Men’s Health Month: Expertise from Trevor Prior

Podiatrist Trevor Prior explains the importance of orthopedic shoes by Vionic

A practicing podiatrist and podiatric surgeon in the UK for more than 30 years, Trevor Prior specializes in sports injuries, biomechanics and gait analysis, orthoses, diabetic foot complications, and foot surgery—all topics he has lectured on nationally and internationally. Trevor is a member of the Vionic Innovation Lab.

As we men get older, family commitments and an ever-busy work schedule mean there is less and less time for ourselves. Trying to meet all these commitments while having some form of social life and trying to maintain fitness becomes increasingly difficult. One of the last things we consider is out feet. However, I regularly see men whose feet are now just another barrier to maintaining some form of balance in their lives.

Unfortunately, as with other aspects of medicine, men are often late in presenting with problems, when there may have been some simple measures they could have taken for prevention. So what are the common things I see and what can be done to minimize problems?

— Many foot problems are related to inappropriately fitting shoes. Our study at Homerton University Hospital demonstrated that 90% of patients and 90% of volunteers were in the wrong sized shoes. For a shoe to fit properly, it should be the same shape as the foot, 1cm longer than the longest toe and ideally have a lace to hold the shoe in place. Simply having the right size shoe can reduce or minimize problems.

Problems with the big toe joint are not uncommon. Stiffness in the joint can be a sign of early arthritis and the joint will become progressively stiffer. Generally, pain will be within the joint or on the top and there may be prominent bone on the top of the joint. This is not always painful but, if it is, it is well worth getting an opinion. A stiff soled shoe which is curved upwards towards the toes (rocker sole) can help in more advanced cases. Inserts (orthoses) inside the shoe can help to reduce load and improve function. Sometimes, injections can help, and, when necessary, surgery.

— A bunion (Hallux Valgus) is where the big toe deviates towards the lesser toes and the joint becomes prominent on the inside of the foot. Again, simple measures such as accommodating shoes and inserts may help with pain.

— Pain beneath the heel is most commonly due to a condition called plantar fasciitis. The plantar fascia runs from the heels to the toes and it is common for symptoms to be felt beneath the heel. Too often, people ignore this thinking it will go away only for it to get progressively worse, so that everyday walking is very painful. It is common to experience pain when you get out of bed in the morning. It then eases with walking but will be there when you get up after sitting for a period. As it gets worse, it is present more of the time. The best thing is to try and treat it when you first get the signs. Rest from impact activity, wearing supportive shoes but with a softer sole, shoe inserts (orthoses), calf stretches and rolling the heel over a bottle of frozen water for five minutes (put a thin tea towel over the bottle to avoid a burn from the cold) can all be very helpful. If it is not settling, see a specialist before it gets too bad so they can advise of other options.

There are obviously a whole range of problems that can occur with everyday activity and sport. The best thing you can do is to be aware of any aches and pains. If they are not settling within a week, then it may be a sign you need to either rest or seek an opinion. If you have symptoms that do not settle overnight, this can be another sign that you need an opinion. Our ability to exercise can vary from day to day – you know the feeling, one day you can do almost anything, another day, everything feels like a struggle. Well listen to your body; it is perhaps best to reschedule that long run if you are having a bad day and just feel stiff and weak. Certainly, if you are performing any sport and your muscle starts to stiffen during the sport, this can be a precursor to a tear. Stop, stretch the affected area and, if the symptoms persist, it may be advisable to stop. The disappointment is far less than the time lost recovering from more significant injury.

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