How shoes affect our bodies and a focus on genital herpes

This BBC podcast is supported by ads outside the UK. Nu har Thomas tappat det igen. Fem arga jobbmejl före lunch. Vad är det som ska för egentligen? Ja, det är ju stolen. Med rätt inredning från AJ-produkter blir arbetsdagen lite enklare. Det kallar vi Happiness at Work. Inredning för hela arbetsplatsen. AJ-produkter.se David är 23 minuter in i lunchrassen och lätar fortfarande efter den här skiftdicken. Den är spålös försvunnen.

Leta mindre. Jobba effektivt med rätt inredning från AJ-produkter. Vi har lösningar som skapar ordning och reda för alla utrymmen. Det kallar vi Happiness at Work. Inredning för hela arbetsplatsen. AJ-produkter.se You're about to listen to Inside Health with me, James Gallagher. If you haven't already, you can download the BBC Sounds app to listen to Inside Health seven days before it's available on other podcast platforms.

Once you're there, you'll find even more podcasts that are available on Sounds before anywhere else. Would you mind if I describe your feet? It depends on the description. Go describe my feet. Okay, that's fine. So actually... Sorry, is that ticklish? Yeah, I have really ticklish feet. What is going on eh? Well, today we're going to see what impact our shoes have on our health. So we're going to analyse how my choice of footwear affects the way that I walk and how that can cause damage.

And we'll see if I'm just bad at buying shoes and get some tips for keeping our feet happy. Then, later on Inside Health, we'll take a look at another embarrassing condition you've asked us to explore.

But let's kick off with those ticklish feet of mine. I went to meet Daryl Tunprasat, Principal Lecturer in Podiatry, armed with a bag of shoes. Hi James! Hi Dao! Welcome to the Biomechanics Lab at University of Brighton! Thank you, I brought a gift for you! Oh, I can see it! Giant bag shoes! Oh, full of goodies! We can have a look at this shoe in a bit! I think this is pretty much every show I own. Where should we start? Let's have a look at your boots first.

okay so you can see uneven wear so you can see that that's more in the middle here, but on the right foot, your wear is more on the outer side. Around the third and the fourth metatarsal pharyngeal joint, so that's the smaller bone. Basically. And that's why I said... Yeah, I'm learning a lot about the way you walk. Now, what are you like when you go to somebody's house and they've kicked off their shoes by the front door? Can you resist? That's interesting.

And also, interestingly, there's a subspecialty in podiatry called forensic podiatry. So that means that they look at footwear patterns or gait in CCTV camera and they're able to identify the person. based on the way that person walks as well. It's definitely true that the way you walk is linked to how you grow up and it's become a unique identity. I want to talk about what the best shoes are.

but first i can see you've got a treadmill i know i know should we have a look at you walking yeah yeah i mean what do you want me to wear How do you feel about walking without a shoe first? I'm happy walking without shoes. Yeah. So, Daryl, if you're going to analyse my gait, what is gait? Gate is the way that the person walks. I would say it's like a pattern of walking that could be unique to that person.

And obviously we all just walk without really thinking about it. It's not something you're conscious of going, oh, left foot, right foot all the time. What's a good gait versus a bad one? Or a good gait is probably when it doesn't lead to injury for you or pain or any problem.

that's not one perfect way of walking because our anatomy is different because our structure is different so the way we walk is also different and that's why it's a unique identity and how much you swing your arm and okay One interesting one is Something that you do habitually can influence your game. For example, if you carry a backpack on one arm all the time, when you're not using that and you walk, it might be that that arm that you're carrying are not swinging as much.

because your body adapts to... It's so used to... Yeah! I wear my rucksack on both shoulders. Yes, it's good! Equally on both shoulders. That's very good. Okay. So we're gonna use a treadmill. Okay, I'm gonna start the cameras now. Oh, interesting. I've never been so intimidated by walking. When a podiatrist says you're walking is interesting, I'm worried. Can I ask, when you were really, really young, like I'm talking about before teaching,

14th year. Has anyone ever told you that you were tall walking? That probably would explain the wear pattern on the smaller tall joint rather than the big tall joint. Would you like to come to the camera and I'll show you what I see. You're walking, it's like you almost have the forefoot or the front of the foot touching down and touching the ground first rather than your heel. Especially on the left side. Your arch height is actually quite within the normal range.

