Quick answer: Foot Pain During Pregnancy has multiple potential causes including mechanical, neurological, vascular, and inflammatory. The patterns we see most often are overuse, poorly-fitted shoes, and biomechanical imbalance. Red flags requiring urgent evaluation: warmth/redness (infection), inability to bear weight (fracture), and unilateral swelling without injury (DVT). Call (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: April 2026
In This Article
Pregnancy changes your feet in ways that most prenatal care providers don’t warn you about — and some of those changes are permanent. The combination of relaxin (the ligament-relaxing hormone), weight gain, postural shift, and fluid retention creates a perfect storm for foot and ankle problems in all three trimesters.
At Balance Foot & Ankle, we see a significant number of pregnant and postpartum patients, and we want to give you accurate information about what’s happening to your feet, what’s normal, and when you need evaluation.
The most important clinical decision with Foot Pain During Pregnancy isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
How Pregnancy Changes Your Feet
Relaxin and Ligament Laxity
Relaxin is a hormone produced primarily in the first trimester that loosens ligaments and joints throughout the body to prepare for childbirth. It doesn’t discriminate — it affects every ligament, including those in the foot and ankle. The arch ligaments (spring ligament, long plantar ligament, plantar fascia) relax, allowing the medial longitudinal arch to drop. This is why:
- Many women’s feet lengthen permanently during pregnancy — up to a full shoe size
- Arch pain and plantar fasciitis develop in women who had no foot problems before pregnancy
- Ankle sprains are more common during pregnancy due to ligamentous laxity
- Flat feet that develop during pregnancy may not fully recover afterward
A 2013 study in the American Journal of Physical Medicine & Rehabilitation found that arch height decreased significantly during first pregnancy and did not fully recover postpartum — suggesting that pregnancy-related foot changes can be long-lasting, particularly in women who gained more weight.
Edema and Swelling
Fluid retention is normal in pregnancy, particularly in the second and third trimesters, and tends to pool in the ankles and feet due to gravity. Normal pregnancy edema: symmetric, pitting, worse at end of day, improves with elevation overnight. Sudden onset severe swelling in one leg — especially with calf pain — requires urgent evaluation to rule out deep vein thrombosis (DVT), which is more common in pregnancy.
Weight Gain and Biomechanical Load
Every pound of weight gain increases the ground reaction force on the foot by 3× during walking (due to lever arm mechanics). The average 25–35 lb pregnancy weight gain therefore increases foot loading by 75–105 lbs per step. Combined with ligamentous laxity, this dramatically increases the mechanical stress on the plantar fascia, Achilles tendon, and arch structures.
Center of Gravity Shift
The gravid uterus shifts the center of gravity forward, causing pregnant women to compensate by increasing lumbar lordosis and shifting weight posteriorly. This changes ankle dorsiflexion demands and can increase Achilles and calf tension — contributing to heel pain and leg cramps.
Key takeaway: Important message for all pregnant women: invest in supportive footwear from the first trimester — not when foot pain develops. Arch support cannot reverse arch collapse that has already occurred; it can prevent the collapse from progressing. Waiting until the third trimester is too late for prevention.
Common Foot Problems in Pregnancy
Plantar Fasciitis
The most common significant foot complaint in pregnant women. Relaxin loosens the plantar fascia while increased weight loads it — a direct mechanism for plantar fasciitis. Classic presentation: stabbing heel pain worst with the first steps after waking or after prolonged sitting.
Treatment during pregnancy: All safe — supportive footwear, OTC or custom orthotics with heel cushion and arch support, calf stretching (most important single intervention), night splint to maintain dorsiflexion overnight, ice massage after activity. We can evaluate and treat plantar fasciitis throughout pregnancy without any medication concerns — the physical therapy approaches are completely safe.
Arch Pain and Flat Feet
Progressive arch collapse from relaxin + weight = arch aching throughout the day, worse with prolonged standing. Start wearing arch-supportive shoes from early pregnancy. OTC insoles (Superfeet, Powerstep) provide meaningful support during pregnancy. Custom orthotics are appropriate for women who develop significant symptoms.
Swollen Ankles and Feet (Edema)
Management of normal pregnancy edema:
- Compression stockings: The single most effective intervention — 15–20 mmHg graduated compression reduces fluid accumulation significantly. Put them on before getting out of bed in the morning.
- Elevation: Elevate feet above heart level for 20–30 minutes, 2–3 times daily
- Hydration: Counterintuitively, adequate hydration (8–10 glasses water daily) reduces fluid retention
- Reduce sodium intake
- Walk regularly: Calf muscle pump action reduces venous pooling
- Avoid prolonged standing or sitting
Leg Cramps
Nocturnal leg cramps affect 30–50% of pregnant women, typically starting in the second trimester. The exact cause is uncertain — proposed mechanisms include magnesium deficiency, calcium shifts, nerve compression, and reduced venous return. Treatment: immediate relief by stretching the calf (pull toes toward shin); preventive calf stretching before bed; magnesium supplementation (discuss with OB); adequate hydration; compression socks.
Ingrown Toenails
Foot swelling and difficulty trimming toenails properly (impaired reach in later pregnancy) both contribute to ingrown toenail development. Partial nail avulsion for infected ingrown toenails is safe during pregnancy — we perform this regularly in pregnant patients under local digital block anesthesia.
