What does a podiatrist treat?

Podiatrists specialize in the foot, ankle, and lower leg. They diagnose and treat heel pain, bunions and hammertoes, tendon injuries, nerve conditions (Morton's neuroma, neuropathy), toenail disorders, skin conditions (warts, calluses, ulcers), fractures, sports injuries, diabetic foot complications, ankle instability, and perform foot and ankle surgery. At Balance Foot & Ankle, Dr. Tom Biernacki DPM, Dr. Carl Jay DPM, and Dr. Daria Gutkin DPM AACFAS serve Howell, Bloomfield Hills, and surrounding Michigan communities.

How often should a healthy person see a podiatrist?

Annual foot exams are beneficial if you are over 60, are an active runner or athlete, have diabetes, have a family history of foot problems, or notice any changes in foot shape, nail appearance, or skin texture. Preventive visits catch problems early — before bunions require surgery or a small nail issue becomes an infection.

Can foot problems cause knee, hip, or back pain?

Yes — the foot is the foundation of the kinetic chain. Overpronation causes the tibia to internally rotate, increasing stress on the knee and altering hip alignment. High arches transmit shock poorly, overloading the ankle and knee. Custom orthotics that correct foot mechanics frequently improve knee, hip, and back symptoms — one of the most underappreciated benefits of podiatric care.

When should I see a podiatrist versus an orthopedic surgeon?

Podiatrists specialize exclusively in the foot, ankle, and lower leg — making them the most experienced providers for most foot and ankle conditions. For foot and ankle surgery, a DPM with high case volume is appropriate. Dr. Tom Biernacki at Balance Foot & Ankle has performed over 3,000 foot and ankle procedures. Call (810) 206-1402.

Why do feet hurt during pregnancy?

Pregnancy produces multiple simultaneous physiological changes that collectively create ideal conditions for foot pain — understanding these mechanisms explains why foot complaints are nearly universal in pregnancy and directs appropriate management. Biomechanical changes with weight gain: the average pregnancy weight gain of 25–35 pounds increases ground reaction force (the force the feet absorb with each step) by 20–30%; this increased load strains the plantar fascia, Achilles tendon, and metatarsal bones that were previously accommodating a lower body weight; the additional load is concentrated in the forefoot, which bears approximately 60% of body weight during the push-off phase of gait. Relaxin and ligament laxity: relaxin is a hormone produced during pregnancy that prepares the pelvis and birth canal for delivery by relaxing pelvic ligaments; relaxin is not selective — it acts systemically, loosening ALL ligaments in the body, including the plantar ligaments, spring ligament, and plantar fascia that maintain the foot arch; the result is progressive arch collapse (flattening) during pregnancy that typically worsens with each trimester; the arch collapse increases the length and tension of the plantar fascia, predisposing to plantar fasciitis; the relaxin-mediated ligament laxity combined with weight gain can permanently change foot arch height and shoe size — approximately 60% of women retain at least one shoe size increase after their first pregnancy. Edema (swelling): the increased blood volume of pregnancy (up to 50% above pre-pregnancy levels), combined with the pressure of the growing uterus on pelvic venous return, produces foot and ankle edema particularly in the third trimester; foot swelling of 1–2 shoe sizes by afternoon is common; shoes that fit in the morning become painfully tight by late afternoon. Center of gravity shift: the anterior shift of center of gravity in pregnancy alters gait mechanics — stride length shortens, stance width increases, and pelvic tilt changes to maintain balance; these postural accommodations alter foot loading patterns and can provoke plantar fasciitis, metatarsalgia, and ankle instability.

What can I do for foot pain during pregnancy?

Foot pain management during pregnancy requires approaches that are safe for the fetus — the majority of conservative podiatric interventions are completely safe in pregnancy, while certain medication and injectable options require more careful consideration. Safe and effective interventions during pregnancy: supportive footwear — the highest-impact, safest intervention; transition immediately to low-heeled (under 1.5 inch), wide-toed, arch-supportive shoes; avoid flat ballet-style shoes and flip-flops that eliminate all arch support; maximum cushioning athletic footwear (Hoka, Brooks Ghost) significantly reduces impact loading; sizing up shoes as the pregnancy progresses is necessary and appropriate — do not try to maintain pre-pregnancy shoe size as feet expand; arch-supportive insoles and orthotics — OTC insoles (Superfeet Green, Powerstep Original) provide meaningful arch support and are completely safe during pregnancy; custom orthotics can be fabricated during pregnancy (the orthotic molds to the foot as it currently is) and provide superior support for significant arch collapse; custom orthotics are particularly beneficial for women who develop severe flatfoot deformity during pregnancy; compression socks — graduated compression stockings (15–20 mmHg) reduce afternoon edema by mechanically supporting venous return; safe and beneficial throughout pregnancy; elevation — elevating the feet above heart level for 15–30 minutes, 2–3 times daily dramatically reduces afternoon edema; calf stretching — the gastrocnemius stretch reduces plantar fascia tension and Achilles tendon load; safe and beneficial throughout pregnancy; avoid prolonged standing — schedule breaks every 30–45 minutes if standing is required for work; massage — gentle foot and calf massage improves circulation; safe with a trained prenatal massage therapist; caution with certain reflexology pressure points that are traditionally avoided in pregnancy. Medications to discuss with OB: acetaminophen (Tylenol) — safe for acute pain management; NSAIDs (ibuprofen, naproxen) — contraindicated in the third trimester; use in first/second trimester should be discussed with the OB; corticosteroid injections — a single well-placed injection for severe plantar fasciitis or Morton's neuroma can be considered when conservative measures have failed; risk-benefit discussion with OB is appropriate.

