You’re Doing This Every Day — It’s Destroying Your Feet | Dr. Courtney Conley

0:00 The reason I got into this work was because of all the foot pain that I've had.

0:03 And I'm working real hard, "Jesse." I'm working real hard to get

0:06 this information out there because it changes people's lives.

0:09 If you go look at all the popular footwear now, it's like a pillow party.

0:13 It's maximal cushion and all this stuff.

0:15 You watch people walk in these, and you're like, they're going to fall over.

0:18 Nobody gets a free lunch.

0:19 If you don't use it, you're going to lose it.

0:21 We are really creating feet that are becoming weaker,

0:24 and it's why we're seeing a high rate of foot pain,

0:27 a high rate of foot diagnoses.

0:29 You got to earn your right to wear minimal footwear.

0:31 You wouldn't squat 100 pounds this week and squat 200 pounds next week.

0:35 So we have to think about that when we're training our feet.

0:38 When I look at my patient base,

0:40 one of the questions I ask them is, what is their step count?

0:43 If it sits below 3,000 steps per day on average,

0:46 I can almost guarantee you we will have the discussion

0:49 that they suffer from some type of depression, anxiety.

0:52 It's almost like those things go hand in hand.

0:55 If you're in a bad mood, go for a walk,

0:57 and if you're still in a bad mood, go for a longer walk.

0:59 I was like, I'm going to move to Colorado,

1:01 and I'm just going to start walking up these mountains,

1:03 and I'm just going to keep going till I feel better.

1:05 And that was 15 years ago.

1:06 And it literally, saved my life.

1:09 "Courtney," as someone who is a huge fan of walking,

1:12 let's start out connecting this practice...

1:15 to health and longevity.

1:17 When I think of walking, I think people forget...

1:20 that it is something that we were...

1:23 literally born to do.

1:25 It's a physiological necessity.

1:27 That's how I really want...

1:29 people to start thinking about walking again,

1:32 almost as an equivalent to breathing and sleeping,

1:36 that it's not really this optional form of exercise,

1:40 that it's this physiological necessity that's required for longevity.

1:46 When we think about breathing optimally and sleeping optimally,

1:51 there's a reason for that, because it creates this efficiency for us.

1:56 And that is how I want walking to really start to be considered as something

2:01 that we have been born to do that we are not taking advantage of.

2:06 It is the most easily accessible, underutilized form of activity...

2:10 that a lot of us are not doing.

2:13 All right.

2:13 So you're making it clear it's important.

2:15 We all need to be doing it.

2:17 What's the right dose?

2:18 If you were to "Google" how many steps a day...

2:21 I should be walking, you'd probably see 10,000 steps.

2:25 And we like to call that a marketing hangover from the 1960s.

2:31 That 10,000 step marker was never based on any...

2:34 scientific research.

2:35 It was actually from a Japanese marketing

2:39 company and they had developed a pedometer...

2:42 called the "Manpo-kei" which basically means 10,000 step meter.

2:46 And since then it's just been this number that we have

2:52 gravitated towards as a number that we should all be hitting.

2:57 And I know being in the clinic for 25

3:00 years that oftentimes that number can seem daunting for people.

3:05 And when you look at the research for...

3:08 people who are not moving that much,

3:12 even getting to 3,800 steps per day can reduce things like dementia by 21%.

3:21 So— those are some pretty big numbers for...

3:24 not a lot of effort.

3:26 And so when we look at that, the sweet spot, as I like to call it,

3:31 a lot of the longevity science is anywhere from 5,000 to 8,000 steps a day.

3:37 For the go-getters out there...

3:39 pushing it beyond 8,000 steps, is there any additional benefit?

3:43 That's a great question.

3:46 I'll give you an example.

3:49 I had a woman in my clinic last week and...

3:51 very active...

3:52 and she was very excited and she had her...

3:54 step count and she said to me, I'm walking 15,000 steps a day.

3:58 And I was like, that's wonderful.

4:01 Are you strength training?

4:03 And she said, well, no,

4:05 I don't have any time because I'm walking 15,000 steps a day...

4:09 And so these...

4:10 are the conversations I also like having.

4:12 When you look at step counts, there actually is a law of diminishing return.

4:18 Now there's nothing harmful with going more, but from a health...

4:23 benefit perspective, that 10,000 to 12,000 marker,

4:26 we start to see things plateau.

4:30 So these are the conversations I will have.

4:32 I say, listen, let's dial back your step count.

4:35 Let's get you to about 10,000 steps per day.

4:38 And now this will leave you some time that we

4:41 can start to incorporate things like strength training or...

4:45 "HIIT" training or other types of activities that can balance out her wellness.

4:51 Okay.

4:51 Somebody who decides after this they're going to embrace walking more.

4:56 How different...

4:57 is the biomechanics, somebody using a walking pad, treadmill...

5:01 versus actually getting outside and walking, quote-unquote normally?

5:06 Anything is better than nothing.

5:08 So when we have patients or people that are sitting at their desk

5:12 all day long and they have the ability to get a walking treadmill,

5:17 for example, at their desk.

5:19 That's great.

5:20 Go for it.

5:22 When you look at walking on a treadmill versus walking outside,

5:27 for the most part, you're going to see similar things.

5:31 There's a little bit of a kickback feature that you get

5:34 from the treadmill that you can take out when you increase the incline.

5:38 But if someone had the option of walking inside versus outside,

5:44 there's a lot of reasons why we recommend getting outside.

5:48 We have sunlight, we have nature, we can walk with people...

5:51 That was one of my favorite...

5:54 parts.

5:54 Researching the book...

5:56 was all the science on relationship walking.

5:59 So I think there's a lot of benefits with...

6:02 getting outside.

6:04 The advantage of treadmill walking, however, is the consistency, the constant.

6:09 So you can put it at a certain pace,

6:11 you can put it at a certain speed, and you can put it at a certain incline.

6:15 And in those controlled environments, we can really work on things...

6:19 like monitoring your heart rate, monitoring gait speed...

6:23 So there are advantages to both.

6:25 And hand in hand with the walking pad or treadmills under the desk...

6:29 Are standing desks any value to just standing throughout the day?

6:34 I always tell my patients, people get excited,

6:36 they're like I got a standing desk.

6:38 I'm like, that's great.

6:39 But still...

6:39 you're not moving.

6:41 Standing and sitting is...

6:42 still a static position.

6:45 So we just need to keep our body moving.

6:48 In the book we have at the end of each chapter,

6:50 I wanted to put something in there called a movement snack.

6:55 So basically, you can break up your periods

6:59 of no motion throughout the day by doing little things.

7:03 I'll tell my patients every hour, set an alarm, stand up, do 10 squats,

7:09 do 10 calf raises, any type of rotation just to get your system moving.

7:15 It's that static lack of motion that we were not designed to do.

7:21 Well, as you share the movement snack piece,

7:23 it gets me thinking about bigger picture over a day.

7:26 Somebody that might be hitting 5,000, 8,000 steps,

7:29 but say they're sitting at a desk all day and then doing that after work.

7:34 Again, tying that to the movement snack piece.

7:36 How different is that versus somebody who's going to get

7:40 up every hour and do these little micro walks?

7:43 I think that's such an important conversation to have...

7:46 We have a lot of athletes that we work with and they'll be like,

7:50 I went on my five-mile run before my workday,

7:54 and so they got their step count in, if you will,

7:56 but then they sit for the next eight to nine hours a day.

8:01 Think about it from this perspective.

8:04 One of the beautiful things about walking is that it helps

8:08 with our glucose regulation and our insulin sensitivity in our bodies.

8:13 So just because you get your workout in the beginning of the day

8:18 doesn't excuse you from not getting movement in the rest of the day.

8:24 One of the best times to take a walk is after we eat so that can...

8:29 help with the regulation of glucose into our cells.

8:33 So even if you're getting your step count in the beginning

8:36 of the day or the end of the day, we still should be...

8:40 making sure that we have movement happening throughout the day.

8:44 For somebody that wants to utilize that practice you talked about,

8:48 walking after meals.

8:50 How long do they need?

8:52 And is this something they could do after each meal?

8:56 Explain the details there to put that into...

8:58 full practice.

8:59 There is a great study looking at people

9:03 who took 15 minute walks three times a day.

9:07 So...

9:07 they would take a 15 minute walk after every meal.

9:12 And their...

9:13 systems, their regulation of glucose was similar to someone taking...

9:17 a 45 minute walk, which I thought was

9:19 pretty encouraging for people because some are like,

9:21 well, I don't really have time to take 45 minutes.

9:24 It's like, that's okay.

9:26 Just take a 10 to 15 minute walk after you eat.

9:30 The research will tell you sooner the better.

9:34 So after you eat, you want to take that walk within 30 minutes of eating.

9:40 It doesn't matter your pace.

9:42 And shoot for about 10 to 15 minutes...

9:45 This has been a very good thing that my daughter

9:48 and I have implemented after dinner because she

9:51 just wants to eat and then she's on her phone

9:54 or she's doing her homework and I'm like,

9:57 listen, if we go for a 10 to 15 minute walk after you eat,

10:00 you're going to feel better, you're going to be able to study and focus more.

10:07 So it's been very digestible for her.

10:09 Try getting a 14 year old to go for a walk with their mom after they eat.

10:15 That's a feat in itself.

10:17 One of the side benefits of walking after meals

10:20 and bringing that glucose down is gonna be weight management.

10:24 So let's expand out and talk about that as a whole.

10:27 When it comes to walking, I know in your book you go deep into zone two.

10:32 So how much walking and at what pace...

10:34 for somebody that wants to use this as a weight loss tool?

10:38 To answer the first question, when we look at walking after we eat,

10:44 for example, we have glucose depending upon what we eat.

10:48 So if we had a meal that had high sugar, liquid sugar,

10:52 lots of carbohydrates, you have an excess amount of glucose in the bloodstream.

10:58 When we take a walk after we eat,

11:01 we have two systems that are pulling the glucose...

11:05 out of our bloodstream into our cells.

11:07 One is the pancreas, so based on insulin, and one is through muscle contraction.

11:15 So if I don't walk after I eat or I'm sedentary after I eat,

11:20 I'm only relying now on one system, my pancreas.

11:23 Pancreas doesn't like that.

11:26 He doesn't want to work that hard.

11:28 So for people that are diabetic who have issues with weight management,

11:33 insulin resistance, you don't want to just rely on your pancreas.

11:37 You get your— muscle system to help you, your muscle contraction.

11:43 And the window for that is so digestible, it's 10 to 15 minutes.

11:48 So that's where I think, from a weight management perspective

11:51 and a sugar regulation perspective, that can be...

11:55 very easy to implement.

11:57 When we look at weight management, it's not an easy conversation.

12:04 Nothing is that simple.

12:07 But what we start to see with...

12:09 patients who have a solid walking practice...

12:13 is that...

12:14 they're very good at stacking behaviors.

12:18 So if I'm walking more throughout the day, I'm probably sleeping better,

12:24 and I'm definitely breathing better, and I'm going to be more cognizant...

12:29 of what I'm eating, for example.

12:33 So you start to build this overall picture...

12:36 of wellness based on the foundation of walking, which I love that idea.

12:43 It is what we as human beings were designed to do.

12:48 As you say that, talk more to our history...

12:50 and what we know about walking in our past.

12:54 We are human beings that are designed to walk

12:58 for long distances and to be very efficient doing it.

13:02 And when you look at...

13:04 the average step count today, it lies around 4,700 steps,

13:08 which means that there's many of us who aren't hitting those numbers.

13:15 And when we look at what our bodies are capable of doing,

13:19 we are efficient human beings.

13:21 When I'm doing gait assessments and watching people walk, it should be fluid...

13:27 and smooth, and it shouldn't look like a struggle.

13:31 And that's what I think is so beautiful about watching people walk,

13:36 is it's a neurological window...

13:38 You can see...

13:40 so many things...

13:41 by how someone's walking.

13:43 Are they struggling?

13:45 Do they have a risk of a fall risk...

13:47 because their balance is off?

13:50 Is their cadence slower?

13:52 Is their speed slower?

