pregnancy that it becomes easy to ignore the changes in the
feet. During pregnancy the body releases hormones that allow
the ligaments to relax in the birth canal. The ligaments in the feet
also relax, causing the foot to lengthen and widen. Many will
complain of a shoe size increase by one or two sizes. In most
circumstances, this flattening and widening of the foot is benign
and no problems result. In the diabetic, this change in foot size
is important to recognize. Despite the increase in foot size, many
moms will continue to wear the same size shoes. As a diabetic,
properly fitting shoes are of utmost importance. Increased
pressure on the foot can cause areas of rub or irritation and
potentially result in ulceration. Once there is an ulceration, one is
at risk for infection, delayed healing and further diabetic foot
complications.
Diabetic neuropathy is the single greatest risk factor for
developing foot ulcerations. Neuropathy is the loss of sensation
in the feet commonly caused by diabetes. Many individuals will
develop neuropathy before they are diagnosed with diabetes.
Others will develop neuropathy years after being diagnosed with
diabetes. Luckily, gestational diabetes is not typically associated
with neuropathy. Unfortunately, type I diabetics develop
neuropathy much earlier than type II diabetics and may have
neuropathy during their pregnancy. Regardless of the type of
diabetes, it is still extremely important to have the feet evaluated
to assess the status of the nerves. Even mild neuropathy
increases the risk of ulceration. Wearing shoes which are too
small causes an increase in friction and an increased risk of
skin breakdown.
Wearing properly fitting shoes during and after pregnancy is of
particular importance. Although the ligaments relax in the foot
during pregnancy, they do not stay relaxed. The post-pregnancy
foot is at higher risk for developing foot problems. There are
multiple reasons contributing to the increased risk. The flattened
foot places excess stress on the ligament that holds up the arch.
The weight gain from pregnancy places excess stress on the
feet. Moms are also carrying their baby, added weight which
transmits to the feet. Moms are staying at home more often and
walking around in slippers and flexible shoes which are
generally not supportive.
To decrease your chances of foot problems during and after
pregnancy follow these steps:
1. Check your feet everyday: This is an absolute necessity if you
are a type I diabetic or if you have diagnosed neuropathy. It is a
good habit to practice. Look for cuts, sores, bruises, openings or
areas of irritation. Remember, if your nerves are not functioning
properly, then you may not feel everything in your feet. If you
cannot reach your feet, have a family member check your feet or
place 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 that
has a rigid sole and bends only where the foot bends (at the
toes). If a shoe seems too confined, find a slipper which has a
semi-rigid sole, or try a clog or slip-in shoe with a more rigid
sole. The remaining aspect of the shoe can be soft and flexible
and allow for swelling, but the sole should be rigid from the heel
to the ball of the foot.
4. Buy shoes that fit your feet: Be aware of the changes your feet
are going through. The feet are most likely widening and
lengthening. Make sure the shoes don't cramp the toes. Your
feet will not shrink after the birth.
5. Watch out for folds in your socks: A simple fold can cause rub
or irritation on your feet. Swelling will be greater by the end of
the day and the small crease that didn't bother you in the
morning can rub an open sore or blister on the toes. Serious
consequences in diabetics can include ulceration and infection.
6. Dry your feet and between toes after showers: Increased
moisture between your toes can lead to skin breakdown and
eventual ulceration.
7. Don't be a victim of fashion: Most moms will avoid high
fashion during pregnancy, but many try squeezing into that
strappy heel after. Wearing high heeled shoes puts excess
stress on the ball of the foot, cramps the toes and increases the
chances of ankle sprains. Tight shoes will increase the chance
of 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 the
water by inserting your hand into the water to wrist depth.
9. Don't use a heating pad on your feet: Although the idea of heat
on your feet may sound soothing after a long day, the heat will
increase swelling and inflammation. Sore feet respond better to
ice. Roll your foot over a frozen sports water bottle to help ease
the achiness in the arch. Wear a sock while doing this and don't
put ice directly on your feet. The heating pad can cause burns in
those who have neuropathy.
10. Don't use any medication on the skin: Be careful of topical
medications during pregnancy and during breast-feeding.
Consult your doctor before use. Don't use medicated corn pads
from the local drug stores if you have neuropathy.
11. Visit your podiatrist: At the first sign of a problem, make an
appointment with your podiatrist. Prevention is much easier than
treatment.
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Christine Dobrowolski is a podiatrist and the author of Those
Aching Feet: Your Guide to Diagnosis and Treatment of
Common Foot Problems. To learn more about Dr. Dobrowolski
and her book visit http://www.skipublishing.com/ or at
http://www.northcoastfootcare.com.
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