st metatarasal and 5th metatarsal) (p> 0.05). Moreover, there was a significant direct relationship between the month of pregnancy and increased weight bearing on the 5th metatarsal in the study group (p= 0.04).

CONCLUSION

There is an effect of pregnancy on plantar pressure distribution as well as weight symmetry which should be considered when designing an antenatal program.

Alterations of Pregnant Gait during Pregnancy and Post-Partum

Physique changes during pregnancy lead to gait characteristic variations. This study aimed to analyse gait of pregnant individuals throughout pregnancy and post-partum. Sixteen healthy pregnant women volunteered as participants and had their lower limb kinematics analysed through a VICON three-dimensional motion system and plantar pressure measured with a Novel EMED force plate. Significant changes were observed in pelvic anterior motion, hip and ankle joint kinematics. Mean pressure distribution and COP trajectory deviation altered accordingly with increased pregnancy time, compared with post-partum. This longitudinal study of pregnant gait biomechanics in T2, T3 and PP reveals lower extremity kinematic and foot pressure alterations to adapt to pregnancy related changes, and the COP trajectory highlights a falling risk during pregnancy, particularly in T3.

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.

Plantar Pressure Differences between Nordic Walking Techniques

High plantar pressure has been associated with increased risk of injury. The characteristics of each physical activity determine the load on the lower limbs. The influence of Nordic Walking (NW) technique on plantar pressure is still unknown. The aim of this study was to analyze the differences between plantar pressure during NW with the Diagonal technique (DT) versus Alpha technique (AT) and compare them with the pressure obtained during normal walking (W). The normality and sphericity of the plantar pressure data were checked before performing a two-way repeated measures ANOVA in order to find differences between speeds (preferred, fast) and the gait (NW, W) as within-subject factors. Then, a t-test for independent measures was used to identify the specific differences between NW techniques. The strength of the differences was calculated by means of the effect size (ES). The results demonstrated that during NW with AT at preferred speed the pressure was lower under the Calcaneus, Lateral Metatarsal and Toes compared to the DT group (p = 0.046, ES = 1.49; p = 0.015, ES = 1.44; p = 0.040, ES = 1.20, respectively). No differences were found at the fast speed (p > 0.05). Besides the increase in walking speed during NW (p < 0.01), both technique groups showed lower pressure during NW compared to W under the Hallux and Central Metatarsal heads (F = 58.321, p = 0.000, ES = 2.449; F = 41.917, p = 0.012, ES = 1.365, respectively). As a practical conclusion, the AT technique may be the most effective of the NW techniques at reducing plantar pressure while allowing NW practitioners to achieve the physiological benefits of NW.

Impact of the quality of life related to foot health in a sample of pregnant women: A case control study

Pregnancy women coincide with numerous anatomical and physiological changes, which are believed to have a harmful effect on the quality of life related to foot health. The goal of this research was to identify and compare the impact foot health and overall health in a sample of pregnancy women and women without pregnancies with normalised reference values.A sample of 159 participants of a mean age of 30.13 ± 6.28 came to the area of midwifery center where self-reported data were registered, informants' with a 1 or various pregnancy was determined and the scores obtained were compared in the foot health status questionnaire (FHSQ). This has 13 questions that assess 4 health domains of the feet, namely pain, function, general health, and footwear.The pregnant women group showed a worse quality of life related to health in general and to foot health specifically at the following domains, foot function, footwear, general foot, health, physical activity, social capacity, and vigor (P < 0.05) and there were no differences at foot pain and general health (P > 0.05).Pregnant women present a negative impact on the quality of life related to foot health, which appears to be associated with the pregnancy period.

Musculoskeletal Effects of Pregnancy on the Lower ExtremityA Literature Review

Pregnant women are often burdened with musculoskeletal symptoms of the lower extremity due to the physical, hormonal, and anatomical changes that occur throughout pregnancy. These symptoms are associated with musculoskeletal dysfunctions, modified gait, joint laxity, muscle imbalance, and increased body mass. This article reviews the literature involving the lower-extremity changes experienced by women during pregnancy and their respective pathophysiologic causes.

A preliminary study of the relation between back-pain and plantar-pressure evolution during pregnancy

This work presents the dynamic study of the plantar pressure in a group of 15 pregnant women. An instrumented insoles (ECnsole) developed by the research group were used in order to measure the plantar pressure distribution. A questionnaire that described their perception of the back pain were filled by the participants. This test were repeated in weeks 12, 20 and 32 of pregnancy. From our preliminary results, the centre pressure in the Y-axis in both foot were slightly displaced towards the heel in week test 20 and 32, and it agrees with the onset of back pain in pregnant women.