13:55 That's a great conversation, "Jesse," is the gait speed.

13:59 We talk about it being the sixth vital sign.

14:02 So when you go to the doctor, for example, they take your vital signs,

14:07 they want to know your temperature, they want to know your blood pressure.

14:12 Because these are basic, fundamental health...

14:15 signs that if something is wrong, it's a flag.

14:19 We should probably look into this.

14:22 And looking at walking cadence and speed as the sixth vital sign,

14:27 that they're putting gait speed just as important...

14:30 as these other things, is something that we should pay attention to.

14:36 Because when you see someone walking slower,

14:39 it can be an indicator or a predictor

14:41 of things like dementia up to seven years in advance.

14:46 I'm into that.

14:47 That's proactive healthcare.

14:49 It's saying, hey, we're not going to wait till we get a diagnosis of dementia.

14:54 We're going to say, hey, you're walking slower.

14:56 Why is that?

14:57 How do we improve your speed?

14:59 How do we improve your step count?

15:01 Because at 3,800 steps a day,

15:03 you're going to decrease your risk of dementia by 25%...

15:06 And that number jumps with the more steps you take per day.

15:11 And that's easy to measure.

15:14 If you were at home,

15:15 you'd go outside and count how many steps you're taking in a minute.

15:21 And those numbers should be around 130, 135.

15:25 And I think that most people don't realize how fast that is.

15:32 So when you're assessing somebody for this gait speed,

15:35 given the importance, is it when they're cognizant that you're measuring them?

15:40 And what I'm getting at here, does it have to be done when somebody

15:44 is unaware and they're walking at their normal cadence?..

15:47 Because if you tell somebody, I'm going to see how fast you're walking,

15:51 they might be able to step up their gait speed versus day to day walking.

15:56 When I'm doing gait assessment in my office,

15:58 I'll put them on the treadmill and I will say,

16:02 I just want you to increase your speed to your outdoor walking pace.

16:07 If you were going to take a walk...

16:09 So I don't cue them any way, let's put it at this speed...

16:12 I just want them to pick a cadence that they feel comfortable in.

16:16 If they're not used to walking on a treadmill, I'll just have them walk in my...

16:21 office or we'll go outside.

16:22 But you're right, you want to have them to be as...

16:26 natural of an environment as possible.

16:29 When I'm watching someone walk, this is a funny story, actually.

16:33 We'll use neurological distractions so I'll have

16:37 them walk and count out loud by ten,

16:40 or say the alphabet just so that they can...

16:43 not be so stiff...

16:44 and know that I'm watching them.

16:47 I was working with someone, very, very smart man.

16:50 He was an engineer.

16:51 And he was very stiff when he was walking.

16:54 And he could tell, he was overthinking everything.

16:58 And I said to him, I said, okay, you're gonna walk,

17:02 and I just want you to name states out loud.

17:05 And he starts walking in my office, and he's like, depression, anxiety, fear.

17:10 And— I looked at him, I was— looking for New York and New Jersey, but...

17:14 I'll roll with that.

17:16 So that was funny.

17:17 But...

17:17 we want to have a distraction, some type of neurological distraction,

17:21 so they can kind of get

17:23 into their groove and just get comfortable with whatever...

17:26 pace they're looking...

17:27 that makes them the most comfortable.

17:30 You quickly mentioned there the connection

17:32 between walking speed or cadence and Alzheimer's.

17:36 Yeah.

17:37 Can you talk about the mechanism there?

17:39 What happens when you're walking is there should be this efficiency.

17:43 There should be this confidence in movement.

17:45 Our feet need to be able to feel the ground.

17:48 Our systems need to be able to rotate.

17:50 And that's why walking...

17:52 it really affects every single system in our bodies.

17:56 So when you see someone with a slower cadence or they're walking slower,

18:01 you have to ask yourself, why is that happening?

18:04 Is it because they're having a difficult time feeling the ground?

18:09 Do they have a fear of balance?

18:12 Is it a strength problem?

18:14 Are they having visual deficits?

18:16 We know that the visual and vestibular system,

18:19 so what we see and what we hear...

18:21 are very important in maintaining our gait speed, and our balance when we walk.

18:28 So we have to tease those out and say,

18:32 why does this person feel that it's necessary to slow down

18:37 their cadence to a pace where they feel comfortable and safe?

18:42 And that's what we want to figure out there.

18:46 Let's expand out to brain health as a whole.

18:49 What happens in the brain as we're walking,

18:51 blood flow and beyond, and why is that beneficial?

18:55 Walking and mental health,

18:56 I feel like we should be screaming this from the mountaintops.

18:59 Every doctor who treats patients in the mental health world,

19:03 I feel like walking should be on their prescription pad.

19:07 I was thinking about this before our conversation.

19:11 When I look at my patient base,

19:13 one of the questions I ask them is, what is their step count?

19:18 If it sits below...

19:20 3,000 steps per day on average,

19:24 I can almost guarantee that we will have the discussion

19:28 that they suffer from some type of depression, anxiety...

19:33 It's almost like those things go hand in hand.

19:37 They've maybe been in chronic pain, which can lead to those things.

19:43 So...

19:44 when we see these step counts that are very low,

19:47 it is almost always associated with some type of mental health issue.

19:55 And when we start increasing that step count,

19:59 we know we have an increased circulation to our brains.

20:03 That's great.

20:04 We need oxygen.

20:06 The other very cool thing that happens is we increase a protein.

20:12 It's "BDNF." So brain-derived neurotrophic factor.

20:16 Think of this protein as...

20:19 fertilizer for your brain.

20:22 And when we walk, we increase that factor.

20:25 And what it does is it basically tells our neurons,

20:30 hey, let's kick into gear here.

20:33 It helps with the synapses, it helps with the growth of these brain cells...

20:39 And so that's something that we really have

20:42 an opportunity to educate our patients on and say,

20:46 listen, we're not just saying walking.

20:50 Go ahead and walk.

20:51 We know we're increasing dopamine and serotonin, we know these things.

20:56 But there also is a very cool

20:58 thing happening that you have this fertilizer basically

21:01 sprinkling onto your brain that's going to improve

21:04 the synapses of your neurons in your brain.

21:08 I think that's very cool.

21:10 You get the growth of new nerve cells and in particular in the hippocampus...

21:14 That's our part of our brain that's responsible for memories.

21:18 That's also the part of the brain where

21:20 we start to see where Alzheimer's affects first.

21:25 So from a mental health perspective, and I really am passionate about treating

21:32 these patients because they'll come into my office...

21:35 with 2,500 steps a day, 2,000 steps a day.

21:38 They're not in a good headspace.

21:41 They're also afraid to...

21:44 go outside and put their foot on the ground,

21:47 especially if there's pain associated with.

21:51 So we will work on...

21:53 what's called a micro walk, which is five minutes.

21:57 You're going to give me a five-minute walk, which is about 500 steps...

22:02 and it's safe for them.

22:04 And they start to say, hey, I just did 500 steps.

22:08 That's great.

22:09 If you do...

22:10 a 10-minute walk, you increase your step count by a thousand

22:14 steps that oftentimes can bump them into that 3,800...

22:19 range where they're starting to say, wow, I feel a little bit better.

22:24 And those symptoms of depression start to go away.

22:29 It really is an open window for a lot of benefit.

22:33 And I think we're out there looking for all

22:37 this stuff we gotta go find this supplement, and we have to do all these things,

22:43 and we have the best treatment available,

22:47 the most easily accessible, underutilized...

22:50 activity...

22:50 for these types of diagnoses...

22:53 Literally walking out your front door.

22:55 As you share this part, it gets me thinking about early in your book,

23:02 talking about your mental health in your 20s,

23:05 and how movement became an antidote...

23:08 to helping you through that time.

23:12 Can you share that story and then when

23:13 walking came in and what that did for you?

23:16 Yeah-— I don't think I realized...

23:19 at the time why movement was so important to me.

23:23 I certainly wasn't trying to increase my "VO2" max in high school or...

23:30 trying to improve my strength capacity...

23:34 But what I did know that when I was suffering with my own issues,

23:39 my parents had gotten divorced when I was 13,

23:43 so I was just starting high school.

23:46 Kind of things went a little awry from there.

23:51 I felt like I didn't have a lot of control over anything.

23:55 I...

23:56 suffered from some addictions,

23:59 and <break time=“2.15s"/> I wasn't going down the right path.

24:05 Every morning when I would wake up,

24:07 the one thing I knew I could control was movement...

24:12 and...

24:12 going for a walk, and it would always clear my head.

24:17 And I went to university.

24:21 And I was a ballet dancer and then a triathlete.

24:25 And I started suffering from a lot of foot pain...

24:29 I had pretty much everything.

24:31 Bunions, neuromas, stress fractures...

24:33 And one of the reasons I'm so passionate

24:36 about this is because there is no other...

24:39 musculoskeletal diagnosis that you could have.

24:42 Low back pain, shoulder pain that will stop you

24:45 in your tracks from movement and walking outside of foot pain.

24:49 For those people who have suffered from foot pain,

24:52 they know what I'm talking about here.

24:54 You don't want to put your foot on the ground.

24:57 And so when I started suffering from these things,

25:00 it took away my one antidote that I had to calm myself down.

25:05 And so things got worse.

25:08 And I found what I was capable of, and— those were not good things.

25:16 And so it became a...

25:18 personal...

25:18 mission of mine...

25:19 to figure this out.

25:22 And that's kind of what started all this.

25:25 I moved out, I was living in Chicago.

25:29 I had my first practice there for about 10 years.

25:34 I was just at one of those crossroads where I was like,

25:37 what do I do at this point?

25:39 I'm not well.

25:40 I don't feel good.

25:41 And so I moved out to Colorado,

25:44 and one of my favorite quotes is, if you're in a bad mood,

25:49 go for a walk, and if you're still in a bad mood, go for a longer walk.

25:54 I was like, I'm going to move to Colorado

25:57 and I'm just going to start walking up these mountains,

26:00 and I'm just going to keep going till I feel better.

26:03 And that was 15 years ago.

26:05 And it literally, saved my life.

26:08 And so when I see people that cannot take advantage of that, it's my why.

26:14 It's why I think I'm here is to be able

26:16 to share what has helped me really be here today.

26:19 <break time=“2.86s"/> It's a tool that we all have access to.

26:25 When you're going through your story,

26:28 you mentioned a number of different foot problems you had...

26:31 I believe it was neuroma, bunion, stress fracture,

26:35 and how that when you couldn't walk anymore and move,

26:38 impacted your mental health and made it worse.

26:41 Talk about what you did specifically because these are common foot injuries,

26:46 a lot of people suffering.

26:48 And the natural inkling for somebody is to stop

26:51 moving when they're in pain and they have these issues.

26:55 So talk about what you did...

26:56 to work through that.

26:58 That's a great question...

26:59 So I basically did what we have been taught forever is brace the foot.

27:06 So implement some type of...

27:09 foot orthosis and get footwear that's very supportive.

27:13 So...

27:14 that's what we learned in school.

27:16 I think when I was in school, it was.

27:18 We had a half a semester of foot and ankle mechanics,

27:21 and then it was, if your patient is in pain,

27:25 cast them for some type of orthosis,

27:27 and if they're still in pain, refer them for surgery.

27:31 Which is really wild to me because we would

27:33 never do that anywhere else in the human body.

27:35 You would never say to someone with low back pain,

27:38 go wear this low back brace...

27:39 for...

27:40 six months, and if you don't get better, go get surgery.

27:43 You would talk about strength and mobility,

27:47 but somehow we just missed that at the foot...

27:49 So I got out of school and I

27:51 went and worked in two different foot orthotic labs.

27:56 And we were making orthotics for people, and I was making them for myself.

28:01 And we were...

28:02 changing them and modifying them and trying

28:05 to figure out how we could tweak them.

28:09 My pain would get better for a little bit,

28:12 but it would always come back or it would shift into my knee or my hip...

28:17 And then I thought about the...

28:18 low back thing, and I'm saying to myself,

28:21 this doesn't make any sense to me at all.

28:24 Why is someone not teaching us...

