There is some controversy as to whether pregnant women should wear heels or not. As a podiatrist, I prefer to stay on the side of caution and eliminate or decrease the wear of heels during this time. However, if heels are to be worn for a special occasion and for a short period of time it's important to consider the implications of wearing heels during pregnancy, what type of shoes to avoid and which to look for.
Some of the changes that women can expect to see in their feet when they become pregnant can be exacerbated by the use of high heels and unsupportive shoes. The following are examples.
Decreased Arch Height: The plantar fascia is a bow-string like ligament, on the bottom of the foot that connects the heel to the ball of the foot. When we stand, our arch flattens because of the weight of our body imposed down onto our feet. During pregnancy, women experience additional weight gain. Wearing high heels can contribute to an increase in the pressure placed onto the joints and muscles of the feet, which can then result in permanent structural changes of the feet including arch collapse.
Increased Foot Length and Width: Hormones that are released during pregnancy in preparation for labor increase the relaxation and laxity of ligaments. This can impact not only the joints in the hips, but also cause stretching in the joints of the feet, ultimately leading to widening and lengthening of the feet and an increase in foot size. High heels also aggravate the symptoms and progression of bunion deformities, as the shape of the shoe does not accommodate the normal structure of the forefoot. A heel-type shoe will press up against the great toe pushing it over towards the second toe further exacerbating bunion deformities. When wearing high heels most of your body weight is pushed forward to the balls of your feet and this can lead to metatarsalgia. Shoes with a narrow toe box can also cause this condition. Hammertoes are also a condition developed by high heels. The heel height forces the toes to bend as they lean forward. Overtime, the bent toe can no longer straighten on its own.
Spider and Varicose Veins: The extra weight women carry around during pregnancy can lead to the accumulation of fluid retention in the feet and ankles due to the increased pressure and stress placed onto the veins of the feet as they work against gravity to push blood back to the heart. The accumulation of fluid in the lower extremities can lead to the formation of small, damaged veins that appear on the surface of the legs called spider veins, and much larger swollen blood vessels called varicose veins. Wearing high heels will only exacerbate the process.
Progression of Underlying Foot Deformities: Females that suffer from underlying foot deformities such as bunions and hammertoes will notice an increase in the progression of their condition due to hormonal changes and decreased arch resulting from weight gain. Increased laxity of the ligaments in the foot will lead to stretching in the joints of the feet, leading to biomechanical imbalances within the feet and subsequent progression of foot deformities. The feet naturally pronate during the gait cycle, which means that the arches collapse when we stand and walk. However, during pregnancy the extra weight women carry around can cause the feet to pronate for abnormally long periods of time. Overpronation can alter the biomechanics and distribution of pressure and weight across the foot and ultimately lead to the progression of underlying foot deformities.
Aches and Pains: The accumulation of weight and fluid in the lower extremities in addition to the biomechanical imbalance mentioned above, pregnancy places a tremendous amount of stress on the foot, which can clearly lead to aches, pain, and fatigue. Wearing high heels during your pregnancy will increase the pressure on your back and knees, which are already under strain leading to more foot, leg and back problems and higher probabilities of injury due to falls.
During pregnancy women should avoid the following type of shoes:
Backless shoes: I rarely recommend that people wear backless shoes for an extended period of time. With backless slippers, they aren't really supporting your feet; it's the other way around. Your feet are supporting the slipper, which you can tell with every step. You're crunching down to hold onto the slipper - gripping them with your feet. This accelerates the formation of a Hammer Toe. While slippers are totally fine for short-term use, I suggest a sturdier shoe that supports your arch and your foot for extended use.
High heels: While I doubt anyone is purposefully wearing a high heel when they don't need to I would avoid wearing anything above a 0.75 to 1 inch heel height. Across the board, I typically recommend looking for a shoe that has slightly less than a 1-inch heel or wedge height rather than one that is completely flat as it places less tension on the Achilles tendon and will feel more comfortable. I recommend avoiding shoes that are completely flat because they will contribute to pronation (collapsing of the arch) which may contribute to plantar and posterior heel pain, shin splints, knee pain, and back pain. I also recommend a shoe that has an arch incorporated into its design, which can also help minimize discomfort so this is a great shoe option if you are looking to increase your height.
