From Pregnancy to Postpartum: The Impact of Foot Changes on Pelvic Floor Health

Since becoming a mother to my two children, I've had to completely overhaul my shoe collection because none of my pre-pregnancy shoes fit anymore. It's an annoying and expensive consequence that many women face after pregnancy.

During pregnancy, the body undergoes significant hormonal changes that affect ligaments, muscles, and joints, including those in the feet. It's common for women to experience an increase in foot size, arch flattening, and changes in gait due to these hormonal shifts and the added weight of the growing baby.

Researchers have discovered that feet can grow between 2 to 10 millimeters with each pregnancy due to irreversible ligament changes that occur throughout the body during pregnancy. A friend of mine had to increase her shoe size from 7 to 9 over three pregnancies.

You might be wondering why these changes are significant. Well, they can have a profound impact on the body's load distribution, particularly affecting pelvic floor health in the postpartum period.

Load distribution refers to how weight is spread and managed throughout the body during activities like standing, walking, and lifting. Proper load distribution is crucial for maintaining balance, stability, and optimal musculoskeletal function.

Changes in foot structure and mechanics during pregnancy can disrupt natural load distribution, leading to imbalances and increased stress on certain areas, including the pelvic floor. Research suggests that excessive foot pronation, or inward rolling of the foot, during pregnancy may contribute to pelvic floor dysfunction postpartum.

Consider this: when you plant your foot while walking, the arch of your foot should lengthen to absorb the weight of your body making contact with the ground, then lift to push off. During pregnancy, your arch is likely already lengthened due to ligament softening. With the arch unable to cushion the load, forces that would have been dampened in the foot travel up the leg into the pelvic floor, potentially causing issues like urinary incontinence, pelvic organ prolapse, and pelvic girdle pain. These foot mechanics may persist into postpartum, contributing to compensations in the leg and hips, further perpetuating pelvic floor issues.

While strengthening foot muscles through exercises is ideal, it takes time. Here are three ways to mitigate foot changes during pregnancy:

1. Wear supportive footwear with good arch support.

2. Avoid prolonged standing or walking in high heels.

3. Consider orthotic inserts for additional support and stability.

In postpartum, continue to focus on strengthening foot and ankle muscles to improve mobility, balance, and responsiveness. This may include exercises such as big toe mobility, arch lengthening and lifting with different weight distribution, and calf raises with different positions and loads.

And if you are like me you may need to update your shoe wear to fit properly. You want shoes that give your toes space to move. There are new studies coming out saying that you should have at least 12mm of space between your longest toe and the end of the shoe. This allows the foot to adapt to uneven ground and shock absorption, by pronating with each foot fall which elongates and expands the foot. The foot needs space to do this, so if they grew during pregnancy, you’ll likely need to get bigger shoes.

Recognizing the link between foot changes during pregnancy and pelvic floor dysfunction underscores the importance of addressing foot alignment and mechanics as part of prenatal and postpartum care. By consulting with a pelvic floor physical therapist and incorporating interventions to address foot changes, women can promote optimal pelvic floor function and overall well-being for both themselves and their babies.