28:27 how to strengthen our foot and how to improve the mobility of our foot?

28:32 Why is this information not out there?

28:34 And it wasn't.

28:37 I had to dig deep.

28:38 And luckily I found some.

28:41 A couple people, one of my biggest mentors.

28:44 And...

28:45 I started basically stalking him.

28:47 And I was like, what are we doing wrong here?

28:52 And then I started that journey.

28:55 I got out of my foot orthoses that I had been in for years.

28:58 I didn't get out of them overnight.

29:00 It was, I'm going to slowly start to take these away.

29:05 And then I started wearing different footwear.

29:09 Wide toe box shoes.

29:11 And at the time, there weren't that many of them out there.

29:15 Shoes that respected the anatomy of the foot.

29:19 I started walking around barefoot a little bit.

29:22 I started exercising my foot.

29:25 And then I started noticing when I would put

29:29 my foot orthotic back in, I'm like, this feels weird.

29:33 It doesn't feel right.

29:35 And so it was this gradual transition

29:38 of getting stronger and getting more mobile.

29:42 And if someone was saying about that to any other part of their body,

29:48 we wouldn't think that would sound weird.

29:50 We're like, yeah, okay.

29:52 It takes time to get stronger.

29:55 And so once my pain started to go away and my balance

29:57 was better and I was training for some "Ironmans" at the time,

30:01 and I'm like, I'm running better.

30:03 Things aren't hurting as much.

30:05 And I said to myself, I need to bring this into my clinic.

30:08 I need to start...

30:09 educating people on this because we're going about this the wrong way.

30:14 And...

30:14 here we are 15, 20 years later.

30:19 And I'm working real hard, "Jesse." I'm working real hard to get

30:24 this information out there because it changes people's lives.

30:27 And just I don't know if it's our societal...

30:32 norms or what we're used to seeing on people's feet,

30:35 but we need to really be rethinking some of this.

30:39 You mentioned in the early days, a couple of mentors that helped guide you...

30:43 Who were they?

30:44 Doctor "Tom Michaud" is probably the biggest one.

30:49 He wrote a book called "Human Locomotion." And when I was in school,

30:55 I carried that book around with me everywhere.

30:57 I think I've read that thing...

30:59 a hundred times.

31:00 And— when I started teaching about this I did my first course in New York City.

31:08 And the following week, I was with a patient.

31:12 And when you can see an email come across and it'll say,

31:16 so and so's, like a notification.

31:18 Yeah.

31:19 And I got a notification that he was emailing me, and I was like, oh, my gosh.

31:24 I couldn't breathe.

31:26 It was almost like I was a celebrity was emailing me.

31:29 And he said, I heard you just taught a course in New York City.

31:33 And I heard it went really well.

31:35 Congratulations.

31:36 And it was one of those moments where I'm just like,

31:39 <break time=“1.99s"/> things come full circle because

31:42 he was just such a huge guide.

31:45 And since then, he has been so generous with his knowledge...

31:50 and...

31:51 he has really helped.

31:52 I'm on the phone with him all the time now, and we're sharing research.

31:57 And he's now retired, but I'm hoping to carry on his work.

32:02 "Jay Dicharry" is also another very good friend of mine who has

32:08 done wonders for this, education platform on foot health and foot education.

32:15 So, yeah, the— world is growing.

32:18 The research-— on foot health and foot strength.

32:24 It's really exciting.

32:26 We should be.

32:27 When you look at some of these researchers out

32:31 there and what they're doing and what they're saying,

32:34 it's basically changing everything we knew about the foot.

32:38 It's not just this foot is.

32:41 We can rely on the passive structures of the foot.

32:44 It's all about strength...

32:46 It's how strong is your foot,

32:48 how strong can we make your foot so we can make walking more efficient.

32:54 We'll get into the strength piece.

32:55 Yeah.

32:56 But first, you mentioned this period of time you were helping make orthotics.

33:01 You later learned they weren't as great as you thought.

33:05 Where are you at now with that?..

33:07 Patient comes to you, they're wearing orthotics...

33:10 Any value there?

33:11 Time and a place.

33:12 I am by no means anti-orthotic.

33:16 In fact, there are often cases that will come in and I'll say to them,

33:21 we need to get you casted for an orthotic.

33:24 Now, that is few and far between.

33:28 15 years ago, that was commonplace.

33:32 Every other patient we were saying, let's cast you.

33:35 I would say maybe on one hand that happens every couple months.

33:41 But there is a time and a place.

33:43 When you think about what a foot orthosis does, it's a load modifier.

33:47 It modifies loads in the feet.

33:50 So if I have a patient with acute heel pain, for example,

33:56 putting a foot orthosis under there can help decrease loads,

34:00 and that can be beneficial in an acute situation.

34:05 And that's the difference, because patients will be in these foot orthoses

34:10 that they were given when they had heel pain,

34:14 but they were never given an exit strategy.

34:17 They were never taught, we're going to start strengthening your foot,

34:23 and then you're going to start to wean yourself

34:27 out of this foot orthosis because you shouldn't need it.

34:32 And that's where we miss the boat on foot orthoses, foot orthotic therapy.

34:38 There has to be an exit strategy...

34:40 because you don't want to deload tissue forever.

34:45 You would never deload your other tissues...

34:48 Things would get weaker.

34:51 And that's what we see happens in the foot when

34:54 we have an extended period of time with foot orthotic therapy,

34:59 we can start to see changes in the muscle and the muscle function,

35:03 muscle strength, and muscle size.

35:07 So unless there's some type of structural variant, and what I mean by that is,

35:12 if there's a torsion or a twisting of the lower leg,

35:15 if there's a severe bunion or something like

35:18 that cannot be treated from a functional perspective,

35:22 then there better be some type of exit strategy for that thing.

35:26 And what about those insoles?

35:28 You can go to the drugstore, get that extra padding to slide into a shoe.

35:33 Similar thoughts with those?

35:35 Yeah, I think we always have to ask the question, why?

35:41 Why do I think that I need more support?

35:48 Why do I think I need more cushion?

35:51 Because feet, when they're functioning like they should,

35:55 do not need arch support.

35:58 They're well-designed to handle our body loads...

36:01 So, for example, when we're walking,

36:03 we put two to three times our body weight through our feet.

36:08 That means that our foot is well-designed to handle those loads...

36:12 Now, if I shove my foot.

36:15 I'm going to grab...

36:17 "Eddie" here.

36:18 If I shove this foot into a shoe that's too pointy, or has a tapered toe box,

36:23 or has a heel that's elevated above the toes,

36:26 so it changes the function of the foot, then you're probably right...

36:31 You do need arch support because it's

36:34 changing the structure and function of your foot.

36:38 But a foot that is sitting in its

36:41 position and is strong does not need arch support.

36:45 People will say, I need more cushion.

36:48 There's a fat pad underneath the heel bone

36:53 that is the best shock absorber out there.

36:58 And the cool thing about the fat pad is that there's a lot

37:02 of receptors in that fat pad that give us information on how we're walking.

37:09 So if I was walking,

37:10 and you know how you have that relative in the house where they're like,

37:14 you can hear them coming from a mile away?

37:16 It's like heavy stomping.

37:17 Yeah.

37:19 Does that sound like a good idea for your body to be heavy stomping around?

37:23 No.

37:23 No.

37:24 It hurts.

37:26 They're like, my knee hurts, my back hurts...

37:29 Well, guess what?

37:30 When you walk and you can feel your heel, you get information.

37:36 So that fat pad says, hey, you're walking too heavy...

37:42 Don't strike so hard.

37:44 Walk a little softer.

37:46 Shorten up your stride.

37:48 And so we get information from our foot on how to be upright,

37:53 on how to be balanced, and how to walk for long periods of time.

37:59 But we jacked all that up.

38:01 Excuse me, and decided to put all this stuff

38:04 underneath the foot that prevents our foot from feeling that.

38:09 So I don't think we should be asking ourselves why one

38:13 in three people over the age of 45 have foot pain...

38:16 Because to me, it's very clear why that is.

38:22 So— those are things I think we need to consider.

38:27 Okay.

38:27 High level...

38:28 You mentioned the toe box being too narrow...

38:32 too much cushion.

38:34 And I know from your book, and you kind of touched on this with the cushion,

38:39 is having the heel a lot higher than the toes.

38:42 Any other big ones that people are currently involved

38:46 in with their shoes that they need to look out for?

38:50 Those are the three big categories,

38:53 is having the wide toe box to allow for toe splay.

38:56 When you look at your foot, the widest part of your foot should be your toes.

39:03 It makes sense.

39:04 I have more real estate.

39:06 I can balance better.

39:08 I can push off of a stronger forefoot.

39:10 The heel to toe, in an ideal world, sits on the same plane.

39:14 It helps the alignment of everything above the foot.

39:18 That's an important conversation too.

39:20 We forget that this beautiful foot is attached to the rest of our bodies.

39:24 So you start messing around with what you do at the foot,

39:27 you best believe it's going to affect your joint mechanics at your knee,

39:30 your hip, and your low back.

39:31 I see it all the time.

39:34 So most footwear out there, even a sneaker or an athletic shoe,

39:39 if you were to "Google," what is the heel-to-toe drop of my sneaker,

39:44 you'll find 8 millimeters,

39:46 10 millimeters where the heel is higher than the toe...

39:52 In my world, that's a...

39:53 high heel because it's shortening the posterior compartment.

39:59 It's shortening the calf.

40:03 People that have heel pain or an Achilles issue,

40:07 that can often be very helpful for them, because-— what is it doing?

40:12 It's deloading.

40:15 So people with those types of symptoms put that shoe

40:18 on and they're like all right, this feels better.

40:21 And then what I always say to them, there's a trade-off.

40:26 So if you're going to be wearing this type of shoe,

40:29 ask yourself why and then do something about it.

40:33 Strengthen your calves, strengthen your feet,

40:38 and then work on getting into a shoe that more mimics our natural mechanics.

40:45 And then the third category that you mentioned was the stack height,

40:51 or the cushion or the sole underneath the bottom of the foot.

40:55 <break time=“2.40s"/> We live in a concrete world.

41:00 So a lot of us are standing on man-made surfaces.

41:05 So walking in thin and flexible-soled shoes is tough for a lot of people...

41:10 You got to earn your right to wear minimal footwear.

41:16 I always say we want the least amount of cushion necessary to complete the task.

41:23 Most of us...

41:24 do not need.

41:26 If you go look at— all the popular footwear now, it's like...

41:30 a pillow party...

41:31 It's maximal cushion and all this stuff.

41:34 And you watch people walk in these and you're like, they're gonna fall over.

41:40 I was at...

41:41 "The Running Event." It's this big event in Austin

41:44 and they have all the new footwear that's coming out...

41:47 and this one brand, and I won't mention any names,

41:50 this guy was standing on this shoe and it had a solid 55 millimeters of cushion.

41:55 And he was standing there talking to me and he couldn't even stand still...

41:59 because it's like this thing was like...

42:01 squishing.

42:02 And I'm like, oh, my gosh, we need to be telling people about this.

42:06 The more stuff, cushion underneath the sole of your foot, the less you can feel.

42:13 You compromise sensory acuity.

42:16 And that's a problem.

42:19 That's a problem for someone who is at fall risk.

42:21 That is a problem for balance.

42:23 Now, if I want to be walking in New York City for eight hours,

42:29 I'm going to want a little bit of cushion, and that's okay.

42:33 But you do not need 4 inches of cushion underneath your foot.

42:39 So there's that sweet spot.

42:41 You mentioned this guy in the big fat cushion under his foot.

42:45 It seems like to me, as I look around,

42:48 that we're heading more and more in that direction.

42:51 Yeah.

42:52 It almost seems like there's a divide too, though,

42:55 with the minimalistic footwear and then the general

42:58 population going to thicker and thicker, more support.

43:02 What are you seeing?

43:04 Oh, how much time do we have here?

43:08 I am by all means not saying that everybody

43:11 needs to walk around in a minimal shoe.

43:15 You have to have a shoe spectrum.

43:18 It's like having a different tool for the task at hand.