Varicose Veins
Increased blood volume and progesterone-driven venous relaxation causes varicose veins in up to 40% of pregnancies. Compression stockings are the primary management. Post-partum, many varicosities improve spontaneously; persistent symptomatic varicosities can be treated after delivery and breastfeeding.
Safe Treatments During Pregnancy
Many women are appropriately cautious about treatments during pregnancy. The following are safe at all stages:
- Supportive footwear and orthotics
- Calf stretching and foot exercises
- Ice or cold therapy for inflammation
- Compression stockings (15–20 mmHg or 20–30 mmHg if significant edema)
- Physical therapy and massage (from appropriately trained prenatal therapists)
- Foot elevation
- Topical magnesium gel for cramps
- Acetaminophen (Tylenol) for pain — discuss all medications with your OB
Avoid: NSAIDs (ibuprofen, naproxen) — avoid particularly in the third trimester (risk of premature closure of ductus arteriosus). Corticosteroid injections — typically deferred until after delivery unless pain is severely limiting function; discuss risk-benefit with your OB and podiatrist.
Postpartum Foot Care
Many women expect foot problems to resolve immediately after delivery — the reality is more nuanced:
- Edema typically resolves within 2 weeks postpartum
- Arch laxity from relaxin may persist during breastfeeding (relaxin remains elevated during lactation) and can take 3–6 months post-weaning to stabilize
- If arch pain, flat feet, or plantar fasciitis developed during pregnancy, continue orthotics postpartum — don’t assume the problem will self-resolve
- Foot size change (lengthening) from relaxin may be permanent — buy new shoes rather than returning to pre-pregnancy shoes that now fit incorrectly
Warning: Seek urgent evaluation during pregnancy for:
- Sudden severe swelling in one leg — possible DVT
- Swelling accompanied by headache, visual changes, or upper abdominal pain — possible preeclampsia
- Calf or leg warmth, redness, or tenderness
- Any foot wound that is not healing (especially diabetic patients)
- Severe foot pain significantly limiting walking or daily activity
Related Conditions
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Do feet go back to normal after pregnancy?
Foot width and edema typically normalize within weeks of delivery. However, foot length (arch drop) may be permanent — particularly after first pregnancy, particularly in women who gained more weight. Studies show arch height decreases measurably during pregnancy and doesn’t fully recover in many women. Wearing supportive footwear during pregnancy reduces the degree of permanent change.
Is it normal for feet to grow a full shoe size during pregnancy?
Yes — quite common, particularly in first pregnancies. Relaxin loosens the ligaments that normally hold the arch in place, allowing the arch to flatten and the foot to lengthen. The foot may return partway toward pre-pregnancy size, but a permanent half-to-full size increase is reported by many women after their first pregnancy. Buy new shoes that fit correctly rather than forcing pre-pregnancy shoes onto feet that have changed.
Can I wear high heels during pregnancy?
We recommend avoiding heels above 1 inch during pregnancy. Heels already compromised by ligamentous laxity are particularly vulnerable to sprains in an elevated-heel shoe. The shifted center of gravity of pregnancy combined with heel elevation significantly increases fall risk. Flat or low-heeled, well-supported, wide-toe footwear is the optimal choice throughout pregnancy.
Is it safe to get a pedicure during pregnancy?
Generally yes, with precautions. Avoid hot water foot soaks (blood pressure effects), ensure the salon uses clean, sterilized instruments (infection risk is higher during pregnancy if any skin is broken), and avoid massage of specific acupressure points on the inner ankle that are sometimes said to stimulate contractions (SP6 point) — though evidence of this risk is limited. Standard pedicure without aggressive chemical treatments is considered safe.
What causes leg cramps in pregnancy and how can I prevent them?
Pregnancy leg cramps are caused by a combination of factors: reduced magnesium levels, calcium redistribution, calf muscle fatigue from carrying extra weight, and reduced venous return causing calf ischemia. Prevention: daily calf stretching (especially before bed), adequate hydration, magnesium supplementation (discuss with your OB), compression stockings during the day, and regular moderate activity to maintain calf pump function.
Sources
- Ribeiro AP et al. Changes in foot arch during pregnancy. Am J Phys Med Rehabil. 2011;90(12):1017-1022.
- Vullo VJ et al. Prevalence of foot pathology in pregnant women. J Orthop Sports Phys Ther. 1996;23(1):41-45.
- Marnach ML et al. Characterization of musculoskeletal symptoms in pregnancy. Am J Obstet Gynecol. 2003;189(5):1299-1303.
- Dunning K et al. Musculoskeletal discomfort of the neck, back, shoulder, and wrist. Am J Ind Med. 2003;44(6):621-628.
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Frequently Asked Questions
When should I see a doctor?
See a podiatrist if pain persists past 2 weeks, prevents normal activity, or is accompanied by red-flag symptoms (warmth, swelling, numbness, inability to bear weight).
Can I treat this at home?
Mild cases respond to RICE protocol (rest, ice, compression, elevation), supportive shoes, and OTC anti-inflammatories. Persistent symptoms need professional evaluation.
How long does it take to heal?
Most soft tissue injuries resolve in 2-6 weeks with appropriate care. Bone injuries take 6-12 weeks. Chronic conditions need longer-term management.
Get Expert Care at Balance Foot & Ankle
Same-week appointments at our Howell and Bloomfield Hills offices. Board-certified podiatric surgeons. Most insurance accepted.
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.