But I can see this part quite clearly that both of your ankles roll in. I go in too much. Yeah. But that's just my body, right? Yeah, yeah. That's just your body. And we have different anatomy. And like, if the body can cope with it fine. There's no indication that it needs to be treated. What do you want me to do now? Let's have a look with the shoes and see if the shoes are actually changing the way you walk. Do you want to wear your usual trainer first? Great, thank you.

Okay, that's fine. That's enough. Thank you very much. I'm now curious with the heavier shoe that you wear, whether that changed the way you walk even further. Can we try that one? Yeah, let's go for it. Let's see. Right then, trainers off. Boots on. Okay.

Let me have a look from the back. I sometimes feel like I'm just flinging my foot forward. Yeah, because it's heavy. When you try to swing your leg, that's caused that effect that you described that you're just flinging the footwear rather than properly. lifting the leg up. Okay, thank you guys. You're listening to Inside Health with me, James Gamble.

So far, Dal Tonprasert from the University of Brighton has shown how our shoes do affect the way that we walk, even when we're completely unaware of it. But does that have any consequences for our health? Let's get back to Dara in the lab. How big an impact do our shoes have on our feet and our foot health? Actually, especially if you're on your feet all the time. So if the footwear does not fit your feet properly, it can lead to deformity. So if you wear...

Like really narrow footwear at the front. It could lead to things like pinching your toes. Yeah, exactly. It could lead to permanent deformity like hammer toes, claw toes, bunions. When we threw bunions. Bunyan, I don't know if you've seen a lot of Celebrity picture, I guess. I always notice their feet and shoes first. Sorry, I'm just like... I just love looking at footwear. But basically, you might see that the big tall joy has shifted.

So it's become like a triangle around the big toe joint and sometimes the joint itself has also become enlarged and people tend to feel pain and also losing the function of the big toe joint, we should push off. using our big toe joy, but if the person has deformities such as bunion, they might not be able to push off, which means they have no choice but to use the smaller bones in order to toe off instead. So it's all linked together really.

what's hammer toe and claw toe? okay hammer toe and claw toe are basically when you're smaller tall rather than being straight they're just a little bit deformed so they change in the shape and you know once it changed when it has arthritis you can't change it back so that's just about the shape of the front and then some shoe can also increase the risk of the person having twisted ankle.

Twisted ankle affects ligament and once you twist your ankle once, you have high likelihood of twisting your ankle again. If we think about how our bodies change as we get older down, does that become a point where we have to just really wear? sensible shoes rather than the glitzy and glamorous stuff? I think basically we call it neuropathy or reduce sensation in the feet.

You know, when you're younger, you're just relying on your sensation to say, oh, this shoe might be too tight or this shoe might be too loose. But when you start losing sensation, you may not be able to feel that feedback that gives you the stability. We might have to visually.

check your feet a bit more so if you see any change in shape that you're not aware of or any like parts that does not look quite right or you don't remember that my feet look like this, then it might be good to seek medical advice and just check to make sure that everything is functioning fine. In a podiatry clinic, I would do vascular assessment in the feet. I would do sensation assessment in the feet and also joint range of motion and strength as a standard, like first.

appointment for everyone. It's always worth doing maybe an annual check or by annual check when it comes to their food health.

you get lots of trends in shoes and like and many of them are purported to have health benefits so you can have barefoot shoes and then you get these really hugely cushioned shoes now seems to be very invoked like is that nonsense or Are there health benefits like a barefoot shoe? Let's roll back. What is barefoot shoes? Barefoot shoes, depending on the company definition, some are just like really thin material and just forming as the natural shape of the body.