43:22 I live in Colorado and I always use the analogy of bikes.

43:26 I have a gravel bike, I have a road bike,

43:28 and I have a mountain bike because I have a different tool for the task at hand.

43:34 So when we think of footwear, we should think of it in the same manner.

43:39 You don't have to live in the, I only wear minimal footwear camp.

43:43 And you certainly don't want to live

43:44 in the, I only wear maximal cushioned footwear camp.

43:49 You have to be able to know when to wear what.

43:54 I think this...

43:56 push towards maximalist footwear is kind of twofold.

44:03 <break time=“2.96s"/> Our society doesn't like to get uncomfortable.

44:10 It's like, let's just make everything easy.

44:13 There's a tradeoff.

44:16 There's always a tradeoff...

44:17 When you put that super cushy shoe underneath your foot,

44:21 the first thing you're going to say to yourself is, wow, this feels great.

44:26 Feels like I'm walking on a cloud.

44:29 Oftentimes, these shoes...

44:31 will have what's called a toe spring to them.

44:34 So...

44:35 it looks like it's a boat almost.

44:38 And what it does is it basically rockers you forward.

44:44 Again, someone that has poor ankle power and poor foot strength,

44:50 they're going to put that shoe on and they're going to be like,

44:54 well, damn, this is easy.

44:57 And they're going to say, why would I not wear this shoe?

45:00 And I'm going to tell them, nobody gets a free lunch.

45:04 If you don't use it, you're going to lose it.

45:07 And so I think we are really creating feet that are becoming weaker.

45:14 We're not paying attention to the consequences of that.

45:18 And it's why we're seeing...

45:20 a high rate of foot pain, a high rate of foot diagnoses.

45:24 You don't have to look too far.

45:27 I work with a lot of professional athletes too, and I keep telling...

45:31 everybody, you guys are getting bigger and stronger...

45:35 You're creating these big, strong bodies...

45:37 on feet that cannot support you.

45:40 "Jay Dicharry," I love when he says this, that you

45:43 reproduce these jet engines of bodies on paper airplanes of feet.

45:48 Not going to work.

45:50 It's not going to work.

45:53 So I'm not saying you can never wear a super shoe.

45:56 You're running a marathon, you want a "PR," that's what the technology...

46:01 is there for.

46:03 But you better pay attention to what you're putting in that shoe because...

46:09 you can't just rely...

46:10 on footwear.

46:11 You will pay the price for it somewhere.

46:13 And whether that's in your foot or in your low back or in your hip, something...

46:17 will show up.

46:19 For somebody middle-aged, they've been walking on these pillows now for years.

46:25 They want to get back to a more functional shoe.

46:29 Let's talk about the healthiest way to do that so

46:33 they don't injure themselves and they have the best experience.

46:36 That is the most important conversation that we could have,

46:40 because this isn't a new conversation.

46:42 In 2007, the "Vibram FiveFingers" came out,

46:45 people are aware of putting your foot on the ground and why that's important.

46:50 The problem is, I don't think the education was there...

46:53 because when people hear this message, they say, well, this makes sense.

46:57 I'm going to bag all of my shoes...

46:59 and I'm going to just start walking around barefoot.

47:03 You have to earn your right.

47:05 You wouldn't squat 100 pounds this week and squat 200 pounds next week.

47:12 So we have to think about that when we're training our feet.

47:16 So I was working with a patient this morning...

47:19 and I said, you're going to go order these shoes,

47:22 and I want you to think of wearing these shoes as one of your exercises.

47:27 So I'll write a treatment plan for them...

47:29 And on the treatment plan, outside of walking steps,

47:33 is you're going to wear these shoes for five minutes a day.

47:37 So he was wearing "Birkenstock" sandals.

47:40 He never had his foot on the ground because his foot has been in so much pain.

47:44 So inside the house he wore "Birkenstocks," and then outside

47:47 he wore a very aggressive shoe with a foot orthosis.

47:51 And so I said, you're going to wear

47:54 this minimal shoe for five minutes in your house.

47:56 That's it.

47:58 Because...

47:59 in those five minutes he's going to be putting more load through his bones,

48:04 more load through his tendons, more load through his muscles.

48:09 These are not bad things.

48:11 They're bad if you overdose.

48:14 So that's how we start.

48:16 And then I'll have him assess, how did you feel that night?

48:19 How'd you feel the next morning?

48:22 Felt okay.

48:22 And then we slowly increase time.

48:26 Once he starts getting comfortable...

48:29 moving around his house, then we have the conversation of outside.

48:33 You're going to go for a 5, 10-minute walk in more functional footwear.

48:38 That doesn't mean minimal.

48:40 I'm not taking him into a barefoot shoe.

48:43 He's going to have a wide toe box, though.

48:45 He's going to have a low to zero drop, not a zero drop.

48:48 And he's...

48:49 I'm going to give him some cushion.

48:51 I want him to be comfortable.

48:54 But we're going to work his way...

48:56 towards building a more resilient body from the ground up.

49:00 And I'll tell you, then the cool thing happens,

49:02 because the patients will come to me and they'll be like, you know what?

49:05 That does feel better.

49:08 My low back does feel better.

49:09 And I'm just like, yes, thank you.

49:11 Because it just makes sense.

49:13 When you do things and you load appropriately, your system starts to respond.

49:19 Okay, so a big part of this...

49:21 finding the right functional shoe...

49:23 to transition, not going too extreme.

49:28 We know from our conversation thus far,

49:30 we want to focus on mobility and strength.

49:34 It sounds like a lot of the transition,

49:37 and at least the strengthening part there comes from the shoes.

49:43 Are there specific exercises, is what I'm getting at, along with the shoes,

49:48 to help facilitate that transition?

49:50 Yes.

49:53 I think a lot of us put too much credit into the shoe.

49:57 If I just get the right shoe, everything's going to be better.

50:03 The shoe is the icing on the cake.

50:06 It should help facilitate what we're doing,

50:09 and so we have to pay attention to what we're putting in the shoe.

50:14 So on a very basic level...

50:16 we should be able to do things with our toes that we do with our hands.

50:22 So we should be able to just lift our big toe.

50:27 You should be able to lift your four toes.

50:30 You should be able to lift all of your toes,

50:32 and here's one of my favorites, and spread them.

50:35 So if you were to look down at your toes,

50:38 you should see daylight between each individual toe.

50:42 That's your intrinsic muscles of your foot...

50:44 working and splaying your foot so that you

50:47 can create strength and power when you walk.

50:51 If you can't do those things, we're baseline.

50:55 But I like baseline because that means you can only go up from there.

51:00 Then we'll look at things like toe strength,

51:03 which I find fascinating that more people are

51:07 not talking about this when you look at...

51:11 longevity.

51:12 One of the big markers that they'll test for is hand grip strength.

51:18 So they'll know, how strong are our hands?

51:21 There was a really cool study out of Japan that looked at 1,400 men,

51:27 and they compared toe strength versus hand grip strength.

51:32 And what they found was that toe strength is lost...

51:36 faster than hand grip strength.

51:39 It was also associated a weakness in our toes with increased fall risk,

51:47 poor regulation of...

51:49 glucose-— and overall metabolic health.

51:54 So...

51:55 we need to be paying attention to how strong our toes are.

52:03 It can be one of these predictors of fall risk as we age.

52:09 So I'll have people in my clinic, I'll have them stand up...

52:12 and kind of go next to a wall.

52:16 They're going to keep their bodies real straight,

52:18 and then they're going to lean into the wall.

52:20 And they should be able to feel their toes pressing into the floor...

52:24 That's what's stopping them from smacking their face up against the wall.

52:29 Most falls as we age happen at the initiation of gait...

52:32 So if I was going...

52:34 If I was stopped and I was going to walk towards you,

52:37 because we can't feel our toes, we lose sensitivity and we lose strength.

52:42 Sarcopenia is a thing, it also happens in the foot.

52:47 So we will look at how far can they lean forward,

52:50 can they control what we call fall envelope?

52:55 And if they can't...

52:57 there's your exercise.

52:59 Start putting strength and loads through the toes.

53:05 I have a little device in my office.

53:07 It's called a dynamometer.

53:09 This is the fun stuff we do in my office.

53:12 But I will test how strong the big toe is and how strong the lesser toes are.

53:17 At a minimum, we should be able to produce

53:21 10% of our body weight out of our big toe.

53:25 So if you were at home and you put

53:27 a credit card or something underneath your big toe,

53:30 someone should— see if they could pull it out...

53:33 You should be able to not let them do that.

53:36 Really engage that foot.

53:39 That big toe, as far as I'm concerned,

53:41 is one of the most important joints in our body.

53:44 It is what we walk.

53:46 It is what we push off of when we walk.

53:50 The lesser toes, two through five...

53:53 if my patients cannot produce about 7 to 8%

53:56 of their body weight out of those lesser toes...

53:59 they are at an increased risk of falling.

54:03 They are at an increased risk of plantar fasciitis,

54:06 of heel pain, because that muscle is the plantar fascia's friend.

54:11 They work together, they share loads...

54:13 So when one of the friends goes away, the plantar fascia has to take...

54:17 on more load.

54:18 He doesn't want to do that.

54:21 So these little things are very indicative of problems

54:26 that can arise if they are not there already.

54:32 So toe strength, then if you move up the chain,

54:37 you look at ankle and ankle power, which,

54:40 if I could preach anything, if you are walking on this planet,

54:45 you should be doing some type of calf raise, period.

54:51 Fall in love with your plantar flexors.

54:54 That is your power when you walk.

54:57 And we lose power faster than we lose strength as we age...

55:01 Power isn't just for athletes.

55:04 When we think training power, we're like, well, I'm not a...

55:08 basketball player.

55:09 I don't need...

55:10 to be able to jump high.

55:11 Power is getting up out of a chair.

55:15 Power is being able to walk quickly across the street.

55:18 Power is being able to have good reaction time.

55:21 And a lot of that comes from your foot and ankle.

55:28 And I hear it all the time.

55:30 I feel like when I'm walking, I just can't, I'm tired.

55:34 I feel like I can't push through my foot.

55:37 And so they'll go to the shoe store...

55:39 and guess what?

55:40 They'll get one of those little rockered shoes and they'll be like,

55:45 here, I got my power back.

55:46 No, you didn't.

55:47 You're actually...

55:47 making it worse.

55:50 So...

55:51 that's where we'll look at, how many calf raises can you do?

55:54 Can you do a single-leg calf raise?

55:58 In the book we have a chart...

56:00 that looks at decade of life.

56:03 So if you're 20s, you should be able to do X amount of calf raises...

56:07 single leg.

56:08 In the 20 years that I've been assessing this, few people hit those marks.

56:15 My favorite population is my running population...

56:18 My runners...

56:18 should be able to give me 35 single-leg calf raises.

56:22 And they better be pretty.

56:24 No cheating.

56:27 And they cannot.

56:28 Some of them can't come close to those numbers.

56:31 And they're in my office with Achilles tendonitis,

56:34 and plantar fasciopathies, and...

56:36 post-tib tendonitis.

56:37 I'm looking at them going, what do you think you're doing when you're running?

56:42 Because it's a single-leg hop over and over and over again.

56:45 That's eight, nine, ten times your body weight going through your foot.

56:51 You better train that foot to handle those loads.

56:56 So there's just a lot of opportunity that I think we

56:59 miss when we are not paying attention from the knee down.

57:04 For somebody who is aware of what you're talking about today,

57:09 and they transition over to minimal or some

57:12 kind of functional footwear in a healthy way,

57:15 are there specific strengthening exercises when they get there?

57:19 And they get their mobility of their foot and ankle,

57:22 they get the strength there as well.

57:25 Other than wearing the functional shoe,

57:29 is there still certain exercises people need to do to maintain that?

57:33 Yeah...

57:34 First would be calf raise, calf variability...

57:37 You can do a seated calf raise, you can do a standing calf raise.

57:41 There's wall bridge calf raises, some type of...

57:44 strength into the plantar flexors of your foot.

57:48 Depending upon where patients lie or sit along that spectrum,

57:53 things like sled pushes.

57:56 Wonderful for foot strength...

