Scott Webb (Host): Taking care of our feet and wearing proper footwear are essential to good foot and ankle health. And my guest today, is going to emphasize these points and share his thoughts about orthotics, high heeled shoes, and more. Enjoyed today by Dr. Parker Peresko. He's a foot and ankle surgeon with Arbor Health. Welcome to Arbor Health and Life Podcast. I'm Scott Webb. Doctor, welcome to the podcast.

Parker Peresko, DPM: Thanks, Scott. It's great to be here. I appreciate you having me on and I'm looking forward to answering all these questions and trying to help out all the people.

Host: Yeah, we probably won't have time. I've been plagued, Doctor, for a couple of months with plantar fasciitis, if that's how you say that. Whether it was because I wasn't wearing proper footwear or I haven't worn proper footwear since, we won't have time to do Scott's foot podcast today, but for the masses, Doctor, what are some of the common foot problems that are caused by wearing the wrong shoes? A lot of us do that. We wear the wrong shoes. Our shoes are too old, whatever it might be. And how can we maybe recognize the signs earlier?

Parker Peresko, DPM: Well, I think we may be able to help you because one of the most common things I see is plantar fasciitis and it can absolutely be caused by inappropriate shoe gear. Something without enough support and that might be the name of the game today is support. So support helps in all things.

Along with plantar fasciitis, I see a lot of flat foot, I see bunion deformities, et cetera, et cetera. A lot of these things can be helped out by wearing the appropriate shoes, something that has more stability, owes to more support and cushioning of the foot. And just an overall balanced structure of the architecture of the foot too. So it's not just taking a beating every day while you're doing your daily activities.

Host: I used to sell shoes, Doctor, in high school at the mall as, you know, it was a common thing that people did, kids did at the time. And, you know, we really used to help people to find the right shoes and fit them for shoes and all of that. And now in this sort of warehouse approach to buying shoes, there's never really anybody around to help us.

So I'm glad to have you and your expertise today. And I want to ask you specifically about high heels and how they affect foot health over time. Maybe what are some stylish alternatives that are a little easier on feet?

Parker Peresko, DPM: That's a good question. It's a question I get pretty often. So one of the things I tell my patients is that with the shoes such as high heels or other things that might not be as accommodative to the foot, we typically don't see the, the effects immediately. It's more downstream. So as we're younger we're able to wear these fashionable shoes and not really see any differences.

But as time progresses, the structure of the foot kind of changes due to different types of shoes. So just being aware that something that's really loading the foot, like a high heeled shoe would, something that's not giving enough support to the foot, much as like a converse or a very flat type of shoe can lead to these things over time.

So it's not necessarily recognizing once your foot is starting to hurt you, it's trying to be preventative and buying more appropriate shoes. I tell people all the time, I stopped wearing my high heels a long time ago because of the same issues.

Host: Yeah, my mom is six feet tall, so she never wore high heels, so she was always trying to find stylish alternatives, you know, for tall ladies, and I don't know that she's ever really cracked the code, but wondering, do you have any suggestions? Is there anything that you recommend when it comes to like keeping our style, but also something that's a little better for foot and ankle health.

Parker Peresko, DPM: You know, not necessarily in terms of specific brands, what I say is that if someone wants to wear something with a little bit of a heel, somewhat of a wedge, three inches or so, I think there's still plenty of fashionable options out there, but as you start to get higher on that spectrum, it's going to cause more and more issues with the foot downstream. So again, no real specific brands, but it's more of a issue relative to the height of the actual shoe, the heel itself.

Like I said, three inches, I think is pretty appropriate. So anything within that range can be okay. Obviously the more fashionable shoes aren't going to have as much padding and support as you'd find in other types of shoes. But, I think going with that baseline rule of keeping it at the three inches, having stability and support and something with a little bit of a backbone and structure to it I think. If you go by those, outlines, I think you should be fine.

Host: Yeah. I am in awe of when I see women, especially wearing four inch heels or higher. And I just, I wonder how they do that. Like, how is that even possible that a human being could walk in those shoes? And I want to shift gears a little bit and talk about running shoes. I had a roommate once who just one day he came home from work and he went out for a run and these crummy old gym shoes he probably had since high school, and then his feet, you know, became a problem and he finally had to invest in really good running shoes. And I want to talk about that for adults who just get a wild hair, whatever it is, they start some new activities, some new sport, pickleball, maybe, what do they need to look for when it comes to picking shoes?

Parker Peresko, DPM: Again, support, support, support. There are actual brands out there that I recommend HOKA, Nike, Aerosoles, MBT. There's a lot of different brands that do have really good shoes and really good structure. Most brands you'll find all have some model that will be more conducive to a healthier, happier foot. Again, it's, I tell my patients to look for three things. Are you able to wash out the shoe like a wash rag? If you're able to, it's usually not a good shoe. It should have some bend in the toe, but not enough to where you can wrap it around itself. Almost like some of the Nike free runners back in the day to where they folded up and you could essentially rubber band them and put them in your pocket.

Another part is looking at the heel. So if you can squeeze the heel together with reasonable amount of force and it touches fairly easily. Those are the three main indicators that I try to tell people because no one shoe works for everyone. But having those concepts in mind when going to try on shoes or find the shoe for you, I think is a, good rule to stand by.

