Musculoskeletal Effects of Pregnancy on the Lower Extremity
This article reviewed the literature involving lower-extremity changes experienced by women during pregnancy and their respective pathophysiologic causes.
Among the general musculoskeletal effects seen during pregnancy, increased body mass coupled with loosening of the sacroiliac ligaments produce anterior displacement of the centre of mass, which continues to increase throughout pregnancy.
The most commonly observed biomechanical compensatory mechanisms during pregnancy are an increase in stance width of up to 30%, an increase in step time, a decrease in stride length, and a longer stance phase.
Pregnant women also adapt their gait to maximise stability in the stance phase to control mediolateral foot motion.
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A considerable amount of pain is often reported in the lower extremities during pregnancy, and this can partly be attributed to faulty foot posture and variations in muscle balance.
The literature shows a general consensus that an increase in foot size is experienced during pregnancy; these changes are more pronounced in women experiencing their first pregnancy.
One of the most commonly observed changes occurring during pregnancy is collapse of the medial longitudinal arch, causing an increase in foot pronation due to increased laxity of the plantar calcaneonavicular ligament and attenuation of the tibialis posterior tendon.
The most notable changes throughout the gestational trimesters were increased total contact area, increases in time of contact at the midfoot and forefoot regions, and reductions in peak pressure and maximum force at the rearfoot at the end of third trimester.
One of the most reported lower-extremity pain symptoms was cramping of the gastrocnemius soleus complex, often lasting several minutes.
There is objective and subjective evidence suggesting better musculoskeletal outcomes throughout pregnancy for women who exercise before pregnancy and remain physically fit during pregnancy.
The authors proposed that the ideal study design on the lower-extremity biomechanical and musculoskeletal changes associated with pregnancy should incorporate a prospective, longitudinal cohort design.
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References:
- Anselmo, D. S., Love, E., Tango, D. N., Robinson, L. (2017) Musculoskeletal Effects of Pregnancy on the Lower Extremity. Journal of the American Podiatric Medical Association: January/February 2017, Vol. 107, No. 1, pp. 60-64
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