57:58 because the heel's off the ground and you're pushing.

58:03 Farmer's carries...

58:04 suitcase carries, where you're holding weight and you

58:08 have to push through your foot, ideally barefoot.

58:12 These are all excellent exercises for your foot.

58:17 Putting a barbell...

58:19 on your shoulders.

58:20 And pressing your big toe into a wedge.

58:23 Putting load through the big toe.

58:25 Some you see that and you talk about it

58:28 and people are like— I would never want to do that.

58:33 Please do.

58:34 But do it safely.

58:35 Work your way there.

58:37 Because the foot can be strengthened a lot and it can handle a lot of loads.

58:43 This is a fun fact...

58:45 There was research looking at runners and runners who had Achilles tendinopathy,

58:51 so pain at the heel, and they had healthy runners, and what these guys and...

58:57 women were able to produce doing a seated single-leg calf raise.

59:01 So you're in the gym,

59:03 the one machine that should have the longest line and no one's ever on it.

59:09 And if you were to sit on that machine and do six...

59:14 single-leg calf raises at 1.5 times your body weight.

59:24 That's a lot of weight...

59:26 I know some people that can't lift 25 pounds.

59:29 I know some people that can't even lift the machine.

59:34 But point being is that soleus,

59:37 your powerhouse of your lower leg, can be trained to heavy loads.

59:43 One and a half times your body weight, six times, single leg seated...

59:48 That's no joke.

59:50 Now, you don't have to.

59:51 I like to get people to about 50% of their body weight.

59:55 I'm happy there.

59:57 But the point is that these tissues...

59:59 can be trained heavily.

1:00:01 And I think when we look

1:00:02 at diagnoses like plantar fasciopathies and Achilles tendinopathies,

1:00:06 that's one of the things we miss, is that we're not loading...

1:00:10 enough.

1:00:13 Like we've been talking about when someone's in pain, especially at their foot,

1:00:19 it's, I better rest, I better get off this thing.

1:00:23 And it's not that rest is the enemy because...

1:00:26 they'll be off of it for a week and they'll be like, all right, feels better.

1:00:31 And then they'll try to return to sport

1:00:33 or return to run or return to even walking.

1:00:36 And if they don't load their tissues or load their tendons,

1:00:39 I can promise you that that pain is going to come back.

1:00:42 And then it's this nasty cycle that they just can't get out of.

1:00:48 So those are all great things for people to do...

1:00:53 to really strength train their feet.

1:00:57 As you bring up rest,

1:00:59 it reminds me of a study you brought up in the book, a newer study.

1:01:04 I think it was 2013, about "RICE." Yeah.

1:01:08 So talk about what that is, and how traditionally,

1:01:11 that's what people are told when they get an injury,

1:01:14 and how that's being debunked.

1:01:17 So "RICE,"-— we've all heard of rest, ice, compression, elevation.

1:01:22 So basically, when we would have an injury, that's what we were told to do...

1:01:28 is get off of it, ice it, compress it, and then elevate it.

1:01:34 And what we have found over the years

1:01:37 is that's actually not what we want to do...

1:01:41 And not only not what we want to do, but almost the exact opposite...

1:01:45 If we were to start with the rest component, tissues need...

1:01:50 gradual exposures to load.

1:01:53 And so when we simply rest our tissues,

1:01:56 now, I'm not saying that this is not warranted.

1:02:00 When you have an acute injury, you have to monitor your activity.

1:02:05 But there has to be this component of movement...

1:02:09 Movement is what decreases inflammation.

1:02:12 When I was in school and we had someone with an ankle sprain,

1:02:16 it was like, grab the crutches, get off of it, rest it, ice it.

1:02:22 Now it's keep that thing moving, circle your ankle,

1:02:26 start to figure out how you can move your toes and move your ankle.

1:02:33 That whole conversation of ice is the...

1:02:37 inflammatory conversation on many levels.

1:02:42 Ice is going to prevent inflammation.

1:02:45 It's going to decrease inflammation.

1:02:48 Inflammation is...

1:02:49 not bad.

1:02:51 It's bad when it's in excess and it lives around.

1:02:54 But an inflammatory response is what we want.

1:02:57 That's what brings blood flow to our tissues.

1:03:00 That's what helps bring nutrients to the area.

1:03:03 So do we really want to be getting rid of this inflammatory response?

1:03:12 So we really have veered away from both

1:03:16 of those recommendations of resting and icing,

1:03:20 and it's more of how do we start to get tissues to move?

1:03:24 And what was interesting is the research that kind of touted all

1:03:30 of this "RICE," they even went back into it and said, we were wrong.

1:03:36 We were wrong...

1:03:37 We do know that movement is what is...

1:03:39 required here.

1:03:40 And that's a tough thing to debunk because even my father,

1:03:45 I was talking to him the other day.

1:03:49 And— he's so funny.

1:03:50 I've been talking about this stuff for literally 20 years,

1:03:55 and he'll still say to me, I went golfing.

1:03:59 It hurt my back.

1:04:00 I'm gonna rest.

1:04:01 I'll put some ice on it.

1:04:03 I'm like, Dad, I've told you this a thousand times.

1:04:07 This is even funnier.

1:04:08 He went to see his "PCP" the other day...

1:04:10 My Dad's 80 years old, no medication.

1:04:12 He's in pretty good health.

1:04:14 And he comes back and he calls me.

1:04:17 He's like, Doctor "Campbell" said I need to start walking more,

1:04:21 so I think I'm going to do that.

1:04:23 I was like, I'm going to kill you.

1:04:25 I've been writing a book on walking for three years,

1:04:27 telling him about how he needs to increase his step count.

1:04:31 And Doctor "Campbell" tells him to increase his step count,

1:04:34 and now he's going to do it.

1:04:36 I digress.

1:04:36 But that's why you can't treat family.

1:04:39 But it's a very hard kind of myth, if you will,

1:04:43 because we have been taught that for very long periods of time rest our tissues,

1:04:49 ice our tissues, wear a foot orthosis, and wear supportive footwear.

1:04:54 So given the importance of movement after an injury,

1:04:58 how does somebody know how far to safely

1:04:59 push that unless they're working with somebody like you?

1:05:04 Small doses.

1:05:05 That's the beauty of...

1:05:07 microdosing.

1:05:08 Everything from walking...

1:05:11 to motion.

1:05:14 I had a patient I've been working with her, and she

1:05:18 has for about three years, she's been in pain.

1:05:21 She rolled into my office in a wheelchair.

1:05:26 And— that was the very question she asked me.

1:05:30 Well, how do I know...

1:05:32 how far I can go?

1:05:35 And I always started her off very small.

1:05:37 I said, you're going to go five minutes,

1:05:41 and then I want you to see how you feel that night and the next morning.

1:05:46 Now, with these people that have— kind of a miss...

1:05:49 Have a different perception of pain, I'll have them look for acute symptoms.

1:05:54 Did your foot get swollen?

1:05:57 Did it get red?

1:05:59 Were there any acute things that you could see

1:06:03 or feel that there had been excess tissue load...

1:06:07 or damage?

1:06:09 And if not, especially in chronic pain patients, that is...

1:06:14 a green light for us to slowly increase dosage.

1:06:17 <break time=“2.95s"/> That's a tough conversation because that's the question.

1:06:22 People are always like, how do I know?

1:06:25 How far I can go?

1:06:27 And I always tell them, keep it simple.

1:06:29 Start small and assess how you feel...

1:06:33 that night and the next morning.

1:06:35 I think the other important conversation here is that we

1:06:39 have a whole chapter on pain in the book.

1:06:44 When I first got out of school, I would tell my patients.

1:06:49 Our goal here, when you come to my office, is to get you pain-free.

1:06:54 And I look back on that, and I say, shame on me.

1:06:58 Shame on me.

1:06:59 That is not the goal.

1:07:02 Pain is a normal— response.

1:07:08 It's a normal human...

1:07:10 response.

1:07:11 It gives us information.

1:07:15 We have to reframe how we think about pain.

1:07:20 Why would we want to try to completely

1:07:22 eliminate something that gives us a signal?

1:07:25 We need to reframe how we're looking at it.

1:07:27 We need to live well with it.

1:07:29 Because to tell someone you're not going to walk until you're pain-free,

1:07:36 they'll be sitting there for years because their nervous

1:07:40 systems are so sensitized that they feel pain...

1:07:44 way before tissue damage is occurring.

1:07:47 So to tell them...

1:07:48 you gotta wait till you're pain-free before

1:07:51 you can start doing things is a disservice.

1:07:56 Let's understand your pain.

1:07:59 Let's try to reframe it.

1:08:02 Because it's not just a musculoskeletal diagnosis.

1:08:06 There is a big, beautiful person behind that diagnosis

1:08:10 that probably has an emotional attachment to some of this pain.

1:08:15 They could have bad sleep, a breakup with their boyfriend, poor...

1:08:19 There's so many factors...

1:08:21 that can feed into their level of pain...

1:08:24 that if we say, wait till you are pain-free,

1:08:27 it's, hey, let's see how we can work with this.

1:08:32 And what I have found over the past 20 years

1:08:36 is you start to build people's confidence in their movement.

1:08:42 They start to feel safe again.

1:08:43 And they say, I took my walk today.

1:08:45 My foot was a little sore, but it wasn't any worse than it has been.

1:08:50 It didn't make anything worse.

1:08:52 So I'm going to keep going.

1:08:54 That's what I want to hear.

1:08:56 And that's that concept of neuroplasticity where

1:09:00 we're reorganizing and changing our brain to experience...

1:09:08 pain differently.

1:09:09 So we've gone into active, strengthening.

1:09:13 Let's shift into passive things like massage,

1:09:16 active release, doing stretches at home.

1:09:20 How do those fit in?

1:09:21 It's a neurological window.

1:09:24 People are going to respond to different things.

1:09:28 I think calming the nervous system is the number one goal for anyone...

1:09:35 who is in acute pain or chronic pain.

1:09:38 We gotta dial it down.

1:09:41 We need to find the parasympathetic tone, which is chill.

1:09:46 Most of us are not in chill mode.

1:09:48 We don't know if we're being chased by a lion or a deadline.

1:09:53 So we're constantly in this state of high sympathetic...

1:09:58 fight-or-flight response.

1:10:01 So things like massage, for example, can really tap into the nervous system

1:10:08 and get people's nervous systems to settle down.

1:10:13 Things like "ART," being able to improve joint motion.

1:10:17 I am all for those things, red light therapies we will use.

1:10:22 But this is the conversation that I will have.

1:10:25 You cannot just do passive care.

1:10:28 It has to be...

1:10:29 if passive care is going to be your window to make you feel better.

1:10:37 That has to be the window so that you can then start to load your system.

1:10:42 So the passive care has to lead to...

1:10:45 active care.

1:10:46 Those things, it needs to be an and conversation, not an or conversation.

1:10:51 <break time=“6.09s"/> People like passive care.

1:10:59 There's a lot of clinics that will come in and— we're going to do

1:11:02 "ART" and we're going to do shockwave and we're going to do these things...

1:11:06 And we don't want patients to rely on those treatments alone.

1:11:10 You got to put the work in.

1:11:12 People need to put the work in...

1:11:15 And that comes from education...

1:11:17 Why?

1:11:18 My...

1:11:18 new patient exams are two hours long.

1:11:24 They get an email that's probably...

1:11:25 more detailed than they could ever imagine with also

1:11:28 a recording of me talking about it again.

1:11:31 Because if you don't understand why you're doing something,

1:11:35 you're not going to do it.

1:11:36 And you're just going to say, why wouldn't I just keep going back

1:11:40 and getting passive care over and over again?

1:11:44 Because you don't want to have to do that.

1:11:46 You want to be out of the office and doing what you love.

1:11:48 And that means you got to take an active role.

1:11:50 In your new book, you talk about backward walking.

1:11:53 Who is that for?

1:11:54 Oh, it's one of my favorites.

1:11:57 There's so many benefits to backward walking.

1:11:59 A lot of the research that you will see

1:12:01 for backward walking is for patients with knee osteoarthritis.

