Why We Care About Feet As Much as the Pelvic Floor During and After Pregnancy
When I attended Herman and Wallace’s HW Connect Conference in October 2023, I was excited to hear a talk by Holly Herman herself. The listed topic was postpartum recovery, and I was ready for new insights to expand our understanding. What I did not anticipate was Holly dedicating the entire hour and a half to talking about feet and the lifelong changes women experience due to pregnancy. Most of the slides featured zoomed-in pictures of celebrities’ feet on the red carpet. However, the information Holly shared alongside those images greatly impacted our practice as pelvic floor physical therapists.
So, why are feet important? First, nearly 27% of pregnant women experience a fall during pregnancy. This places both the mother and baby at risk for complications during pregnancy, labor and delivery, and the postpartum period. Second, changes in foot structure can affect low back and pelvic girdle pain during the second and third trimesters. Pain in the low back and pelvic girdle can impact a person’s ability to participate in physical activity during this period and their ability to prepare for labor and delivery. Finally, these changes can have long-term effects. Evidence shows that having multiple pregnancies may be one reason females experience more musculoskeletal diagnoses, such as osteoarthritis, compared to males.
What Contributes to Foot Changes During Pregnancy
- Increased lymph node size: This contributes to swelling in the feet as pregnancy progresses.
- Impaired circulation: This impacts muscle and joint function.
- Increased ankle utilization: Pregnant patients tend to rely on their ankles more than their hips during the second and third trimesters while walking.
- Increased levels of relaxin: This hormonal change increases the laxity, or stretchability, of ligaments.
As you can see, multiple systems—hormonal, cardiovascular, and musculoskeletal—influence foot structure during pregnancy. All these changes culminate in shifts in how the feet, and consequently the legs, function during daily activities like walking.
Changes in Walking During Pregnancy
- Flattened foot structure during the third trimester
- Increased use of low back muscles in the third trimester
- Decreased walking speed
- Reduced utilization of hip muscles
- Increased pressure through the mid and rear portions of the foot
Why This Matters for Pelvic Floor Physical Therapy
When we treat patients presenting with urinary incontinence, pelvic organ prolapse, or low back, hip, or pelvic pain, we always consider the transfer of load from their feet to their pelvic floor. Even in patients who have not been pregnant, increased foot pronation can alter pelvic and hip motion during walking.
Our pelvic floor muscles share many connective tissue, muscle, and nerve connections with the hips, low back, sacrum, tailbone, and, yes, the feet. If the feet do not absorb and translate forces appropriately, this can disrupt the functional lengthening and contracting of pelvic floor muscles, leading to impairments such as incontinence, pain, and prolapse.
We can cue a patient through kegels all day long, but if their feet are not strong and moving effectively during daily activities, they will continue experiencing symptoms. This holistic approach is what helps our patients succeed in the long term, addressing multiple symptoms simultaneously and enabling them to return to—or even surpass—their previous strength and function.
So, thank you, Holly Herman, for making us obsessed with feet.
If this blog is making you curious about your feet or if you are experiencing symptoms of low back, hip, or pelvic pain, urinary incontinence, or pelvic organ prolapse, please contact our clinic to learn more about how pelvic floor physical therapy can help you specifically!