Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer: Pregnancy causes foot pain through multiple mechanisms: relaxin hormone loosens ligaments causing temporary flat feet and arch pain, weight gain increases heel and ball-of-foot pressure, and fluid retention causes ankle and foot swelling. Most foot pain in pregnancy resolves post-partum. Safe treatments include supportive footwear, compression socks, and custom orthotics.
Relaxin Hormone and the Pregnant Foot
During pregnancy, the body produces relaxin — a hormone that loosens pelvic ligaments in preparation for delivery. Unfortunately, relaxin affects ALL ligaments, including those of the foot. The result: arches collapse, feet pronate excessively, and the foot can actually increase in length and width by up to half a shoe size. This ligamentous laxity causes arch pain, plantar fasciitis, and posterior tibial tendon strain that many pregnant women experience in the second and third trimesters. In some patients, the foot change is permanent after pregnancy.
Ankle and Foot Swelling in Pregnancy
Edema (swelling) of the feet and ankles is extremely common in pregnancy — affecting up to 80% of pregnant women. It results from increased blood volume, pressure of the growing uterus on pelvic veins, and hormonal fluid retention. Swelling is typically worst in the third trimester, after prolonged standing, and in hot weather. Sudden severe unilateral swelling or swelling with significant pain should prompt immediate medical evaluation to rule out deep vein thrombosis (DVT).
Plantar Fasciitis in Pregnancy
Plantar fasciitis is particularly common in pregnancy due to: ligamentous laxity increasing arch collapse, weight gain increasing heel loading, and gait changes from altered center of gravity. The characteristic morning heel pain and post-sitting pain are typical. Treatment must be modified for pregnancy: corticosteroid injections should be avoided in the first trimester; NSAIDs are contraindicated; stretching, orthotics, and supportive footwear are the primary interventions.
Safe Foot Care During Pregnancy
Safe interventions for foot pain in pregnant patients: supportive footwear with good arch support and wide toe box (avoid heels, which worsen all pregnancy-related foot problems), quality OTC or custom orthotics to support the collapsing arch, medical-grade compression socks for edema management (generally safe in pregnancy with good arterial circulation), elevation of feet during rest periods, gentle calf and plantar fascia stretching, and regular foot elevation when sleeping. Most interventions used for foot care in pregnancy are safe — consult your OB and podiatrist for individualized guidance.
Dr. Tom's Product Recommendations
DASS Medical Compression Socks
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Medical-grade graduated compression socks for pregnancy edema management. Reduce lower leg and ankle swelling safely during second and third trimesters. OB-approved generally.
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Pregnancy ankle and foot swelling, third trimester edema, varicose veins in pregnancy
Peripheral arterial disease — confirm adequate circulation before use during pregnancy
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PowerStep Pinnacle Orthotic
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Arch support orthotics to counteract relaxin-induced arch collapse in pregnancy. Reduces plantar fasciitis pain and posterior tibial tendon stress. Fits most pregnancy-friendly footwear.
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Pregnancy plantar fasciitis, arch pain from relaxin ligament laxity, flat foot support
Severe biomechanical deformity requiring custom prescription devices
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✅ Pros / Benefits
- Most pregnancy foot pain resolves post-partum as relaxin levels normalize
- Conservative treatments (orthotics, compression socks, supportive footwear) are safe and effective
- Early arch support can prevent permanent post-partum flat foot changes in some patients
❌ Cons / Risks
- Corticosteroid injections and NSAIDs are restricted — treatment options narrower than for non-pregnant patients
- Foot size may permanently increase after pregnancy — post-partum shoe fitting is often needed
- Some patients develop long-term flat feet and plantar fasciitis that persist after delivery
Dr. Tom Biernacki’s Recommendation
Pregnancy-related foot pain is often dismissed as ‘just part of being pregnant.’ It doesn’t have to be. Proper arch support, compression socks for edema, and appropriate footwear can make a dramatic difference in comfort through the third trimester. The one thing I really emphasize to pregnant patients: don’t wear heels or flat unsupportive shoes. Flip-flops and ballet flats are particularly hard on the relaxin-laxened arch. Supportive sneakers with orthotics are the prescription for the whole pregnancy.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Is it safe to get custom orthotics while pregnant?
Yes — custom orthotics are completely safe during pregnancy and are often one of the most effective interventions for pregnancy-related plantar fasciitis and arch pain. They can be prescribed at any stage of pregnancy and continue to be useful post-partum.
Will my feet stay bigger after pregnancy?
For some women, yes. The relaxin-mediated ligamentous laxity can cause permanent foot lengthening and widening, especially with subsequent pregnancies. Starting arch support early in pregnancy may partially mitigate this by limiting arch collapse during the period of maximum relaxin effect.
When during pregnancy does foot pain typically start?
Foot pain usually begins in the second trimester as relaxin levels peak, weight gain accelerates, and postural changes become significant. Third trimester is often the most symptomatic period. Most symptoms begin resolving within weeks to months after delivery as relaxin normalizes.
