Pregnancy, Diabetes and Your Feet
by Christine Dobrowolski, DPM MS

There are so many changes the body undergoes during 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.

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.