1:12:05 So patients with knee pain walking backwards,

1:12:08 it can be very beneficial for them.

1:12:10 Ten minutes a day, for example.

1:12:12 And what you're doing is there's a lot

1:12:16 of things that are happening when you start walking backwards.

1:12:19 Instead of having...

1:12:20 the walking gait cycle,

1:12:21 which is a heel strike and rolling to the toes, it's the opposite.

1:12:25 So it's a pressing with the toes and dropping the heel down.

1:12:28 So it's almost like you're pushing yourself backwards.

1:12:32 There's a lot of quadricep or quad engagement...

1:12:36 with walking backwards.

1:12:39 Strong quads help decrease loads at the knee.

1:12:45 So that's why that intervention can be so effective...

1:12:49 I think the other thing that a lot of people

1:12:53 don't talk about there is that there's a lot.

1:12:57 It's a completely different neurological input.

1:13:02 You're walking backwards, your visual field is changing.

1:13:06 You're loading your joints differently.

1:13:09 So when I have patients that have pain walking forward.

1:13:13 So they'll be like, when I'm walking,

1:13:15 I get to 10 minutes and then things start hurting.

1:13:17 I say, I want you to stop.

1:13:19 You're going to turn around, you're going to walk backwards for a couple minutes

1:13:25 and then you can turn around and walk forward.

1:13:27 You're going to change the loads...

1:13:29 You're going to give them a different stimulus to their brains.

1:13:34 And that little break can be very helpful.

1:13:37 So that walking backwards, we joke in Colorado,— we see people walking

1:13:42 backwards they must be one of Doctor "Conley's" patients,

1:13:46 because it's one of my favorite things...

1:13:48 to give people to do.

1:13:49 I think there's a lot of benefit for that, not only for patients with knee pain,

1:13:54 but just overall pain.

1:13:58 I want to come back to the shoes.

1:14:00 And we've talked about functional shoes and that continuum

1:14:04 goes all the way to the minimalistic.

1:14:07 Somebody brand new to these kind of shoes.

1:14:11 Let's walk them through going to buy their first pair.

1:14:14 Yeah.

1:14:15 Is this something they can go to a regular shoe store and get?

1:14:18 And then the specifics, what are the things that are non-negotiable they

1:14:23 want to look for for their first pair?

1:14:26 Most— running shoe stores, like a specialty store...

1:14:33 will carry functional footwear.

1:14:38 There's unfortunately not that many brands out there.

1:14:44 The three that come to my mind are...

1:14:47 "Altra Running," "Topo Athletic," and "Notace." So those are

1:14:50 the ones we talk about in the book.

1:14:52 These brands have my non-negotiable, which is a wide toe box.

1:14:59 If you are new to this conversation,

1:15:02 that is the easiest thing to implement because there is no break-in.

1:15:07 It's just put your foot in this shoe.

1:15:09 The one thing people will say with the wide toe

1:15:12 box is it kind of feels loose, it feels sloppy.

1:15:17 And I say to them, yes,

1:15:18 because your foot is not filling up the shoe, you don't have good toe splay.

1:15:24 That's when we'll implement things like toe spacers,

1:15:27 which I love because you can wear a toe spacer in these shoes...

1:15:31 to fill up the space.

1:15:33 It will give you that toe splay.

1:15:36 So the wide toe box is non-negotiable and all three of those brands have it.

1:15:41 The next would be the heel-to-toe drop.

1:15:45 All of those brands sit below 6 millimeters.

1:15:52 So they will have a 4 millimeter heel-to-toe drop.

1:15:56 "Topo" will have a 5 millimeter heel-to-toe drop.

1:15:59 And for someone who has...

1:16:00 restricted ankle mobility or they have a history of...

1:16:04 heel pain or Achilles pain.

1:16:06 I'll say, let's get you in something a little lower than what you are in.

1:16:11 So all of those are fine.

1:16:13 And we're going to work on some of those things.

1:16:16 <break time=“4.82s"/> So that's where I would start.

1:16:22 If you are new to this, it's the wide toe box, and getting into...

1:16:28 something that's a little less...

1:16:30 heel-to-toe drop...

1:16:31 The hardest transition is the thin and flexible sole.

1:16:35 So if this is...

1:16:36 a very new conversation to you,

1:16:39 go with one of those functional brands because it'll be an easier transition.

1:16:45 The difference between a functional shoe and a minimal

1:16:50 shoe is the thin and flexible sole.

1:16:55 And that's harder for people to get used to because it's 14...

1:17:00 millimeters of stack height or even less.

1:17:04 And so,— your foot's basically on the ground.

1:17:07 How different...

1:17:08 is being in one of those shoes, the latter there, than being barefoot?

1:17:14 Well, if you think about the stack height of it,

1:17:17 whenever your foot can feel the ground and there's no interference,

1:17:22 you're going to get all of that sensory information.

1:17:26 That's the environment...

1:17:28 But the problem is...

1:17:29 who can walk around barefoot?

1:17:32 We're on— man-made surfaces.

1:17:35 Many of us cannot do that.

1:17:37 So...

1:17:38 in those thin and flexible soles,

1:17:40 the research will say anything about 20 millimeters or below, which 20...

1:17:46 millimeters is still pretty thick, 15, 14.

1:17:51 It's like if you were to take out

1:17:54 your factory insert of your shoe and stand on it.

1:17:58 You really can feel the ground.

1:18:01 I like that.

1:18:03 It took me a while to get into that.

1:18:07 But even— with patients with knee pain that's— so wild to me.

1:18:12 People with knee pain are like,— I must have to get

1:18:17 a cushioned shoe because that's going to be easier on my joints.

1:18:22 I caution you...

1:18:24 more cushion...

1:18:26 changes where those forces go.

1:18:29 So even with my patients with knee pain,

1:18:34 I'm like, put something thin and flexible underneath that foot.

1:18:39 Their gait changes,— the speed of pronation or how their foot unlocks change it.

1:18:47 So it's a very different feel...

1:18:49 But when you put the work in, I think people on the other end are like,

1:18:53 wow, this does feel better, not only at my foot but everywhere else.

1:18:57 But it takes time.

1:18:58 Somebody like you that's wearing a minimal shoe,

1:19:02 do you feel it's still important to spend a certain amount of time barefoot?

1:19:06 Oh, yeah, I'm like the-— reason I got into this work

1:19:10 was because of all the foot pain that I've had.

1:19:14 So I— still have a bunion.

1:19:15 Doesn't hurt me anymore, though.

1:19:17 Nobody's touching that thing.

1:19:20 I still have a neuroma because those don't go away.

1:19:23 So I am the perfect example of the shoe spectrum...

1:19:27 I try to spend as much time as I can barefoot at home.

1:19:32 My foot's on the ground.

1:19:35 I have my minimal footwear when I go to my office.

1:19:39 Most of the day...

1:19:41 I'm in my minimal footwear.

1:19:44 Now if I'm going to a museum in New York

1:19:48 City and I'm going to be standing in one place...

1:19:51 where I don't have...

1:19:53 movement through my foot, that's when I move along the shoe spectrum and say,

1:19:58 I'm going to go into my "Altras," because I

1:20:01 still have my foot in a wide toe box.

1:20:04 I still have...

1:20:05 my low-to-zero drop,

1:20:07 but I'm going to have some cushion underneath my foot because I'm standing...

1:20:12 on concrete.

1:20:13 When I go to airports, which I'm in a lot,

1:20:17 I love having my "Altras." It just— helps me out a little bit.

1:20:22 So that conversation, I think is important of knowing when to wear what.

1:20:29 I think the other one that we should talk about is when we're in the gym.

1:20:36 Go for it...

1:20:37 Yeah.

1:20:37 The strength training.

1:20:40 It's one of my biggest pet peeves when I see people...

1:20:44 trying to squat or deadlift in a "HOKA," for example.

1:20:49 Your "HOKA" is not a strength training shoe.

1:20:52 That's a running shoe or a walking shoe.

1:20:55 But when you're trying to lift heavy things, where do you get your power from?

1:21:01 Your foot being on the ground.

1:21:04 You have to feel your foot so you can power through your foot...

1:21:08 to use your legs.

1:21:11 And when you're standing on something that doesn't give you that sensory...

1:21:16 perception, you're basically sending mixed signals to your knee

1:21:20 and to your hip and to your back about where your body is,

1:21:24 about how stable your system...

1:21:26 should be.

1:21:28 So regardless if you are new

1:21:30 to this functional or minimal footwear conversation,

1:21:33 if you are a gym goer and you're strength training in the gym, please wear...

1:21:40 more minimal footwear.

1:21:43 It's very, very important.

1:21:46 We always get the question too, if I'm squatting,

1:21:51 can I wear the shoes that have the lifts in them?

1:21:58 If you were an Olympic lifter and you're lifting 500 pounds,

1:22:02 there's a reason those shoes exist.

1:22:04 Most of the people that I know, though, are not Olympic lifters...

1:22:08 So if you feel the need...

1:22:10 to squat...

1:22:11 with your heel elevated, the question I propose to you is, why is that?

1:22:16 Is it because you have poor ankle mobility that you can't squat without it?

1:22:21 Is it because you have poor...

1:22:23 proximal stability, where you need some support...

1:22:27 in order to be able to...

1:22:29 drop down into that squat?

1:22:30 And if so, work on those things.

1:22:34 Because we should be able to do most things

1:22:38 in that gym with our foot on the ground.

1:22:42 Do you have any thoughts on grounding,

1:22:44 getting the barefoot right on the grass or in the dirt?

1:22:48 There's always mixed camps with that...

1:22:50 about how beneficial is it?

1:22:53 I have a lot of...

1:22:54 patients, I'll be out in Colorado, I live in the mountains.

1:22:58 There's a lot of people walking around barefoot on the dirt out here.

1:23:02 And this is what I usually will say to them...

1:23:06 from a treatment perspective.

1:23:09 I live more in the world of strength

1:23:11 and mobility in that kind of biomechanical sense.

1:23:15 If people feel better when their foot is

1:23:17 on the ground and they appreciate what's happening there,

1:23:20 by all means, go for it.

1:23:23 So that's kind of how I speak on that topic.

1:23:26 There are benefits to having that foot

1:23:28 on the ground and being able to feel the earth.

1:23:32 When we look at how the foot should be able to adapt,

1:23:38 "Jesse," the foot is controlled by our central nervous system,

1:23:45 and it should be able to adapt and feel...

1:23:48 things, and that's how it propels us forward.

1:23:53 So it's constantly changing shape and constantly adapting to what we feel.

1:23:57 And when that foot is on the ground,

1:23:59 that's when we get the biggest benefit of that.

1:24:03 Throughout the conversation,

1:24:05 we've talked about a number of conditions of the foot.

1:24:08 Some of them related to your past and things that you still deal with.

1:24:13 Let's take some time and go over some of these.

1:24:16 The most common ones, starting with bunions.

1:24:18 Yes.

1:24:19 You've mentioned the fact that you've dealt with these.

1:24:22 Still have them, or at least one.

1:24:24 What are they?

1:24:25 And then for somebody with one, what's the best they can hope for?

1:24:29 So a lot of people think that a bunion is the problem where they see the bump.

1:24:37 We're talking about a hallux valgus.

1:24:39 So this is on the inside of the foot.

1:24:43 A bunion is an instability in the transverse plane of the foot.

1:24:50 So basically, what I mean by that is when your foot hits the ground,

1:24:56 it has to be strong.

1:24:58 It has to be able to control all

1:25:01 the different motions that our foot goes through.

1:25:04 And when we don't have that stability when we go to walk,

1:25:10 the joints start to change, if you will.

1:25:13 And we can start to get a shifting of the metatarsal, of the first bone there.

1:25:18 And you start to get this bump formed.

1:25:20 <break time=“2.09s"/> For those of you with bunions,

1:25:23 if you were to look down at your nail bed.

1:25:26 So when you look at the...

1:25:28 nail bed of the big toe.

1:25:31 Sometimes that nail bed will be flat and it'll be diving in.

1:25:35 So it'll just look like the toe is flat...

1:25:38 and going in.