Flip flops: While flip flops are a convenient option, they can be worse than walking barefoot if they don't have arch support incorporated into its design and are worn for prolonged periods of time. When you wear flip flops your toes have to constantly grip the flip flop as you walk with every step, which could cause or exacerbate hammertoes. The only advantage of wearing a good flip flop such as the Ascent Sandal at home is that the flip flop has arch support, which can provide cushion, support, and protection to your arch from hard floors.
Flat sandals or shoes: Women's sandals should have somewhat of a slight heel less than 3/4 inch in relation to the front. It's actually better for you than sandals that are flat because it takes the stress off the Achilles which can help with the alignment of your posture, ankles, knees, and spine. You should also ensure that the sandal is wide enough in the forefoot but also that the straps are not too loose to avoid injury. Make sure the shoe is also not flimsy in the middle. If it bends easily, you are not getting adequate support in the arch, which will result in foot pain such as arch pain, heel pain.
During pregnancy the extra weight in front of a pregnant woman's body shifts the center of gravity of their feet forward and balancing becomes more difficult with increased weight, which increases risk of falling. The extra weight also puts more stress on the joints and muscles, particularly on the pelvis and lower back. Overall, I recommend that pregnant women wear a comfortable supportive walking shoe most of the time. I wouldn't recommend that pregnant women wear a kitten heel. Kitten heels have a thinner heel and provide less support for your body making it difficult to stay balanced increasing the possibility of falls and injury.
I recommend that pregnant women should wear comfortable and supportive walking shoes while out and a supportive sandal while in the home.
Here are some examples of walking shoes I recommend to wear outside that have the features described above:
When looking for a sandal to purchase, a safe choice if you are not sure, is to purchase a sandal that has the APMA (American Podiatric Medical Association) seal of approval. These sandals will have a generous amount of arch support, for instance, shoes from ABEO, Aetrex, Chaco, FIT-FLOP, Strive Footwear, Naot, and Vionic shoes.
At home, I rarely recommend flip flops because they lack back straps and support for your arches especially for prolonged periods of time. However, when walking at home I do prefer some support rather than no support. One shoe that you may want to consider is the Ascent Groove Sandal if you tend to walk on hard surfaces at home. In my opinion, the Groove Sandal is the best flip flop currently available on the market as they provide superior arch support to prevent over-pronation and relieve pain particularly in people suffering from Plantar Fasciitis. These flip flops styled sandals have a uniquely designed Plantar Fascial Groove and built-in orthotic arch support, which naturally molds to the shape of the foot. The top footbed layer provides excellent cushioning while a firm, durable sole, and elevated heel lift correct foot posture to reduce muscle strain and fatigue. During the quarantine, I had the opportunity to fully evaluate the Groove Flip Flop. I love these flip flops and I have been wearing them every day after work and on the weekends since the pandemic started back in March. These flip flops can be worn at home all day as they provide exceptional comfort and arch support, and ultimately they help promote good foot health.
The second runner up is the VIONIC Bella II Sandals. These flip flops are lightweight and have a flexible EVA (Ethyl Vinyl Acetate) footbed which absorbs shock, reducing stress on feet, ankles, and knees.
For the third runner up I would suggest the Birkenstock Gizeh EVA sandals. The BIRKENSTOCK Gizeh flip flops are modeled on the cork sandal and their footbed will offer the same comfort and arch support you would expect from Birkenstock. These flip-flops are also ultra-lightweight, highly flexible, shock-absorbent, waterproof, and skin-friendly.