The influence of body mass on foot dimensions during pregnancy

In this study, a time-series approach was used to measure women's feet to accurately analyze changes in foot size and body mass during pregnancy. One-hundred women who were pregnant for the first time were asked to respond to questions on subjective complaints of foot discomfort listed in a questionnaire. Among these 100 women, a sample of 30 was obtained and used to measure the women's feet from the twentieth week of the gestation period until labor. The data (from 5 of the 30 women) were used to establish a prediction model for the influence of body mass on changes in foot size during pregnancy. The results indicate that the women subjectively complained that their shoes were too tight, resulting in foot discomfort. From the twentieth to the thirty-eighth week of pregnancy, the average increase in foot length, width, and back foot surface was 0.86 cm (3.6%), 0.25 cm (2.6%), and 18.36 cm(2) (11.9%), respectively. The height of the arch decreased by an average of 0.52 cm (-24.2%). Body mass accounted for more than 90% of the variation (R(2)) in foot dimensions during pregnancy and, thus indicated satisfactory predictive ability. The prediction model developed in this study can serve as a reference for clinical applications and shoe design to prevent women from experiencing extreme discomfort in their feet during pregnancy.

Anthropometric foot changes during pregnancy: a pilot study

BACKGROUND

Women's feet change during pregnancy owing to hormonal and anatomical changes, thus having a strong influence on the decrease in their quality of life during pregnancy. This preliminary study aimed to value the anthropometric and positional changes that affect their feet.

METHODS

Ten pregnant women were measured during their gestational period to analyze the anthropometric changes in their feet from the 12th week of pregnancy. We examined the changes that occured in foot length, forefoot width, arch of the foot height, and the fixed position of the foot by using the Foot Posture Index, and we analyzed three intervals corresponding to pregnancy weeks 12, 24, and 34.

RESULTS

The most significant finding, with a reliability rate of 95%, is the decrease in internal arch height, which descends 0.65 mm (0.0394 inches) on average at the final stage of the pregnancy period. This change happened in 18 of the feet analyzed, tending toward pronation according to the measure provided by the Foot Posture Index, with a change of 3.78 points on this scale.

CONCLUSIONS

The foot of the pregnant woman tends to flatten during gestational weeks 12 to 34, taking a more pronated posture, and the anthropometric changes in late pregnancy result in increases in foot length and forefoot width, changes that seem to be moderate.

Static and dynamic biomechanical adaptations of the lower limbs and gait pattern changes during pregnancy

The purpose of this literature review is to evaluate the studies that have investigated static and dynamic biomechanical changes of the lower limbs and gait patterns during pregnancy. Original articles on this subject, published between 1934 and 2012, were considered. In general, pregnant women demonstrated greater hip flexion, more extended knees and less plantar flexion ankles. These changes could explain the gait patterns of pregnant women characterized by increased hip angles, decreased propulsion forces associated with increased durations of stance phase and changes in distributions of the plantar loads with increased loads in the forefoot and decreased ones in the rearfoot. This can lead to arthrokinematic deviations that, with time, contribute to the development of musculoskeletal discomfort. In summary, these findings showed the importance of further longitudinal studies to investigate the relationships between musculoskeletal discomfort in pregnant women in the lower limbs and gait changes observed throughout this period.

Spinal curvature and characteristics of postural change in pregnant women

OBJECTIVE

Pregnant women often report complaints due to physiological and postural changes. Postural changes during pregnancy may cause low back pain and pelvic girdle pain. This study aimed to compare the characteristics of postural changes in pregnant compared with non-pregnant women.

DESIGN

Prospective case-control study.

SETTING

Pregnancy care center.

POPULATION

Fifteen women at 17-34 weeks pregnancy comprised the study group, while 10 non-pregnant female volunteers comprised the control group.

METHODS

Standing posture was evaluated in the sagittal plane with static digital pictures. Two angles were measured by image analysis software: (1) between the trunk and pelvis; and (2) between the trunk and lower extremity. Spinal curvature was measured with Spinal Mouse® to calculate the means of sacral inclination, thoracic and lumbar curvature and inclination.

MAIN OUTCOME MEASURES

The principal components were calculated until eigenvalues surpassed 1.

RESULTS

Three distinct factors with eigenvalues of 1.00-2.49 were identified, consistent with lumbosacral spinal curvature and inclination, thoracic spine curvature, and inclination of the body. These factors accounted for 77.2% of the total variance in posture variables. Eleven pregnant women showed postural characteristics of lumbar kyphosis and sacral posterior inclination. Body inclination showed a variety of patterns compared with those in healthy women.

CONCLUSIONS

Spinal curvature demonstrated a tendency for lumbar kyphosis in pregnant women. Pregnancy may cause changes in spinal curvature and posture, which may in turn lead to relevant symptoms. Our data provide a basis for investigating the effects of spinal curvature and postural changes on symptoms during pregnancy.