[2026-01-26] Pressure Asymmetries and Low Back Pain in Pregnancy: A Smart Insole-Based Analysis

Jennara Wongpalee; Soodkhet  Pojprapai; Amornlert Phanvatr; Piyaphun  Nunta; Anon  Seedapeng; Supalak Luadlai; Dipak  Kumar Agrawal; Patcharin  Jantata

doi:10.33165/rmj.2026.e274019

Authors

Jennara Wongpalee Division of Maternal Newborn Nursing and Midwifery, Faculty of Nursing, Maejo University, Chiang Mai, Thailand https://orcid.org/0009-0007-6106-6774
Soodkhet Pojprapai School of Ceramic Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima, Thailand https://orcid.org/0000-0003-4988-9501
Amornlert Phanvatr Division of Maternal Newborn Nursing and Midwifery, Faculty of Nursing, Maejo University, Chiang Mai, Thailand
Piyaphun Nunta Health Development Section, Faculty of Liberal Arts, Maejo University, Chiang Mai, Thailand
Anon Seedapeng Health Development Section, Faculty of Liberal Arts, Maejo University, Chiang Mai, Thailand
Supalak Luadlai Business Psychology Area, Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand
Dipak Kumar Agrawal School of Ceramic Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima, Thailand
Patcharin Jantata Obstetrics and Gynecology Division, Antenatal Care Clinic, Sansai Hospital, Chiang Mai, Thailand

DOI:

https://doi.org/10.33165/rmj.2026.e274019

Keywords:

Plantar pressure, Low back pain, Pregnant women, Smart Insole

Abstract

Background: Low back pain is a common condition affecting pregnant women that arises from hormonal and biomechanical changes that alter posture, gait, and balance. Traditional studies focus on general biomechanical adaptations, often neglecting dynamic plantar pressure changes, left-right foot asymmetries, and their link to low back pain.

Objectives: To study the effects of plantar pressure analysis on walking and balance, and to explore the relationship between plantar pressure and low back pain in pregnant women.

Methods: This was a cross-sectional study of 85 pregnant women recruited through simple random sampling and participated in a 10-meter walk test using SuraSole insoles to collect plantar pressure data across eight-foot zones. Data were analyzed using descriptive statistics, paired t test assessed plantar pressure differences between the left and right feet in the pregnant women, and Pearson correlation, paired measurements, and relationships involving continuous variables.The Scheffe’ method was used to test the mean of each pair of means. The relationship between low back pain and plantar pressure using a multiple linear regression analysis.

Results: Pregnant women exhibited significantly higher plantar pressure in the forefoot and heel zones (P < .05). Pregnant participants showed significantly greater plantar pressure in the left heel, medial forefoot, and medial midfoot than the right side (P < .01), reflecting left-side dominance. Plantar pressure positively correlated with gestational age and body mass index. Heel pressure was strongly associated with lower back pain, while toe and forefoot zones showed weaker correlations.

Conclusions: Pregnancy affects plantar pressure distribution and foot asymmetry. Increased plantar pressure, particularly in the heel zone, strongly correlates with low back pain. Left-right foot asymmetries in the pregnant women emphasize the need for targeted interventions, such as improving gait mechanics and suitable shoes and promoting walking exercises to reduce low back pain during pregnancy.

References

Cheema ZR, Akhtar MW, Alam MM, Saeed S, Burhan M, Rizwan M. Prevalence of low back pain in pregnant females. J. Health Rehabil. Res. 2024;4(2):291-295. doi:10.61919/jhrr.v4i2.775

Alsaadi A, Alkhalfah L, Ataya S, Kudsi M. Low back pain during pregnancy: prevalence, pain characteristics, risk factors among pregnant women seen at Primary Health Care Centre in Damascus: a cross-sectional study. Res Sq. 2023:1-10. doi:10.21203/rs.3.rs-3474945/v1

Cherni Y, Desseauve D, Decatoire A, et al. Evaluation of ligament laxity during pregnancy. J Gynecol Obstet Hum Reprod. 2019;48(5):351-357. doi:10.1016/j.jogoh.2019.02.009

Daneau C, Abboud J, Marchand AA, et al. Mechanisms underlying lumbopelvic pain during pregnancy: a proposed model. Front Pain Res. 2021;2:773988. doi:10.3389/fpain.2021.773988

Casagrande D, Gugala Z, Clark SM, Lindsey RW. Low back pain and pelvic girdle pain in pregnancy. J Am Acad Orthop Surg. 2015;23(9):539-549. doi:10.5435/JAAOS-D-14-00248

McKinney ES, James SR, Murray SS, Nelson K, Ashwill J. Maternal-Child Nursing. 6th ed. Elsevier; 2021.