1:25:40 Sometimes that nail bed will look like it's rotating where—

1:25:46 not only is it going in, but there's this rotational...

1:25:50 shift to it.

1:25:52 When you see that nail bed that's shifting,

1:25:54 that's rotating, you can be pretty certain...

1:25:57 that you're not controlling the rotation of your body, because you're seeing...

1:26:03 this bunion start to form as a result of that.

1:26:07 If there's no rotation and that nail bed is flat,

1:26:11 you better take a look at your footwear, because the footwear...

1:26:18 does change the structure of the feet.

1:26:22 So when we think about bunions,

1:26:25 we want to look at how strong is the foot and the right footwear.

1:26:31 But then the other thing that I think a lot of people miss is...

1:26:34 do you have bunions on both feet?

1:26:38 Because if you do, you better be looking at who's driving the car,

1:26:42 because that's your pelvis and your hips.

1:26:45 That's why I always tell my patients it's never just a foot problem.

1:26:51 And they'll be like, well, my grandma had a bunion.

1:26:54 And I say, hold up, timeout.

1:26:56 You don't come out of the womb with a bunion.

1:26:59 You might have had...

1:27:01 connective tissue laxity or hypermobility.

1:27:04 Those types of things, those genetic things can be inherited, if you will.

1:27:10 <break time=“3.85s"/> When you go to the doctor and they say,

1:27:16 does your grandmother have heart disease?

1:27:18 And you say, yes.

1:27:19 What do they tell you to do?

1:27:22 Better eat right.

1:27:23 Better exercise...

1:27:25 If you have <break time=“1.99s"/> a genetic disposition for heart disease,

1:27:30 it's the same conversation we should have with bunions...

1:27:34 If you know your grandma has a bunion, take proactive measures.

1:27:38 Wear the right footwear.

1:27:40 That is a non-negotiable that you are in a wide toe box shoe.

1:27:45 Strengthen your foot, and also think about what's happening at your pelvis...

1:27:51 So if you were to stand up and...

1:27:54 take your pelvis and...

1:27:57 think about the pelvis as a bowl of water.

1:28:00 If I were to stand up and dump out all the water.

1:28:03 So this is called an anterior tilt, or I'm kind of arching my low back.

1:28:07 What you should feel there is your arches start to drop,

1:28:12 and you should feel more pressure on the inside of the foot.

1:28:18 You might even see an increase of the angles of your bunions.

1:28:24 Anterior tilt is not bad.

1:28:26 We have to be able to do that motion.

1:28:29 We just don't want to live there...

1:28:32 So we should be able to control our pelvis, tilting it forward.

1:28:35 We also should be able to tuck our tailbone.

1:28:40 Now, if we're standing and we tuck our tailbone,

1:28:43 there is a direct correlation between what your pelvis

1:28:46 and hips are doing and what is happening at your foot...

1:28:50 Because when you tuck your tailbone, you should feel your arches lift.

1:28:56 And you should also see your bunion,

1:28:58 if it's flexible, start to straighten out a little bit.

1:29:03 So when I see people with bilateral bunions on both feet,

1:29:10 I'm not only looking at how I can improve strength at their foot, but also...

1:29:15 do we need to work on strength of pelvis,

1:29:20 motion of their pelvis, strength of their hips?

1:29:24 And usually that answer is yes.

1:29:27 So there's a lot that can be done.

1:29:29 Toe spacers are...

1:29:31 so incredibly helpful.

1:29:32 I wear them every single day.

1:29:35 It took me six months to wear them every day

1:29:38 because my foot was so weak and it was so uncomfortable.

1:29:41 After about 10 minutes, I was throwing that thing across the room.

1:29:45 But the reason I still wear them is I was late to the— party here.

1:29:50 My bunion had already formed.

1:29:52 It has decreased, and like I said, there is no pain...

1:29:55 But I like having that spacer in there to keep my toes aligned.

1:29:59 And those spacers can be worn in every single shoe we've talked about today,

1:30:04 whether it's functional or minimal.

1:30:08 So those are all important things with people that have bunions...

1:30:14 the footwear.

1:30:16 Watch the tops of the shoes...

1:30:18 So this is another little trick when you look at your footwear,

1:30:24 the upper of the shoe.

1:30:25 So that's the material on the top of the shoe.

1:30:29 Try to get something that's flexible,

1:30:31 like whether it's made out of mesh or some type of material,

1:30:35 because a lot of the footwear...

1:30:37 will have seams or leather seams...

1:30:40 over the inside of the big toe or the outside

1:30:42 of the pinky toe here so the foot can't expand.

1:30:47 And so every time they...

1:30:48 walk, the foot pronates.

1:30:51 That's a good thing.

1:30:52 And the forefoot expands.

1:30:54 If you are in a shoe that doesn't allow that expansion,

1:30:58 don't be asking yourself why your— foot hurts.

1:31:01 I'm telling you.

1:31:03 It's because you don't have...

1:31:05 the expansion at your forefoot.

1:31:09 It's one of my favorite things to treat,

1:31:12 especially when they're caught early, that mild to moderate bunion formation.

1:31:19 And this is the last thing I'll say about it,

1:31:22 because I could turn this whole podcast about bunions.

1:31:25 There's a muscle on the inside.

1:31:27 It's called abductor hallucis, and it straightens the big toe.

1:31:32 So in my office, I'm giving people exercises for abductor hallucis so

1:31:38 that they can strengthen the muscle that's going to help straighten their toe...

1:31:44 We would do that anywhere else.

1:31:47 If I had a difficult time lifting a weight, I would say go do some bicep curls.

1:31:55 Every time you think about your foot,

1:31:57 think about what I would do at the rest of my body...

1:32:00 So you can strengthen your foot.

1:32:02 You can strengthen these muscles that will help balance your foot better.

1:32:07 One of the unique things...

1:32:08 of a bunion versus a neuroma or a stress fracture...

1:32:11 is that you can actually see the physical change.

1:32:14 Yeah.

1:32:15 Somebody implementing what you just talked about there.

1:32:18 How much of that is reversible?

1:32:20 To reverse a bunion?

1:32:22 Yeah, to actually see it physically go back to a normal state.

1:32:27 Or is that not even possible?

1:32:29 In your mild stages of bunions, you will see changes to the foot.

1:32:34 In your mild stages of hammertoes, you will see changes to the foot.

1:32:40 With mine, when it's irritated.

1:32:43 If I were to wear the wrong footwear, when I'm in my cycling shoe, for example,

1:32:50 which is still a wide toe box cycling shoe,

1:32:53 the toe will get irritated, you'll see inflammation.

1:32:57 Those things can all change.

1:33:00 But early intervention is the key.

1:33:03 I always will look at patients with bunions and see if it's flexible because

1:33:09 what can happen is this big toe will start to creep under the second toe.

1:33:18 And once that starts to happen,

1:33:21 and the big toe gets stiff and rigid and you cannot move him,

1:33:25 it's a very different conversation, because now you can't move the toe.

1:33:33 We know there's going to be an increased risk of...

1:33:36 falls, balance problems.

1:33:40 We don't want people's feet to get to that point.

1:33:43 We need to have a proactive conversation, not a reactive one.

1:33:48 I'm probably dating myself here, but when I was younger,

1:33:52 they used to do scoliosis checks in schools.

1:33:55 You'd go to the school nurse, they'd check you for scoliosis.

1:33:59 We need to be looking at our kids' feet.

1:34:02 Because if we had them in the right

1:34:04 footwear and we let their feet feel the ground...

1:34:08 and get stronger and develop naturally,

1:34:11 you'd probably put me out of business, throw me into retirement.

1:34:16 Because...

1:34:17 a lot of what I see is a result of something

1:34:20 that I think can be changed if we just paid more attention.

1:34:25 So that early intervention is very important...

1:34:28 And— start small.

1:34:32 I don't want people to listen to this and be like,

1:34:34 I gotta throw away all my shoes and I need to.

1:34:37 That's not the conversation, it's little bits...

1:34:40 Get yourself the right pair of shoes,

1:34:42 walk around barefoot a little bit at a time, start to...

1:34:45 feel what it feels like, and you'll be able to see difference.

1:34:48 A lot, actually.

1:34:50 The brain is plastic.

1:34:51 It's a...

1:34:52 conversation of hope.

1:34:54 You quickly mentioned kids there.

1:34:57 Just to go into that for a minute, how different,

1:35:00 if at all, is what we've been talking about today for kids?

1:35:04 If you look at any baby on the planet,

1:35:06 the first thing they do is rip their shoes off and rip their socks off.

1:35:10 Because their little brains are screaming for information...

1:35:14 They're developing.

1:35:16 If you've ever seen a baby crawl with a shoe on, they can't even.

1:35:21 They can't plantar flex their foot because the shoe's so stiff and rigid...

1:35:26 You don't want to mess around with...

1:35:28 their development...

1:35:29 at that age...

1:35:30 So with the kids, it's as often as we can, their shoes are off.

1:35:35 Different textures, grass, sand, rocks.

1:35:40 Let them feel the ground.

1:35:42 In a lot of other countries outside of...

1:35:44 the United States, they have that in their schools where they

1:35:48 take their shoes off and the kids are walking around barefoot everywhere.

1:35:54 And their feet are developing.

1:35:59 I have a lot of parents that will call me and they'll say,

1:36:02 my children's feet are flat.

1:36:05 And we talk about what age that is.

1:36:09 Ages 6, 7, 8, their feet are still developing.

1:36:15 And so to see flat feet...

1:36:17 in children...

1:36:18 is normal.

1:36:19 That's part of...

1:36:20 their bodies developing.

1:36:22 So we don't want to panic at that age and say, my children's feet are flat.

1:36:27 They have knock knees or genu valgum.

1:36:30 We need to get them into an orthotic,

1:36:33 we need to get them into an aggressive shoe.

1:36:35 They're still developing.

1:36:37 The only time there's cause for concern, is once they get into 10 years old,

1:36:43 11 years old, they have a difficulty with sports.

1:36:46 They have one side that's weaker or asymmetrical.

1:36:49 Those are the things that you're like, maybe we need to take a look at this.

1:36:54 But for the most part, with the kids, we have a very,

1:36:58 very big opportunity to allow their foot to get stronger

1:37:02 and avoid a lot of these problems that I see.

1:37:05 Kids' footwear has come a long way.

1:37:10 On our website, we have a whole children's footwear

1:37:15 section for people to take a look at, so...

1:37:19 that can be beneficial for them.

1:37:21 You went into flat feet for kids...

1:37:24 How different is that for adults?

1:37:26 That's an important conversation to have,

1:37:29 because if I had a penny for every patient that came in and said,

1:37:33 I was told I have flat feet, that's why I have these foot orthoses, it's like...

1:37:38 timeout.

1:37:39 When you look at someone's foot,

1:37:43 there's so many different variations to the anatomy of the foot that, in fact,

1:37:48 most of us, when we stand in a position of mild to moderate pronation...

1:37:53 So what that means is that when I'm standing in front of you,

1:37:58 a lot of us will look like our feet are flat.

1:38:02 Flat feet does not mean that there's something wrong.

1:38:06 We have to look at the function of the foot.

1:38:10 So can the foot change shape?

1:38:13 Can they move?

1:38:15 Can they tuck their tailbone, for example, and their arches lift?

1:38:21 When I rotate, can I see my arches lift when I rotate?

1:38:27 Do they have good toe strength?

1:38:29 Do they have good calf strength?..

1:38:31 And if— they're checking all of the boxes,

1:38:33 I don't care what that thing looks like.

1:38:37 It's not what it looks like.

1:38:38 It's how it functions.

1:38:40 And I have plenty of patients who have...

1:38:44 flat feet or they even think that they do, that are completely fine.

1:38:52 And that's a very important conversation to have,

1:38:55 because I think we have been taught that if

1:38:59 you see someone that has a flat foot, that's bad.

1:39:03 And it must mean that they need some type of support.

1:39:06 And I really want to change that conversation

1:39:09 into, it really doesn't matter what it looks like.

1:39:13 How does it function?

