Gebelikte farklı trimesterlere göre ayak ve ayak bileği eklemi ile dengede meydana gelen değişikliklerin karşılaştırmalı olarak incelenmesi

Abstract

Sökmez Ogün F., A Comparative Study of the Changes Occur in Every Trimester in Foot, Ankle Joint and Balance in Pregnancy. Hacettepe University, Institute of Health Sciences, Physical Therapy and Rehabilitation Program Master Thesis, Ankara, 2018. The purpose of this study is; to analyze the changes occur in foot and ankle joint of the pregnant and their balance depending on their trimester and identify the relation between the changes. 32 primipar pregnant women and 23 non-pregnant women at the same age included in this study. Pregnant individuals were evaluated once in every trimester for three times in total. Non-pregnant women were evaluated only once since they did not accept to come three times for evaluation. In this study, body mass index, muscle strenght, normal range of movement, foot and ankle dermatologic and vascular changes, sensitivity and pain assessment and the evaluation of spine and foot posture, Foot Function Index, static and dynamic balance assessment were evaluated for each participant. In the conducted measurements, it is identified that there is an increase in the measured metatarsal width when it is given weight to as BMI increases in both foot at first and second trimester (p<0.05) and there is an increase at right footprint arch indeks and Chippaux Smirak Index as BMI increases at second trimester which means that there is a decrease in arch (p<0.05). As a result of the analysis of our study which we identified the torakal and lumbal curve degrees of the individuals by using a fleks ruler, it is identified that there is an increase in torakal and lumbal curves in the pregnants. This difference between the trimesters were statistically found meaningful for each of the three trimesters(p<0.05). When the spinal curves of the pregnant case and non-pregnant case are compared, at first trimester torakal areas of the pregnant were lower than the nonpregnant(p<0.01), it is balanced with the healthy individuals at the third trimester where it is identified that the curve at lumbal area is too much when it is compared with the non-pregnant at the third trimester(p<0.05). It is identified that, navicular heights decrease as the pregnancy period proceeds however it is stated that this decrease is only meaningful for the right (p<0.05) but not for the left(p<0.05). In our study, it is identified that metatarsal width, foot volume, foot lenght, midfoot area assesments for both foot during three trimester gradually increases(p<0.05). In paralel with these findings, higher degrees were obtained for the right foot for Chippaux indeks value and also plantar arch indeks value for both foot of pregnants in the measurements of the footprint. In terms of the statical balance test results, the difference between first and third trimesters was found statistically meaningful for the amount of front-back swing when the eyes are open and balance mean when the eyes are closed (p<0.05). There was no meaningful difference between the dynamical balance of the pregnants between the trimesters (p>0.05). It is found that, when the pregnants’ and control group individuals’ dynamical balance means are compared, there is a statistically meaningful difference between the pregnants at both first and third trimester values and dynamical balance values of the control group (p<0.05). At the end of this study, it is found that during pregnancy, there is a balance disorder and changes in foot and ankle which affect balance and also some changes were observed at spine posture throughout the pregnancy that has negative effects on balance. In the light of this information, considering the body biomechanics of the pregnants that can be changed , in order to enable the pregnants to have a healthier life during both pregnancy and after the pregnancy, it is important to have modifications such as an appropriate arch support or shoes and protective approaches such as intrinsic muscle exercise training in order to keep arch height at normal limits. It is understood that, information gained through this study will lead the others working in this field and studies must be increased in this field with more individuals.