This is an article for those pregnant women in the community, to inform you about the special foot and ankle concerns during your pregnancy.

Pregnancy & Foot Pain
Flat Feet, Swollen Feet and Leg Cramps Are All Common Pregnancy Problems
by Terence Vanderheiden, D.P.M.

The last thing you want to worry about when you are pregnant is your feet, but pregnancy can lead to problems that affect your feet and legs. There are things you can do to help stop or lessen the problems. Here are the causes, treatments and preventive tips for common foot problems during pregnancy are discussed.

Flat Feet
Causes: Hormones increase during pregnancy. Some of these hormones help relax ligaments and other structures to allow a vaginal birth. These same hormones can also relax the ligaments in your feet, leading to flat feet (fallen arches) and over-pronation. This loosening of ligaments can also increase your shoe size during pregnancy; you may have to wear a half or whole size larger after you give birth.
Your growing womb, baby, and breasts contribute to weight gain that causes extra stress on your already compromised feet, especially your arches. It is not uncommon for pregnant women to develop heel pain (plantar fasciitis) because of the extra weight and stress on the arches. Your center of gravity and how you walk and stand are also affected by the changes in your body, and these may cause problems with your balance.
Prevention/Treatment:
-Try to avoid standing for long periods of time and walking barefoot. Take a break when you can, and sit down and elevate your feet.
-Extra weight, loose ligaments and decreased balance all require extra support for the feet.
-Supportive, properly fitted shoes and over-the-counter arch supports are a good place to begin. -If you still have problems, see a podiatrist to discuss custom orthotics.

Swelling
Causes: Edema (swelling) is an increase in fluid in the tissues of your body. Swelling in your feet and ankles during pregnancy is very common. It is usually caused by an increase in blood volume that occurs to help you carry extra oxygen and nutrients to your baby. Pregnancy hormones can also cause changes in the blood vessels, which may lead to swelling. All of this extra fluid needs a place to go, and gravity usually pulls it down to your feet and ankles. You may notice that your shoes become too tight. Increases in foot size that are due to swelling are common and temporary. If you notice swelling in your face, around your eyes or if the swelling occurs very suddenly, however, you should see a doctor right away. These could be signs of pre-eclampsia.
Prevention/Treatment:
-Do not stand still for long periods of time. Walking gets your calf muscles working, which helps pump some of the extra fluid out of your legs and feet. That said, be sure to rest several times a day, elevating your feet as much as possible when sitting down.
-Wear compression stockings to help decrease the swelling. Knee-high stockings are good, but thigh-high stockings are even better because they ensure that the extra fluid will not collect around your knees.
-Discuss external pneumatic compression devices with your doctor.
-Drink plenty of water throughout the day. Try to avoid foods that contain large amounts of salt, as they will increase your fluid retention.
-Take a bath or go swimming; the water puts an outside force on the swelling and helps to decrease it.
-Rest on your left side. This decreases the pressure on blood vessels and allows more fluid to move from your legs to your upper body.
-Consider reflexology to help decrease the swelling.
-Wear the correct shoe size for your foot.

Leg Cramps
Causes: Leg cramps usually involve painful spasms of the calf. It is not clear why pregnant women are more prone to getting them. It may be due to changes in calcium concentration, tired muscles (due to extra weight gain) or pressure from your growing womb on the blood vessels and nerves. Leg cramps are most common during the second trimester. They can occur both day and night, but are more common at night.
Prevention/Treatment:
-Stretch and massage the muscles in your legs and feet.
-Go for a walk to get some exercise.
-Take a warm bath to relax your muscles.
-Talk to your doctor about taking calcium, magnesium or sodium chloride supplements.
-Drink plenty of water throughout the day.
-If you do get a cramp, stretch your calf muscle by making your knee straight and pulling/moving your foot back toward your nose. This will help to relieve the spasm in the calf muscle.

Varicose Veins
Causes: Varicose veins are veins that have become enlarged and usually stick out above the surface of the skin. They may look like twisted, purple cords or strings. Increased blood volume and pregnancy hormones cause changes in the blood vessels that may lead to varicose veins. Varicose veins are also a result of the weight of your growing womb and baby putting pressure on blood vessels. Varicose veins are common in the legs, but can also occur in the vulvu and rectum (hemorrhoids).
Prevention/Treatment:
-Do not stand for long periods of time. Walking is good because it helps keep the blood moving to your exercising muscles, which then help push the blood back to your heart.
-If driving for a long distance, stop frequently to stretch and exercise your legs. This will also help prevent a deep venous thrombosis (DVT), a serious type of blood clot.
-Try not to cross your legs, as this can put pressure on blood vessels and nerves.
-Talk with your doctor about taking Rutoside (rutin) in your last trimester.

Toenail Changes
Causes: Your toenails tend to grow faster during pregnancy. This is usually due to increased blood volume and circulation of hormones. Prenatal vitamins can also help to improve the overall health of your hair and nails. However, as you are providing nutrients for your baby, the cells in your toenails can sometimes be deprived of an adequate amount of nutrients, which may cause you to develop nail changes such as brittleness; ridges or grooves that go across your nail; or dark, discolored lines/streaks (melanonychia) in the nail bed. A nail might even become loose and fall off. These nail changes will usually go away after your pregnancy.
Prevention/Treatment:
-Do not wear shoes or socks that are too tight. The extra pressure they put on the skin around the nails may cause ingrown toenails.
-Eat healthy, well-balanced meals. This will help supply the nutrients needed for you and your baby.
-Do not trim toenails too short. Swollen skin can overlap the corners of short toenails, causing ingrown toenails.
-Have someone else trim your toenails or get a pedicure if you are not able to see/reach your feet.

The above information is a general guideline to follow. You may have different needs than someone else, so you should always check with your doctor before you start or stop any new treatment or exercise program.