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📞 (810) 206-1402 Book Online →When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
★ DR. TOM’S COMPLETE 2026 ORTHOTIC RANKING
9 Best Prefab Orthotics by Use Case
PowerStep, Currex, Spenco, Vionic, and PowerStep Pinnacle — every orthotic I’ve fitted to thousands of patients across both Michigan offices. Each card includes pros, cons, and the specific patient I’d give it to. Real Amazon ratings, review counts, and prices below.
Best All-Purpose Orthotic for Most Patients
Semi-rigid arch shell + dual-layer cushion + deep heel cup. The orthotic I’ve fitted to more patients than any other for 15 years. APMA-accepted. Trim-to-fit design works in athletic shoes, casual shoes, and most work boots.
✓ Pros
- Semi-rigid arch shell provides true biomechanical correction
- Deep heel cup centers the heel and reduces lateral instability
- Dual-layer cushion (top + bottom) lasts 9-12 months daily wear
- Available in 8 sizes for precise fit
- APMA-accepted and clinically validated
- Lower price than PowerStep Pinnacle for equivalent function
✗ Cons
- Too thick for most dress shoes (use ProTech Slim instead)
- Some break-in period required (3-7 days for arch tolerance)
- Not enough correction for severe pes planus or rigid pes cavus
Dr. Tom’s Recommendation: If a patient has run-of-the-mill plantar fasciitis, mild flat feet, or arch fatigue, this is the first orthotic I try. Better value than PowerStep Pinnacle for 90% of patients, which is why I swapped it into our clinic kits three years ago. Sub-$50 typically.
Maximum Motion Control · Flat Feet & Severe Over-Pronation
PowerStep’s most aggressive stability orthotic. Adds a 2°-7° medial heel post on top of the standard PowerStep platform — designed specifically for flat-footed patients and severe pronators who need real corrective force.
✓ Pros
- 2°-7° medial heel post adds aggressive pronation control
- Same trusted PowerStep arch shell, more correction
- Built specifically for flat-foot biomechanics
- Excellent for posterior tibial tendon dysfunction (PTTD)
- Removable top cover for cleaning
✗ Cons
- Too aggressive for neutral-arch patients
- Needs longer break-in (10-14 days) due to stronger correction
- Adds 2-3 mm of stack height — won’t fit slim dress shoes
Dr. Tom’s Recommendation: When a patient comes in with significant flat feet AND symptoms (heel pain, arch pain, knee pain), the Original PowerStep isn’t aggressive enough. The Maxx is what gets prescribed. About 25% of my flat-footed patients end up here.
Low-Profile · Fits Dress Shoes & Narrow Casuals
3 mm slim profile with podiatrist-designed tri-planar arch technology. Engineered specifically to fit inside dress shoes, oxfords, loafers, and women’s flats without crowding the toe box. Vionic was founded by an Australian podiatrist.
✓ Pros
- 3 mm slim profile (vs 7-10 mm for standard orthotics)
- Tri-planar arch technology adds support without bulk
- Built-in deep heel cup despite slim design
- Fits dress shoes WITHOUT having to remove the factory insole
- Trim-to-fit · APMA-accepted
✗ Cons
- Less arch support than full-volume orthotics
- Top cover wears faster than thicker alternatives
- Not enough correction for severe foot deformities
Dr. Tom’s Recommendation: My default when a patient says ‘I need orthotics but I have to wear dress shoes for work.’ Slim enough to fit in oxfords and pumps without the heel sliding out. The single highest-impact change you can make for office workers with foot pain.
Built-In Metatarsal Pad · Morton’s Neuroma · Ball-of-Foot Pain
Standard Pinnacle orthotic with a built-in metatarsal pad positioned proximal to the metatarsal heads — the exact location that offloads neuromas and metatarsalgia. No need for separate met pads or pad placement guesswork.
✓ Pros
- Built-in met pad eliminates DIY pad placement errors
- Specifically designed for Morton’s neuroma + metatarsalgia
- Same trusted PowerStep arch + heel cup platform
- Top cover protects sensitive forefoot skin
- Faster relief than orthotics + add-on met pads
✗ Cons
- Met pad position is fixed (can’t fine-tune individual placement)
- Some patients with very small or very large feet need custom
- Slightly thicker than the standard Pinnacle
Dr. Tom’s Recommendation: If a patient has Morton’s neuroma, sesamoiditis, or generalized ball-of-foot pain (metatarsalgia), this saves a clinic visit and a prescription. The built-in pad placement is anatomically correct for 80% of feet. Way better than DIY met pads.
Adaptive Dynamic Arch · Athletic & Daily Wear
Currex’s flagship adaptive arch technology — the orthotic flexes with your gait instead of fighting it. Different stiffness zones along the length give you targeted support at the heel, midfoot, and forefoot. Available in three arch heights (low/medium/high).