Wear Appropriately Sized Shoes: Shoes should accommodate your feet and not the other way around. There is a natural give for shoes as they will accommodate your feet more comfortably after several days of use but overall shoes should feel as comfortable as possible when you first try them on at the store to avoid damaging your feet. Have your feet measured with a Brannock device. Remember as I mentioned above your feet will change shape and size during pregnancy. You should always buy your shoes in the evening when your feet are most swollen. If the shoe feels comfortable at the end of the day they will most likely feel comfortable throughout the day. One trick to determine whether the forefront of your shoe is wide enough is to trace your foot onto a piece of paper at the end of the day when your feet are most swollen. Then place the shoe over the tracing of the foot. If the tracing of the foot is external to the periphery of the shoe then you know that your shoes are too narrow.
Wear Comfortable Shoes: I recommend avoiding high-heeled shoes particularly during the latter stages of pregnancy, as they are going to be difficult to manage simply because it will be very hard to balance, they won't feel comfortable and will place a tremendous amount of stress not only onto your feet but your body as well. Wear a low heeled-shoe for work if you feel that you have to, otherwise wear comfortable sneakers. Also, keep in mind that Increased weight means that shoes will break down sooner and therefore will need to be replaced earlier as they will not provide the same amount of protection.
Wear Orthotics: I recommend wearing custom-fitted orthotics as they are personalized support that will alleviate any symptoms of pain and discomfort while maintaining proper alignment of the body. Although it is of greater importance for people that suffer from flat feet, everyone, including pregnant women regardless of their foot type can benefit from orthotics as they help redistribute weight evenly across your feet.
Wear Compression: Wearing compression stockings is important throughout pregnancy to minimize the accumulation of fluid retention in the lower extremities, which can lead to painful achy feet and the formation of varicosities as mentioned above. During pregnancy women also have an increased risk of developing a blood clot in the legs also known as a DVT (Deep Venous Thrombosis), when blood accumulates in the veins of the lower extremities as they work against gravity.
Avoid Walking Barefoot: Walking barefoot on hard surfaces for an extended amount of time is bad for your feet because it allows your foot to collapse which can lead to a tremendous amount of stress not only to the foot but to the rest of the body. Our feet naturally pronate during the gait cycle, however, when we walk barefoot we pronate for a longer period of time which then alters the biomechanics and distribution of pressure and weight across the foot. This imbalance may increase the progression of underlying foot deformities such as bunions and hammertoes and lead to painful conditions associated with excessive pronation such as arch/ heel pain, shin splints/ posterior tibial tendonitis, and Achilles tendonitis. This imbalance can then translate upward affecting other parts of the body such as our knees and back. Walking barefoot also exposes our feet to bacterial and fungal organisms that can infect the skin and nails. These organisms can lead to infections that change the appearance, smell, and comfort of the foot such as Athlete's foot or fungal nails. In some cases, women with thickened, dry, scaly feet assume that their feet need moisturizing with an everyday cream when in fact what they need is an anti-fungal cream instead because they have a fungal infection that is causing the scaliness. These organisms tend to grow in dark and moist environments. Women often contract these infections as they are highly contagious by walking barefoot in communal bathing facilities and gyms. These organisms first infect the skin and then they may infect the nails subsequently leading to thickening, discoloration, and brittleness of the nails. Both conditions become not only unsightly but also contribute to an unpleasant odor. Ultimately the skin and nails become painful as the skin fissures and cracks and the nail thickens putting more pressure onto the toes.
Exercise: Avoid standing or sitting with your legs in a downward position for prolonged periods of time as doing so will increase swelling in your lower extremities. It's important to exercise throughout pregnancy to stay healthy. Walking is the safest and most comfortable exercise during pregnancy. If you are an experienced runner, then it is safe to say that you can continue a moderate level of exercise during the first trimester and well into the second. However, I like to make my patients aware that the extra weight in front of their body shifts the center of gravity of their feet forward, making balancing more difficult to maintain which increases your risk of falling. The extra weight also puts more stress on the joints and muscles, particularly on the pelvis and lower back. Overall, I recommend walking as the preferred activity of choice during pregnancy as it is the safest and most comfortable exercise.
Moisturize: Another condition pregnant women suffer from is dry and cracked heels as a result of hormonal changes that lead to loss of elasticity and moisture in the skin. The key is to routinely moisturize and exfoliate the feet and legs to reduce the accumulation of dry and cracked skin.
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