What I like about a lot of barefoot style shoes is that the forefoot or the front of the toe box are usually bigger in that way. I like it better. However, it's not going to have all the health benefit that It claimed to be a thing because it depends on the person. For example, if one person has always been wearing shoes as they grow up, their body is used to having a little bit of cushion. So if they switch to bad foot shoe and start running,

then don't just switch and do heavy impact activities straight away. Do a little bit of a slight change and adaptation. You need to ease your way into it. Yeah, exactly. I bet for a shoe is better for running, though, because some people make that argument that it strengthens everything up. Research suggests that when you use barefoot shoes, it does increase muscle activity. Underneath your feet, there are a lot of internal muscles.

that may not be as activated so yes it increase muscle activity and can help to strengthen the muscle but also Barefoot shoes are not the only thing that can strengthen those muscles. You can do strengthening exercise. So barefoot shoes, there's no reason not to use them but just to ease your way into it if you do. And also think about the environment because the barefoot shoes usually have quite thin sole.

So if you're going to be walking somewhere that is quite rough terrain, then is it suitable for those rough terrain and obviously not all like barefoot shoes or minimalist shoes are the same and you think about how slippery the surface is as well and the traction of those surfaces of the sole of the footwear. What's plantar fasciitis?

So it's an inflammation of plantar fascia. Plantar fascia is a structure that runs along the bottom of the foot. So it starts from the heel and goes through the arch and then it inserts into the toe basically. So the most common area of pain is in the heel area. And the term that they commonly describe this is first step pain. So patient would be like, oh, first thing in the morning when I put the weight down, it's really sharp pain, painful.

and then throughout the day is turned from sharp pain into more achiness and that's just because overnight plantar fascia because it's inflamed there's more tension around the area so it's quite stiff so first step is like you're trying to stretch that stiffness out so that leads to sharp pain. And when it's become a bit loose, then it's more achiness that is indication of inflammation in the area.

Is that caused by footwear? Actually, there's certain footwear that increase the risk of plantar fasciitis. So things that increase risk of plantar fasciitis based on research is BMI. The higher the BMI, the more weight. on the body, so it's putting more tension into plantar fascia.

Other thing is like if you have pronated or flat feet because normal foot should have a little bit of arch, right? And if they have flat feet, they already stretch the plantar fascia. So there's already tension within it. So when you do activity on it, it leads to more problems. And then shoes, especially very, very flat shoes. Because if it's flat shoes, it's just like you don't have anything underneath and when you walk on it, your plantar fascia is under tension all the time.

so the body is trying to heal the area but then if the body has not successfully healed the area it's become this low level inflammation that just stay for a long period and make things a bit more difficult to heal It could be quite painful, can't it? Yeah, it's really painful for someone had patient who come in and say there's like 10 out of 10 pain first step and

As I said, it's because of the stiffness of it. So my advice to those patients would be to do manually, like just massage the area or just move the joy around just to kind of like release the tension a little bit before they start walking.

When we think about shoes, is it just about our feet or does it affect all of our health? Well, actually, if it does change your posture, it can impact further up the, we call it kinetic chain, right? So it could impact the knee, it could impact the hip and also our back as well. Another type of shoes is things like high heels because high heels change the way the person walks entirely. It changes the knee position, it changes the hip position, the overall posture.

and people who are inexperienced walk in high heels a certain way and then people who are experienced walk in high heels a different way. Yes, it can have impact further up the chain and the longer you are in that footwear, the more impact it would have on the knee, on the back and upper. Even sometimes, even with the shoulder and can lead to other problems.

Now, before we go, I know producer Tom has a surprise for me. James. Thank you, Tom. From the lens in Brighton. I can see gold glittering out of here. What size heel is that, Tom? Seven inches. That's seven inches. On many levels, I want to ask the question, why? But I suppose I should ask you now, and I'll have my revenge with you, Tom, afterwards. Why have you plotted to put me in seven-inch heels? I think when we were talking, we talked about the impact of footwear on other parts of the body.

