Plantar Pressure Changes and Their Relationships with Low Back Pain during Pregnancy Using Instrumented Insoles

Low back pain affects around 50% of pregnant women and presents significant morbidity and persistence for years in 20% of postpartum women who report that pain. Numerous studies have documented gait alterations during pregnancy and postpartum. Therefore, an analysis of the relationship between certain gait parameters and low back pain was attempted using low-cost validated instrumented insoles. This work presents a longitudinal cohort study carried out during routine gynecological follow-up visits in the first, second, and third trimesters of pregnancy at an Obstetrics and Gynecology Service. Sample size was 62. Plantar pressure data were collected with specially designed instrumented insoles containing four force sensors to measure peak pressure, center of pressure, and stance phase time in each foot and in each pregnancy trimester. The analysis was carried out on a two-dimensional level, simultaneously considering the data from both feet using Hotelling’s test. This longitudinal study detected relationships between certain gait parameter changes and low back pain during pregnancy. It revealed a cyclic tendency of low back pain prevalence with a maximum in the second trimester and a decrease in the third trimester, which was correlated with alterations of the pregnant gait: excessive foot pronation and rearfoot pressure increase.

[1]  Gun Johansson,et al.  Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up , 2002, European Spine Journal.

[2]  Jack Parker,et al.  Identification of Walking Strategies of People With Osteoarthritis of the Knee Using Insole Pressure Sensors , 2017, IEEE Sensors Journal.

[3]  J. Clapp.  Exercise during pregnancy. A clinical update. , 2000, Clinics in sports medicine.

[4]  R. Ruano,et al.  Changes in the plantar pressure distribution during gait throughout gestation. , 2011, Journal of the American Podiatric Medical Association.

[5]  Alberto J. Palma,et al.  A preliminary study of the relation between back-pain and plantar-pressure evolution during pregnancy , 2015, 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[6]  J. Błaszczyk,et al.  Adaptive changes in spatiotemporal gait characteristics in women during pregnancy. , 2016, Gait & posture.

[7]  L. W. Friedmann,et al.  Low-back Pain in Pregnancy , 1987, Spine.

[8]  T. Hübert,et al.  A Colour Ripeness Indicator for Apples , 2012, Food and Bioprocess Technology.

[9]  Timo J. Salpavaara,et al.  Embedded capacitive sensor system for hip surgery rehabilitation: Online measurements and long-term stability , 2008, 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[10]  R. Block,et al.  Physiologic changes in the foot during pregnancy. , 1985, Journal of the American Podiatric Medical Association.

[11]  F. Carpes,et al.  WOMEN ABLE-BODIED GAIT KINEMATICS DURING AND POST PREGNANCY PERIOD , 2008 .

[12]  A. Basgul,et al.  Plantar Pressure and Foot Pain in the Last Trimester of Pregnancy , 2010, Foot & ankle international.

[13]  M. Besser,et al.  Changes in foot function throughout pregnancy , 2001 .

[14]  B. Hoggart,et al.  Pain: a review of three commonly used pain rating scales. , 2005, Journal of clinical nursing.

[15]  J A Coplan,et al.  Rotational motion of the knee: a comparison of normal and pronating subjects. , 1989, The Journal of orthopaedic and sports physical therapy.

[16]  Yaodong Gu,et al.  Characteristics of the centre of pressure progression for pregnant women during walking , 2015 .

[17]  J. Davids,et al.  A Biomechanical Analysis of Gait During Pregnancy* , 2000, The Journal of bone and joint surgery. American volume.

[18]  D P Morales,et al.  Validation of Instrumented Insoles for Measuring Height in Vertical Jump , 2016, International Journal of Sports Medicine.

[19]  M E Franklin,et al.  An analysis of posture and back pain in the first and third trimesters of pregnancy. , 1998, The Journal of orthopaedic and sports physical therapy.

[20]  Alberto J. Palma,et al.  Embedded sensor insole for wireless measurement of gait parameters , 2013, Australasian Physical & Engineering Sciences in Medicine.

[21]  S. Trevino,et al.  Dimensional changes of the feet in pregnancy. , 1988, The Journal of bone and joint surgery. American volume.

[22]  G. Gijón-Noguerón,et al.  Changes in foot posture during pregnancy and their relation with musculoskeletal pain: A longitudinal cohort study. , 2017, Women and birth : journal of the Australian College of Midwives.

[23]  A. Gutke,et al.  Predicting Persistent Pregnancy-Related Low Back Pain , 2008, Spine.

[24]  A. Maiya,et al.  Do Structural Changes of the Foot Influence Plantar Pressure Patterns During Various Stages of Pregnancy and Postpartum? , 2017, Foot & ankle specialist.

