Pregnancy Leads to Lasting Changes in Foot Structure
| Autor: | Elizabeth R. Boyer, Natalie A. Glass, Patricia Teran-Yengle, Neil A. Segal, Howard J. Hillstrom, H. John Yack |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Ligamentous laxity medicine.medical_specialty Physical Therapy Sports Therapy and Rehabilitation Osteoarthritis Greater trochanteric pain syndrome Article Pregnancy Subtalar joint medicine Humans Longitudinal Studies Foot business.industry Rehabilitation medicine.disease Low back pain Parity medicine.anatomical_structure Knee pain Linear Models Physical therapy Female medicine.symptom business Foot (unit) |
| Zdroj: | American Journal of Physical Medicine & Rehabilitation. 92:232-240 |
| ISSN: | 0894-9115 |
| DOI: | 10.1097/phm.0b013e31827443a9 |
| Popis: | Women are disproportionately affected by musculoskeletal disorders, which are a significant cause of functional limitations and disability. Studies have found a higher prevalence of chronic joint pain (1.3x),1 including foot pain (1.3x),2, 3 knee pain (1.3x),4 hip pain (1.4x),4–6 greater trochanteric pain syndrome (3.3x),7 and low back pain (1.2x)8 in women than in men. In addition, women are at higher risk for osteoarthritis,9 especially in the knee (1.8x),10 in comparison with men. Studies have suggested that the increased risk for musculoskeletal problems may, in part, relate to biochemical and biomechanical changes that occur in a woman’s body during pregnancy. Vullo and colleagues11 have suggested that there may be musculoskeletal changes that persist following pregnancy, as parous women are more likely to develop new lower limb musculoskeletal disorders than are nulliparous women. The increase in body mass12 in combination with a seven to ten-fold increase in the relaxin hormone level during pregnancy13, 14 have the potential to place atypical stresses on the musculoskeletal system. It is possible that acute or chronic pathomechanics, seen as deviant arthrokinematics might contribute to structural changes that may have long-term consequences. Studies have reported increases in foot length, width, and volume during pregnancy.15, 16 The increased foot width has been attributed to downward movement of the head of the talus in the context of body weight and relaxin effects on the arch, the first metatarsophalangeal joint and the subtalar joint during pregnancy.17 Block and colleagues17 studied the increased hindfoot pronation that occurs during pregnancy and reported that the talus drops approximately 1 cm in association with loss of static arch height and is accompanied by increased subtalar and first metatarsophalangeal joint range of motion. In addition to the anatomic changes in the foot, there are also changes in gait pattern during pregnancy.18–20 Nyska found that, during pregnancy, the center of pressure on the foot shifts posteriorly to compensate for the increased anterior abdominal mass.21 The combination of ligamentous laxity in the arch, increased body mass and the shift in the center of pressure towards the posterior part of the foot during pregnancy may contribute to change in length of the ligaments supporting the arch, leading to loss of arch height. In turn, changes in foot biomechanics that occur with changes in the foot structure can alter the normal control of forces propagating from the foot to more proximal lower limb joints and spine22 and may contribute to pain in the feet, knees, and hips.23 Therefore, disruption of the interaction between skeletal and musculotendinous and ligamentous structures through loss of arch height may predispose to painful musculoskeletal conditions. Perhaps more important than the foot changes that have been reported during pregnancy is the issue of whether these changes return to baseline or persist postpartum. Although numerous scientific studies have assessed the characteristics of the arch during pregnancy, they have not reported whether the changes persisted long-term. We are aware of only one case report,24 and a myriad of anecdotal reports of changes in arch height and foot width that did not resolve postpartum. However, there is a need to assess the validity of these reports through prospectively studying whether there are permanent changes in foot structure. Therefore, the purpose of this study was to determine whether altered foot structure persists following pregnancy by assessing static arch structure and dynamic arch function during the first trimester of pregnancy and 4–5 months postpartum. We hypothesized that a significant reduction in arch height persists postpartum, evident during static and dynamic conditions. |
| Databáze: | OpenAIRE |
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