Pregnancy, Diabetes, and Your Feet
By Christine Dobrowolski
Doctor of Podiatric Medicine and Author
September 2004
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 allows 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 of the foot is benign and no problems result.
But, 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, proper 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 that
are too small causes an increase in friction and increases the
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 that transmits
to the feet. Moms are staying at home more often and
walking around in slippers and lose, flexible shoes that are generally
not supportive.
To decrease your chances of foot problems during and after pregnancy
review the following tips:
- 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 regardless. Look for cuts, sores,
bruises, openings or areas of irritation. Remember that if your
nerves are not functioning properly, than you may not feel everything
that is happening to 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 foot over it.
- Check your shoes before you put your foot in them.
- 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 that has
a sole that is semi-rigid on the bottom, 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.
- 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
foot will not shrink after birth.
- Watch out for folds in your socks: A simple fold can cause
rub or irritation on your foot. 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 blisters on the toes.
Serious consequences in diabetics can include ulceration and
infection.
- Dry your feet and between toes after showers: Increased moisture
between your toes can lead to skin break down and eventual ulceration.
- Don't be a victim of fashion: Most moms will avoid high fashion
during pregnancy, but may 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 chances of ankle
sprains.
- 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.
- Don't use a heating pad on your feet: Although the idea of
heat on your feet may sound good after a long day, the heat
will increase swelling and inflammation. Sore feet respond better
to ice. Rolling your foot over a frozen sports water bottle
will 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.
- 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.
- Visit your podiatrist: At the first sign of any problems,
make an appointment with your podiatrist. Prevention is much
easier than treatment.
About the Author: 
Christine Dobrowolski is a podiatrist and author of Those
Aching Feet: Your Guide to Diagnosis and Treatment of Common Foot
Problems. More detailed descriptions of diabetic foot problems
and methods of prevention are mentioned in the book. She is member
of the American Podiatric Medical Association and has written
articles in the Journal of Foot and Ankle Surgery and The Lower
Extremity Journal. She has co-authored a chapter in The Comprehensive
Textbook of Foot Surgery in addition to writing Those Aching Feet.
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Diabetes
and pregnancy, fertility issues, gestational diabetes, parenting, 