Murray SS, McKinney ES. Holub KS, Jones R. Foundations of Maternal-Newborn and Women's Health Nursing. 7th ed. Elsevier; 2019.

Kouhkan S, Rahimi A, Ghasemi M, Naimi SS, Baghban AA. Studying the changes of the lumbar and thoracic curvatures and pelvic tilt inclinations during pregnancy in primigravida women. J Rehab Med. 2015;3(4):42-52. doi:10.22037/jrm.2014.1100062

Conder R, Zamani R, Akrami M. The biomechanics of pregnancy: a systematic review. J Funct Morphol Kinesiol. 2019;4(4):72. doi:10.3390/jfmk4040072

Berber MA, Satılmış İG. Characteristics of low back pain in pregnancy, risk factors, and its effects on quality of life. Pain Manag Nurs. 2020;21(6):579-586. doi:10.1016/j.pmn.2020.05.001

Segal NA, Boyer ER, Teran-Yengle P, Glass NA, Hillstrom HJ, Yack HJ. Pregnancy leads to lasting changes in foot structure. Am J Phys Med Rehabil. 2013;92(3):232-240. doi:10.1097/PHM.0b013e31827443a9

Hamada HA, Mosaad D, Fahim M, Abd El-Samea G, Youssef A, Matar AG. Dynamic plantar pressure and ground reaction force during pregnancy: a prospective longitudinal study. Cogent Engineering. 2019;6(1):1602969. doi:10.1080/23311916.2019.1602969

Masłoń A, Suder A, Curyło M, et al. Influence of pregnancy related anthropometric changes on plantar pressure distribution during gait—a follow-up study. PLoS One. 2022;17(3):e0264939. doi:10.1371/journal.pone.0264939

Richer L, Fortin E, Gagnon G, et al. Impact of plantar fasciitis on postural control and walking in young middle-aged adults. Foot. 2022;53:101951. doi:10.1016/j.foot.2022.101951

Cervera-Garvi P, Aguilar-Núñez D, Páez-Moguer J, Jerez JM, Navarro-Ledesma S. Differences in the impact of plantar fasciopathy on the spatio-temporal gait parameters between participants with bilateral plantar fasciopathy and healthy subjects: a cross-sectional study. Applied Sciences. 2023;13(4):2133. doi:10.3390/app13042133

Welte L, Kelly LA, Kessler SE, et al. The extensibility of the plantar fascia influences the windlass mechanism during human running. Proc Biol Sci. 2021;288(1943):20202095. doi:10.1098/rspb.2020.2095

Caravaggi P, Pataky T, Günther M, Savage R, Crompton R. Dynamics of longitudinal arch support in relation to walking speed: contribution of the plantar aponeurosis. J Anat. 2010;217(3):254-261. doi:10.1111/j.1469-7580.2010.01261.x

Yamane T. Statistics: An Introductory Analysis. 2nd ed. Harper and Row; 1967.

Physiopedia. Numeric Pain Rating Scale. Accessed 23 August 2025. https://www.physio-pedia.com/Numeric_Pain_Rating_Scale

National Initiative on Pain Control™. Pain Assessment Scales. Accessed 23 August 2025. https://www.physio-pedia.com/images/9/97/Pain_assessment_scales.pdf

Agrawal DK, Jongpinit W, Pojprapai S, et al. Smart insole-based plantar pressure analysis for healthy and diabetic feet classification: statistical vs. machine learning approaches. Technol. 2024;12(11):231. doi:10.3390/technologies12110231

Mei Q, Gu Y, Fernandez J. Alterations of pregnant gait during pregnancy and post-partum. Sci Rep. 2018;8(1):2217. doi:10.1038/s41598-018-20648-y

Martínez-Martí F, Ocón-Hernández O, Martínez-García MS, et al. Plantar pressure changes and their relationships with low back pain during pregnancy using instrumented insoles. J Sens. 2019;2019(1):1567584. doi:10.1155/2019/1567584

Bertuit J, Feipel V, Rooze M. Temporal and spatial parameters of gait during pregnancy. Acta Bioeng Biomech. 2015;17(2):93-101.

Bahrizal AR, Meiyanti M. Association between heel height and low back pain in sales promotion girls. JKKI. 2017;8(3):198-204. doi:10.20885/JKKI.Vol8.Iss3.art9

McClinton S, Weber CF, Heiderscheit B. Low back pain and disability in individuals with plantar heel pain. Foot. 2018;34:18-22. doi:10.1016/j.foot.2017.09.003