Host: Yeah, and I don't want to put you in a position, you know, because you're not being sponsored per se by HOKA or anyone else, but does spending more, is that more of a guarantee that we'll be able to get a more quality shoe that's going to last longer and be better for our feet, or do we not need the 200 to $300 shoes?

Parker Peresko, DPM: I think within reason. Generally the recommendation is change out your shoes every six months to a year. Sometimes I'm even guilty of not doing the same myself, but I will say that there's a fairly reasonable correlation between spending a little bit more on a pair of shoes and them having that extra stability and support that's going to allow you to not see me as often.

Host: Even though folks love seeing you, I'm enjoying seeing you today. I'm sure they love coming into the office to see you. Let's talk about things like diabetes and the issues that folks have with their feet. If they're, you know, living with or suffering from diabetes, what kind of footwear should they be on the lookout for when they head to the store?

Parker Peresko, DPM: Yeah, so this is a bigger one. Depending on the level of diabetes someone has, depending on some of the comorbidities such as neuropathy, which is somewhat of a loss of sensation in in your feet; the number one recommendation is custom diabetic shoe gear, and that's custom made for the patient, usually by a durable medical equipment company where they're fit for it, there's molds made for it, and it just helps to protect the foot overall so they don't develop wounds down the line.

But otherwise, in someone who just has early stage diabetes, no complications that are severe, I think going by the rules that we previously outlined would work for them as well. One of the bigger things for diabetic patients is making sure they wear shoes at all times. Especially if you have that numbness, that lost sensation; you may not be able to feel some things while you're walking around that could essentially poke up into your foot, cause wounds, cause infection down the line.

So just being aware of those things are, I would say, the biggest aspects of talking about shoe gear in a, in the diabetic patient.

Host: Yeah, I've heard that from other experts, that diabetics definitely don't want to go barefoot. Even when it may seem appropriate, right? Even on the beach, even on vacation, good to have something on your feet. And, uh, I have, uh, kind of high arches, so I've been struggling with that most of my life, and I know a lot of people have either flat feet like my son, or high arches. So how about for these folks, and me, when it comes to picking out shoes?

Parker Peresko, DPM: Again, going with those same concepts, I don't think there's one shoe type out there or any brands that I've ran by that are specifically, rather that I've seen work specifically for a higher arch foot type, especially there are some out, some out there that can provide more support for a flat foot type.

When you're getting into more of the severe stages of having a higher arch or having a flatter foot that's been going on for a long time, at that point, it's better to look into either over the counter orthotics or custom orthotics. And I think that would provide more long term solution.

Host: Well, you must have been reading my mind because I wanted to finish up today and talk about orthotics. I see them, the over the counter ones you're referencing, and I know some folks like my dad spent a lot of money, like a lot, on his custom orthotics. So maybe you can give us a sense there, the range, maybe who the over the counter is more appropriate for, but just in general, the role that orthotics play in keeping our feet happy, you know, if you will.

Parker Peresko, DPM: I usually always have patients try over the counter orthotics first, especially if it's something that's more mild. They've only been having pain for a limited amount of time. You know, they had a history of, yeah, my feet were looked this way or that way when I was younger, but I never really had to do anything.

I usually to tell them to attempt some over the counter orthotics. There's a million different brands out there. Superfeet, Don Joy, et cetera, et cetera. Most can be found at local sporting goods stores or even on Amazon. They typically range from anywhere to 15 to $40. And you know, they do that for about a month, two months trial, breaking it in progressively over time.

But if those tend to fail, that's when we start to look at the more custom route.

Host: Yeah, I imagine, Doctor, it's a lot like glasses, you know, when my eyes started to go, I grabbed, you know, the three pack of readers at the local drugstore, and that worked for a while, and then eventually I ended up with these, which are like, you know, tri level, you know, just want to give you a chance as we close, and this has been great to have your time today. Final thoughts, takeaways, when we think about foot and ankle health, what folks can do to help themselves, and or what you can do to help them.

Parker Peresko, DPM: Yeah. Again, thanks for having me on today. I've really appreciated it. Again, the big thing is shoes can really make a huge difference. So going by those concepts that we talked about, stability, support, structure, I think are some of the biggest things in looking into it. In terms of overall health, not trying to advocate for myself, but getting in sooner than later to specialist if something is bothering you, if it's been bothering you for a long time, you've tried things, you've started to change your activity, you're not able to do the things you used to enjoy, get in sooner than later because otherwise the problem becomes worse and there's not as many options to maybe treat it down the line, such as just with some good shoes.

Host: Yeah. Good shoes. You know, one of the things I've learned Doctor, in hosting these is prevention is always better. Early diagnosis, always better than trying to treat and chase it after the fact. So I appreciate your time. Thanks so much.

Parker Peresko, DPM: Thank you. Have a great day. I appreciate it.

Host: You too. And if you'd like more information on foot and ankle health, ask your primary care provider for a referral to Dr. Parker Peresko at Arbor Health, Morton Clinic. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for additional topics of interest. Thanks for listening to Arbor Health and Life Podcast.