And the shoes that can demonstrate it the best is in heels. Especially if the person is not used to wearing heels, you can see the way the gait changes really significantly in the knee. in the hip because it's unstable so you would be like a lower leg. I'm gonna be bracing and squatting, okay? I think from everything I've learned... I just don't think there's enough room for my toes. Well, actually you might be able to feel straight away where the pinch point of...

heels off and how it impacts other joints within the body. I'm gonna give you a hand. Right, I'm just wanting to tip forward and over. Yeah, yeah. So I'm having to lean back. Long term though, because you're leaning back, you have to compensate by hunching the shoulder forward to make it still straight. So it can have an impact. Right. Shall I take some steps? Yes. I feel like I'm walking like a praying mantis. I am in awe of anybody that walks in seven inches. Oh, I'm having to...

not really move my foot and I have to fix my foot, lift my knee and then place it back down and that is a very mechanical way of walking. I can feel the number of times my heel is wobbling until I refine the stability through the heel. It's like I can't quite trust my hair. It's all on the toes. Yeah, yeah. Is that sounding normal? Yeah, but that's for

We call them inexperienced wearer, but then once you experience, you change your gait, you adapt to it as well. That was a bit where I nearly went backwards. I think I would like to take them off if that's okay. Yeah, yeah, yeah, that's fine. But do you feel any pinch in your knee or anything? Not knee, it was the squeeze on the toes. Toes is the worst bit. So you feel the toe first, but as you described earlier that you need to lift your knee more.

so it means you're overworking your knee as well so longer use can lead to knee pain and you know back pains or they are damn fine though uh-huh it looks really cool it looks really nice Out of the shoes you've seen me in, which ones are you most happy about me wearing? Probably your trainers. Would you, Dal, be happiest if everybody just bought trainers? Well, I can't say that because I don't wear trainers all the time either.

I wear nice looking shoes sometimes as well so I can't impose that on everyone I'm afraid because I know that if I don't like the style of it I would not wear it. Gold heels. All I can say is pulling them. Anyway, thank you to Dalton Prasert at the University of Brighton and producer Tom for that experience.

But in a completely unrelated move, I think we should talk about embarrassment now. In the last series, we looked at how feeling embarrassed affects our health and we got a huge response from you. And one of the really common conditions you mentioned was genital herpes.

So we're joined again to discuss by Dr. Vanessa Appiah, a consultant physician in genitourinary and HIV medicine at Bart's Health NHS Trust. Hi. Hello, Vanessa. Hi, very well. Shall we chat genital herpes? Yes, please. Let's do that. Shall we just start off with what are genital herpes? Because sometimes they can be quite easily confused with other things, can't they? So they're genital herpes or it's a genital wall.

So genital herpes, so it's a sexually transmitted infection caused by a virus called herpes simplex virus. And it's an infection that can be passed on through vaginal sex, anal sex or oral sex. The most common symptom that people will know about is the small blisters that can happen in the genital area. And that can really, they can burst and they can leave kind of open red sores around the genital area. And it can also cause a kind of tingling and burning sensation around your genitals as well.

It is like a cold sore. So you can get these blisters and these sores on your mouth as well. And that's what we call cold sores. So just because you have a cold sore doesn't mean that you've got genital herpes. And if you have genital herpes, it doesn't mean that you'll definitely have cold sores. And what's the difference between those and a walk? very different I would say. The only common thing between them is that they're viruses.

Herpes is caused by herpes simplex virus and for genital warts it's caused by human papillomavirus. Genital herpes tends to be more painful and genital warts are raised lesions and don't tend to be painful, but they can be itchy and cause some discomfort. Do we know how many people suffer from genital herpes? You know, when we're talking about anything that can cause embarrassment, we often recognise that it's likely under representative of what's truly happening in the population.

Within the UK, our figures are around 23% of adults having the virus. One in four adults affected. That's a huge number. It really is significant and I use those figures not to alarm people but to just say it is common and you're not alone. And for that reason, please make sure that if you do have symptoms or you have any concerns about it, to go and speak to your GP or go to your local sexual health clinic to get that support you need.

What's it like in one of your clinics when someone gets that diagnosis? some of the most distressing consultations that I've had is when I've shared with someone that I think it is a diagnosis of herpes and trying to manage their anxieties and fears about it because There is so much misinformation out there and a lot of stigma related to it. You mentioned the myths that people come in with. What are the big ones?

