February 2012 - Advanced Physical Medicine
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Pregnant women often have many lower extremity complaints as they gain weight during their pregnancies. The most common complaints include: swelling, pain, varicose or spider veins, and cramping. The release of the hormones progesterone and relaxin, that get the body ready for delivery of the baby can contribute to lower extremity swelling and less stable feet and ankles. This can make the feet feel like they have grown, although the bones in the feet are actually not increasing in size. It is essential to wear properly fitting shoes during this time.

Swelling, also known as edema, usually will increase in severity later in the pregnancy. Fluid pools in the extremities because of the enlarged uterus, which does not allow for the veins to function as efficiently at removing this fluid from the legs, feet, and ankles. Helpful tips for reducing the swelling and corresponding discomfort include elevation of the legs, compression stockings, stockings without seams, stockings that are the correct size, and reducing standing or walking. It is important to note that pregnancy related swelling is usually symmetrical and involving both sides. If the swelling is only on one side, this could be a medical emergency known as a deep vein thrombosis or a blood clot. It is important to report to the nearest emergency department if you think you have this condition, as it can be life threatening.

Pain often occurs in the feet and ankles during pregnancy due to the swelling and increased weight gain. Bunions, neuromas, tendonitis, hammer toes, arthritis, and other foot or ankle conditions can become worse or develop with pregnancy. The release of the hormone relaxin during pregnancy can make the lower extremities less balanced and less stable, and this can lead to new injuries if the foot is not protected with supportive shoes or inserts. One common condition that can develop is heel pain or plantar fasciitis, and this is due to the weight gain. The heel pain with this condition occurs typically with the first steps after rest or sleep, and it involves irritation in the plantar fascia on the bottom of the foot. The condition can improve with icing, stretching, supportive shoes, night splints, orthotics, and physical therapy. In non-pregnant patients, injections and oral anti-inflammatory medications can be used, but these are contraindicated in pregnancy.

Varicose Veins or spider veins are common in the lower extremities when pregnant and can be worse in women that stand or walk extensively during the day. Compression stockings can help with these conditions.

Night cramps in the legs are also a complaint of pregnant women. Some ways of preventing night cramps are stretching and getting exercise, maintaining adequate hydration, and taking the correct combination of vitamins.

In summary, it is important to protect the feet during pregnancy. Although exercise is usually great during pregnancy, it is important to rest and elevate, wear supportive shoe gear or orthotic devices, wear compression stockings, and maintain adequate hydration. Many of these conditions improve or completely resolve up to six months after pregnancy.

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