✓ Pros
- Dynamic flex zones adapt to natural gait cycle
- Three arch heights ensure precise fit
- Lighter than rigid orthotics (no ‘heavy foot’ feel)
- Excellent for runners and athletic walkers
- European podiatric design (German engineering)
✗ Cons
- More expensive than PowerStep Original ($55-65 typically)
- Less aggressive correction than Pinnacle Maxx for severe cases
- Three arch heights means you must self-select correctly
Dr. Tom’s Recommendation: I started recommending Currex three years ago for runners who said PowerStep felt ‘too rigid.’ The dynamic flex zones respect natural gait. Best for active patients who walk 8K+ steps daily and don’t need maximum motion control.
Running-Specific · Heel Strike + Forefoot Strike Compatible
Currex’s purpose-built running orthotic. The midfoot flex zone is positioned for runner’s gait mechanics, with a flared heel cushion for heel strikers and a forefoot rocker for midfoot/forefoot strikers. Tested on 1000+ runners during product development.
✓ Pros
- Designed by German biomechanics lab specifically for runners
- Dynamic arch flexes with running gait (not static like PowerStep)
- Three arch heights (low/medium/high)
- Reduces overuse injury risk in mid-distance runners
- Lightweight (no impact on cadence)
✗ Cons
- Premium price ($60-75)
- Not aggressive enough for severe over-pronators (use Pinnacle Maxx)
- Runner-specific design = less ideal for daily walking shoes
Dr. Tom’s Recommendation: If a patient runs 20+ miles per week and has plantar fasciitis or shin splints, this is the orthotic I prescribe. The dynamic flex zones respect running biomechanics in a way that no rigid PowerStep can match. Pricier but worth it for serious runners.
Cavus Foot & High-Arch Patients
Polyurethane base with a deeper heel cup and higher arch profile than PowerStep — built for cavus (high-arched) feet that need maximum cushion and support. The 5-zone cushioning system addresses the unique pressure points of high-arch feet.
✓ Pros
- Deeper heel cup centers the heel for cavus foot stability
- Higher arch profile fills the void under high arches
- 5-zone cushioning addresses cavus foot pressure points
- Polyurethane base lasts 12+ months
- Available in Wide width
✗ Cons
- Too tall/aggressive for normal or low arches
- Won’t fit slim dress shoes
- Pricier than PowerStep Original
- Some patients find the arch height uncomfortable initially
Dr. Tom’s Recommendation: Cavus foot patients are often misdiagnosed and given low-arch orthotics — that makes everything worse. Spenco’s Total Support has the arch profile that high-arch feet actually need. About 15% of my patients have cavus feet; this is what they wear.
Cushion Layer · Standing All Day · Gel Pressure Relief
NOT a true biomechanical orthotic — this is a cushion insole. But for patients who want gel pressure relief instead of arch correction (or to add ON TOP of factory insoles in work boots), this is the best gel option on Amazon.
✓ Pros
- Genuine gel cushioning (not foam pretending to be gel)
- Targeted gel waves under heel and ball of foot
- Trim-to-fit · works in most shoe types
- Sub-$15 price (most affordable option in this list)
- Massaging texture is genuinely soothing
✗ Cons
- ZERO arch support — this is cushion only
- Won’t fix plantar fasciitis or flat-foot issues
- Compresses faster than PowerStep (4-6 months)
- Top cover wears through in high-mileage applications
Dr. Tom’s Recommendation: I recommend these to patients who tell me ‘I just want my feet to stop hurting at the end of my shift’ and who don’t have a biomechanical issue. Construction workers, factory workers, retail. Pure cushion does the job for them.
Tight-Fitting Shoes · Cycling Shoes · Hockey Skates
PowerStep Pinnacle’s slim version of their famous Green insole. The trademark stabilizer cap is preserved but the overall thickness is reduced — works in cycling shoes, hockey skates, ski boots, and other tight-fitting footwear that the standard PowerStep Pinnacle can’t fit into.
✓ Pros
- Stabilizer cap centers the heel (PowerStep Pinnacle’s signature feature)
- Slim profile fits tight athletic footwear
- Lasts 12+ months daily wear
- Excellent for cycling shoes specifically
- Built-in odor-control treatment
✗ Cons
- Premium price ($45-55)
- Less cushion than PowerStep equivalents
- Not as aggressive correction as Pinnacle Maxx for flat feet
- The signature ‘heel cup feel’ takes 1-2 weeks to adapt to
Dr. Tom’s Recommendation: If you’re a cyclist with foot numbness, hot spots, or knee pain — this is the orthotic. The stabilizer cap solves cycling-specific biomechanical issues that no other orthotic addresses. Worth the premium for athletes.
None of these solving your foot pain?
Some patients (about 30%) need custom-molded prescription orthotics. We make 3D-scanned custom orthotics in our Howell and Bloomfield Hills offices — specifically built for your foot mechanics.
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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.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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