[25]  Relation between foot pain and plantar pressure in pregnancy , 2017, Turkish journal of medical sciences.

[26]  M I Bullock,et al.  The relationship of low back pain to postural changes during pregnancy. , 1987, The Australian journal of physiotherapy.

[27]  Yaodong Gu,et al.  Alterations of Pregnant Gait during Pregnancy and Post-Partum , 2018, Scientific Reports.

[28]  Carlos A. F. Marques,et al.  POFBG-Embedded Cork Insole for Plantar Pressure Monitoring , 2017, Sensors.

[29]  T. Asai,et al.  Differences in trunk control between early and late pregnancy during gait. , 2015, Gait & posture.

[30]  J. Achten,et al.  Midfoot plantar pressure significantly increases during late gestation. , 2009, Foot.

[31]  I. Sacco,et al.  Static and Dynamic Biomechanical Adaptations of the Lower Limbs and Gait Pattern Changes during Pregnancy , 2013, Women's health.

[32]  S. Ribas,et al.  Análise da pressão plantar e do equilíbrio postural em diferentes fases da gestação , 2007 .

[33]  P. Katonis,et al.  Pregnancy-related low back pain. , 2011, Hippokratia.

[34]  Nathan S. Lewis,et al.  Array-based vapor sensing using chemically sensitive carbon black-polymer resistors , 1997, Defense, Security, and Sensing.

[35]  B. Erdem,et al.  Pregnancy-related low back pain in women in Turkey: Prevalence and risk factors. , 2018, Annals of physical and rehabilitation medicine.

[36]  H. Yack,et al.  Pregnancy Leads to Lasting Changes in Foot Structure , 2013, American journal of physical medicine & rehabilitation.

[37]  Wendy Gilleard,et al.  The stance phase of walking during late pregnancy: temporospatial and ground reaction force variables. , 2005, Journal of the American Podiatric Medical Association.

[38]  O. G. Meijer,et al.  Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence , 2004, European Spine Journal.

[39]  Z. Gugala,et al.  Low Back Pain and Pelvic Girdle Pain in Pregnancy , 2015, The Journal of the American Academy of Orthopaedic Surgeons.

[40]  Zarko Krkeljas.  Changes in gait and posture as factors of dynamic stability during walking in pregnancy. , 2017, Human movement science.

[41]  W.J. Tompkins,et al.  An umbilical data-acquisition system for measuring pressures between the foot and shoe , 1990, IEEE Transactions on Biomedical Engineering.

[42]  S. Dugan,et al.  Musculoskeletal disorders of pregnancy, delivery and postpartum. , 2007, Physical medicine and rehabilitation clinics of North America.

[43]  M. Nyska,et al.  Planter foot pressures in pregnant women. , 1997, Israel journal of medical sciences.

[44]  P. Thompson,et al.  A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. , 2013, American journal of obstetrics and gynecology.

[45]  J. Mitternacht,et al.  Plantar pressure distribution during and after pregnancy , 2013 .

[46]  Rezaul K. Begg,et al.  Foot Plantar Pressure Measurement System: A Review , 2012, Sensors.

[47]  Qiao Li,et al.  In-Shoe Plantar Pressure Measurement and Analysis System Based on Fabric Pressure Sensing Array , 2010, IEEE Transactions on Information Technology in Biomedicine.

[48]  I. Mogren,et al.  Low Back Pain and Pelvic Pain During Pregnancy: Prevalence and Risk Factors , 2005, Spine.

[49]  R. Santos-Rocha,et al.  Kinematic Analysis of Gait in the Second and Third Trimesters of Pregnancy , 2013, Journal of pregnancy.

[50]  S. Liddle,et al.  Interventions for preventing and treating low-back and pelvic pain during pregnancy. , 2015, The Cochrane database of systematic reviews.

[51]  C. K. Wong,et al.  Gait in Pregnant Women: Spinal and Lower Extremity Changes From Pre- to Postpartum , 2010 .

[52]  Piotr Porwik,et al.  BIOMETRIC RECOGNITION SYSTEM BASED ON THE MOTION OF THE HUMAN BODY GRAVITY CENTRE ANALYSIS , 2010 .

[53]  Priya Ponnapula,et al.  Lower extremity changes experienced during pregnancy. , 2010, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[54]  G B Andersson,et al.  Prevalence of Back Pain in Pregnancy , 1991, Spine.

[55]  W. Gilleard.  Trunk motion and gait characteristics of pregnant women when walking: report of a longitudinal study with a control group , 2013, BMC Pregnancy and Childbirth.

[56]  Rgn Pgce Amelia Williamson MSc,et al.  Pain: a review of three commonly used pain rating scales , 2005 .