Do feet permanently get bigger during pregnancy?

The evidence on permanent foot changes during pregnancy is clear and often surprising to patients — a meaningful proportion of women permanently retain at least some of the foot growth that occurs during pregnancy. Research findings on permanent foot size change: a 2013 study published in the American Journal of Physical Medicine & Rehabilitation followed women through pregnancy and found that approximately 60–70% had permanent increases in foot length of 2–10mm (roughly half a shoe size to a full shoe size) that persisted at least 18 months postpartum; a second pregnancy further increased foot dimensions in some participants; foot width increased proportionally; why the permanent change occurs: two mechanisms: 1) the relaxin-mediated ligament laxity that allows arch collapse during pregnancy — if the arch does not fully recover postpartum (which is common), the increased foot length from arch collapse is permanent; 2) the mechanical load of pregnancy weight gain on the already-lax arch accelerates structural deformation of the medial longitudinal arch; postpartum recovery of arch height is incomplete in many women, and the postpartum foot shape reflects the new arch height. Practical implications: it is appropriate and necessary to re-measure foot size after pregnancy; forcing feet into pre-pregnancy shoes after significant size change causes plantar fasciitis, metatarsalgia, and nail damage from toe crowding; the shoe size change is most pronounced in first pregnancies and in women who gained more weight during pregnancy; prevention — custom orthotics during pregnancy that support the arch may reduce the degree of permanent arch collapse by mechanically maintaining the arch position during the period of maximum ligament laxity; this is an area of ongoing clinical interest; what to tell patients: plan to replace significant portions of your shoe wardrobe after a first pregnancy; have feet re-measured 3–6 months postpartum when most acute edema has resolved but the structural changes are fully established.

Is it safe to get a pedicure or foot massage when pregnant?

Both pedicures and foot massage are largely safe during pregnancy with some important modifications and precautions — the specific concerns are reflexology pressure points traditionally associated with labor stimulation, infection risk in nail salon environments, and chemical exposure from nail products. Pedicures during pregnancy: safety considerations: ventilation — nail salon fumes (acetone, toluene, formaldehyde in some nail products) pose a theoretical risk with prolonged high-level exposure; choose salons with good ventilation or outdoor air flow; brief exposure during a standard pedicure is generally considered low-risk, but avoid poorly ventilated spaces; positioning — in the third trimester, the semi-reclined position required for a pedicure may be uncomfortable and can compress the inferior vena cava; sitting for shorter periods and adjusting position as needed is appropriate; avoid aggressive cuticle cutting — the immune changes of pregnancy increase the risk of minor wound infections; avoid cutting deeply into the cuticle; use nail products labeled '3-free' (free of formaldehyde, toluene, and dibutyl phthalate) if possible; infection risk from footbaths — request a disposable liner in the pedicure tub; open-jet footbaths can harbor bacteria (Mycobacterium) even after cleaning; disposable liners eliminate this risk; when to skip the pedicure: active skin breaks, open wounds, or ingrown toenails with infection should be treated by a podiatrist rather than a salon before any pedicure. Foot massage during pregnancy: generally safe — gentle foot and lower leg massage improves circulation, reduces edema, and alleviates foot fatigue; the traditional reflexology concern: certain pressure points on the foot (particularly the ankle and heel areas) are claimed by reflexology practitioners to stimulate uterine contractions; the scientific evidence for this is extremely limited; most obstetricians and midwives consider standard massage safe throughout pregnancy; deep tissue or very firm massage over the ankle areas during the first trimester is generally avoided out of caution; seek a trained prenatal massage therapist for formal sessions; partner foot massage with moderate pressure is safe throughout pregnancy.

Foot Pain During Pregnancy by Trimester: Causes & Relief

foot-pain-during-pregnancy-trimester - Balance Foot & Ankle Michigan

Watch: How to Cure Plantar Fasciitis in One Week? [FAST Heel Pain Relief!] — MichiganFootDoctors YouTube

Foot Pain During Pregnancy: By Trimester

Dr. Tom Biernacki, DPM explains pregnancy foot pain by trimester. Call (810) 206-1402.

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Foot Health & Care Resource Center (American Podiatric Medical Association)

📋 Dr. Tom Biernacki, DPM, FACFAS answers:

Pregnancy produces a predictable set of foot changes that are worth understanding before they catch patients off guard. Relaxin, the hormone that loosens pelvic ligaments for delivery, acts systemically — it also loosens the ligaments of the foot, allowing the arch to flatten and the foot to lengthen and widen, sometimes permanently after multiple pregnancies. This is why many women find that their shoe size increases by a half to full size after their first or second pregnancy. That change is normal and does not require treatment, but it does mean that supportive footwear and possibly custom orthotics become important to prevent arch pain and plantar fasciitis as the foot mechanics change.

Swelling of the feet and ankles (edema) is also expected, particularly in the third trimester, and is usually managed with elevation, compression socks, and limiting prolonged standing. The changes that warrant prompt evaluation are unilateral swelling that is significantly worse on one side compared to the other (which can indicate deep vein thrombosis), severe or sudden swelling accompanied by headache or visual changes (preeclampsia), and any numbness, burning, or tingling in the feet that does not resolve with position changes. These symptoms should be reported to the obstetric provider immediately.

Dr. Tom Biernacki, DPM

Foot Pain During Pregnancy: By Trimester

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