So the myth is that I've got it because I've been sleeping around with so many people and that's what people are going to think about, that I'm never ever going to be able to have another partner again. I'm never going to be able to have kids. I'm never gonna be able to get rid of it or manage it. I'm always gonna be infectious.

it's really important to challenge those in conversations like this, but also within the consultation. While we're talking about myths, I see this all the time, can you get herpes from going to the toilet? Just to reassure people, so outside the body, the herpes virus has a very short life and it cannot survive and it quickly dies and surfaces like toilet seats.

The risk of you getting herpes from a toilet seat or any other surface for that matter is really low and nearly impossible. So I would always say that you cannot catch it from a toilet seat. Of all the things to worry about, that's not one of them. Yeah, exactly. Vanessa, why don't you take a listen to this? Someone wrote in to insidehealth at bbc.co.uk. My husband and I both suffered from genital herpes.

He unwittingly passed it on to me very early on, but as we then both had it, it wasn't an issue. However, my husband died at a relatively young age. Since then, more than ten years ago, I would have loved to have met someone else, but couldn't face the prospect of having to explain about the herpes. I have not shared this with even my closest friends and have always resisted if they've wanted to introduce me to someone new.

If only this condition were more out in the open, I would not feel such a massive stigma. You can feel the weight of the diagnosis hanging over that, can't you? Yeah, you can just feel the weight of what that's done and how that's really impacted her quality of life, recovering from the grief of losing her husband and trying to think about how to navigate the next part of her life. And then this is holding her back.

I've seen many people limit their life in this way and just really painfully and I would say unnecessarily as well. Why unnecessarily? There are many ways that we can support people in terms of their symptoms and managing whether they will pass it on to their partner. So it just doesn't mean that You know, I've got herpes. I'm definitely going to pass it on to someone and that's going to be it. That's not the case.

I think one of the things that adds to the stigma of it all is that sense that your body never gets rid of it. It's not like a gonorrhea or a syphilis where there's a bout of medication, it's cleared from your body, and it's just... get on with your life. It's always lingering. So there are some people that will be exposed to the virus and never ever get the virus. There are some people that are exposed to the virus, but they never have any symptoms.

And there are some people that will be exposed to the virus, will get one episode and it never happens again. and then there are some people that get it, it happens once, and then it may happen more frequently. We can't predict which group that you will fall into. So Vanessa, you can't completely get rid of it from your body, but when you have your peak of symptoms, there are those lesions there. Is there anything you can do about it then? The sooner you go and speak to someone...

the better. So within the first five days of you getting those lesions, there are tablets that we can give you that will reduce the virus multiplying and also those same tablets. can reduce you shedding the virus, reducing the risk of shedding the virus means you are less likely to pass it on. When does genital herpes go from something that is uncomfortable and unpleasant and, as we've heard, embarrassing to something that is

risky and dangerous. That scenario, when we become more concerned about it, I would say is in pregnancy. So if you have had herpes and you are pregnant, it's important to share that with your midwife. Typically what happens is that you're given treatment in the latter part of your pregnancy and it will stop you having an episode around delivery so you can have a vaginal delivery if it is appropriate. If you do have genital herpes during delivery, then there's a risk that

herpes can be passed on to the baby, which unfortunately can be fatal. Most babies do recover with antiviral treatment, but we don't want this to happen. So I would say it's really important to be open and honest. whether you've had herpes before or whether you've developed new symptoms so that we can support you in the right way. I suppose that the dream would be a vaccine.

That would be a dream. Unfortunately, we don't have any licensed vaccines at present and it is a complex vaccine to develop, but there is a lot of work still ongoing to see what can be developed in the future. Well, Vanessa, thanks so much for chatting. It's been a pleasure. Thank you. And thank you for getting in touch with insidehealth at bbc.co.uk with your embarrassing conditions.

Next week, we're looking at allergies. And in the meantime, you can explore an interactive guide of health issues that people often find uncomfortable discussing. You can visit bbc.co.uk slash inside health and follow the links to The Open Universe. See you next time. You've been listening to the Inside Health Podcast with me, James Gallagher. The producer was Tom Bonnet and the assistant producer was Siobhan Maguire. The show was a BBC Wales and West production for Radio 4. See you next time.