1:39:15 I've heard you share a story about being on vacation

1:39:18 on the beach and the boy with flat feet.

1:39:21 Share that one.

1:39:22 Yeah.

1:39:22 We were in Mexico on vacation, and as always,

1:39:25 I'm obsessively watching people walk on the beach.

1:39:29 And I saw this boy running.

1:39:31 He had a beautiful running gait.

1:39:33 And running on sand is hard.

1:39:36 He had this nice, long stride length.

1:39:39 And I was with my fiancé,

1:39:41 and he could tell that I was obsessing over this running gait.

1:39:45 And he looks at me and he's like, please, "Courtney," don't say anything.

1:39:50 But I can't help myself.

1:39:52 I'm like, this is amazing, because when he was running,

1:39:55 if you looked at his print in the sand, his foot looked like a pancake.

1:40:02 And so, of course, I went up to him and I was like,

1:40:05 hey, and I explained <break time=“3.17s"/> my obsession with foot strength.

1:40:11 And so we actually ended up having a very good conversation.

1:40:16 But his foot was the flattest foot I've seen,

1:40:19 and he was able to run beautifully on sand.

1:40:23 He did not have a problem.

1:40:25 That flat foot didn't need a foot orthotic.

1:40:28 He was very good.

1:40:29 His central nervous system was able

1:40:31 to adapt and create strength and create power.

1:40:34 Another story that I like to share is I was

1:40:37 in Belize with my mom and daughter on spring break,

1:40:41 and I saw these two men building a house barefoot.

1:40:46 Their foot was wide, it was flat, and it was very, very strong.

1:40:53 And if you think about it, we have four layers of muscles in our feet.

1:41:00 Wouldn't it make sense that if I had a strong foot,

1:41:03 that it might look flatter, it might look bigger, it might look wider?

1:41:09 I think that's interesting that-— we're so used

1:41:12 to seeing people's feet where they look atrophied,

1:41:15 where you almost can't see any muscle and you can just see bone.

1:41:19 That's what my foot used to look like, my foot looked atrophied.

1:41:24 But seeing these feet that are strong and wide and flat

1:41:29 was really confirmed all the recent research that we're seeing,

1:41:35 which is, do not assume that there is a problem

1:41:39 in the foot just because you see that it is flat.

1:41:43 A couple more pathologies I want to go into greater detail on.

1:41:47 One being plantar fasciitis.

1:41:49 Explain what that is and how it develops.

1:41:52 There is a lot of research and talk

1:41:57 that plantar fasciitis is an evolutionary mismatch disease.

1:42:01 So basically what that means is that it doesn't make sense.

1:42:05 We have evolved to have a very strong foot.

1:42:09 Why are there so many of us that have this diagnosis of heel pain?

1:42:14 We talked earlier about how muscle function supports

1:42:19 the plantar fascia so that when you have weak feet,

1:42:23 the loads have to go somewhere.

1:42:26 So plantar fasciitis, or an acute diagnosis,

1:42:32 they will say it could be inflammatory at the heel.

1:42:37 Plantar fasciopathy, or when it's more chronic, can be more of a repetitive,

1:42:44 degenerative type of diagnosis based on weak feet.

1:42:49 But I think when we talk about

1:42:53 treatment for this, whether it's acute or chronic,

1:42:58 most people that have plantar fasciopathy or heel pain

1:43:06 will have had it for long periods of time.

1:43:11 The ones that have it acutely, that pain goes away.

1:43:15 But there are patients that have this for long periods of time.

1:43:20 If you were to "Google," what should I do for my plantar fasciitis?

1:43:26 You're going to see ice on there.

1:43:28 You're going to see,

1:43:29 put some water in a water bottle and stick it in the freezer,

1:43:34 and then roll the bottom of your foot with your ice bottle.

1:43:39 We know— that's not going to be the solution.

1:43:42 It might be acutely, it might make you feel a little bit better.

1:43:46 They might say, stretch your calves.

1:43:49 Definitely, you'll see get a foot orthosis to take loads off of the fascia,

1:43:56 and definitely get super, super cushy footwear.

1:44:01 Now, acutely, go do all those things because it's an acute diagnosis,

1:44:07 you want to deload when something is acute.

1:44:12 But you cannot deload forever.

1:44:18 So— there was a cool study looking at the cohort was small,

1:44:22 there were 20 people.

1:44:24 And these were recreational runners with heel pain.

1:44:29 And what they had them do was for six weeks,

1:44:35 run barefoot on grass for 15 minutes a couple times a week.

1:44:43 Now...

1:44:44 for someone who's had heel pain, they're going to be like,

1:44:48 there is no way I'm doing that.

1:44:51 I need my orthotic, I need my cushion.

1:44:53 Basically, they did the exact opposite of what we've been told to do,

1:44:58 which is run barefoot, which puts more load through the plantar fascia,

1:45:03 puts more load through the foot.

1:45:06 Six weeks of doing that, 19 out of 20 of them had decreased symptoms.

1:45:13 Twelve weeks later, same conversation.

1:45:16 Now, I know there were people that said,

1:45:20 well, there's only 20 people in the study.

1:45:22 I don't care.

1:45:23 What we should be saying there is, maybe we should rethink this.

1:45:27 Maybe we should think about what if we started slowly implementing load

1:45:32 into the foot with patients with heel pain rather than deloading all the time.

1:45:38 And so that's where I think really,

1:45:41 we're kind of missing the boat when we're treating these patients.

1:45:44 I think that initially, yes, a lot of research, foot orthoses can be beneficial.

1:45:49 You better have an exit strategy.

1:45:51 You better have a strategy on getting that foot stronger.

1:45:55 You have to be able to produce power.

1:45:58 And the other thing with heel pain is it's never just a foot problem.

1:46:03 So if you have chronic heel pain,

1:46:06 make sure you are finding someone who's assessing your entire body.

1:46:10 What is your knee doing?

1:46:12 What is your hip doing?

1:46:13 How are these motions affecting your foot?

1:46:17 All right, last one you've mentioned, you have a neuroma.

1:46:20 Yes.

1:46:21 What is that and what causes it?

1:46:23 Oh, these are tough.

1:46:26 A neuroma is an irritation.

1:46:28 So in between the toes, we have nerves that sit in between the toes.

1:46:34 And what can happen is one of those nerves can get irritated.

1:46:38 And the body's response to that is it

1:46:41 can form this kind of sheath around the nerve.

1:46:45 So it's— looks like a little ball if you will.

1:46:49 And the problem with that is every time you go to walk and push off,

1:46:56 you will have pain at the ball of your foot.

1:46:59 And I can tell you, it is very painful.

1:47:03 It will feel like your foot's broken,

1:47:05 because you're basically stepping on this nerve every time you propel forward.

1:47:13 Once the neuroma is formed, they're your friend for life,

1:47:19 but they do not have to stay symptomatic.

1:47:25 How does that happen?

1:47:27 Well, very similar conversation with plantar fasciitis.

1:47:32 In the initial stages of neuroma pain, you have to deload.

1:47:37 You want to take pressure off of the ball

1:47:41 of the foot so that things can settle down.

1:47:45 This is a perfect time to implement your shoe that has the toe spring,

1:47:50 for example, or the shoe that has the rocker.

1:47:54 Because it's going to facilitate my gait, it's going to help me.

1:47:59 I have a pair of recovery sandals in my garage right

1:48:02 now that when my neuroma starts talking to me, I will wear.

1:48:08 It's called a recovery sandal for a reason.

1:48:11 It's recovering.

1:48:12 It's taking loads out of your foot.

1:48:15 It should be easier to walk.

1:48:18 You can't wear a recovery sandal forever.

1:48:21 So as the foot, the neuroma, the inflammation is starting to settle down,

1:48:26 we're working on things to improve the function of the foot.

1:48:30 You're working on your ankle mobility.

1:48:33 Tight calves, restricted ankle motion will put too

1:48:39 quick and too fast load through the forefoot.

1:48:41 My heel's going to come up too quickly, so you want to slow that down.

1:48:46 Stretch your calves, mobilize your ankles.

1:48:50 The other reason why we start to get these diagnoses in the forefoot,

1:48:54 neuromas, stress fractures, what have you, is because the forefoot is unstable.

1:49:00 If I go to push off on toes that are squeezed together,

1:49:04 that are very weak, I have an instability at my forefoot.

1:49:08 So of course things are going to get compressed.

1:49:11 Of course I'm going to have nerve pain.

1:49:14 Of course I could potentially have stress fractures.

1:49:17 So the other part of that treatment for neuromas is

1:49:21 how much splay can I get out of my toes?

1:49:25 How much strength can I produce at push off?

1:49:29 And so those are all the things we will work on.

1:49:33 The other option for treating neuromas is surgical.

1:49:37 So what they'll do is some will

1:49:41 want to cut the deep transverse metatarsal ligament.

1:49:44 So that's the ligament that runs across the forefoot here.

1:49:48 And if I had the neuroma in between toes three and four, for example,

1:49:52 and I cut that ligament, it basically gives the nerve room to breathe.

1:49:59 People will be like, yeah, that sounds great,

1:50:02 and it'll feel good for a little bit.

1:50:05 But keep this in mind.

1:50:07 You've just disrupted a ligament that stabilizes the front of your foot.

1:50:13 You're going to pay the price for that down the road.

1:50:17 So that's when you'll see patients that have had a neuroma surgery,

1:50:21 and then a couple years later, they'll have had this surgery,

1:50:24 and then it's boom, boom, boom, surgery after surgery.

1:50:27 And then, those are very different conversations.

1:50:32 So for— those of you who have neuromas, hang tight.

1:50:35 They do get better it just takes time.

1:50:37 Three to six months' time.

1:50:39 So just get in the right type of footwear,

1:50:41 start working on these things, and that pain will go away.

1:50:44 You just have to be a little patient.

1:50:47 All right, last question for you.

1:50:48 Summer's coming here in Ontario.

1:50:50 Yep.

1:50:50 Okay.

1:50:51 One of my favorite.

1:50:53 Actually, I'd say my favorite type of footwear is flip-flops.

1:50:57 Even plain, they allow foot or a toe splay.

1:51:01 And yeah, I'm trying to think if there's anything else.

1:51:05 They're relatively thin.

1:51:06 How do you feel about those functionally?

1:51:10 That's a good question to ask my daughter because I tell

1:51:13 her that word is worse than the, the real F-word in our house.

1:51:17 Here's— the issue with the flip-flop.

1:51:20 All of those things are correct.

1:51:22 If the flip-flop had a back strap on it, go for it.

1:51:27 Because the problem when there's no back strap on the sandal

1:51:31 is when I go through the swing phase of gait, right?

1:51:34 So I'm walking, my foot comes up through the swing phase.

1:51:38 That flip-flop is falling off of my foot.

1:51:41 But this is how it stays on.

1:51:43 I have to curl my toes, I grip my toes.

1:51:47 So then we end up walking in the flip-flop, and we're doing this.

1:51:52 In the walking gait cycle, our toes should never do this, they stay flat.

1:51:59 We roll through the foot.

1:52:01 Toe gripping is a sign of a weak foot.

1:52:04 It's a sign of, I'm trying to stabilize my body and claw my way forward.

1:52:08 So if you want to wear a sandal, I'm all for it.

1:52:11 Just wear one that has a back strap on it

1:52:13 so that when you go through the swing phase, you can actually relax your toes.

1:52:17 When you showed that hand movement of what the toes do,

1:52:23 it looked like a hammertoe.

1:52:24 Yeah.

1:52:26 Could that lead to it?

1:52:27 Yeah.

1:52:28 If you look at the two causes of hammertoes.

1:52:31 There's two causes, one is flexor stabilization.

1:52:35 So what I mean by that is when I'm walking and I go to push off my back foot,

1:52:41 if I don't have good strength to my foot,

1:52:44 my toe flexors will do this because they're trying to push me forward.

1:52:49 My flexors are stabilizing my foot.

1:52:52 So this is one cause of hammertoes, weak feet.

1:52:56 The other cause of hammertoes is,

1:52:58 as I'm going through swing phase, so I'm bringing my foot around,

1:53:03 if I have bad or restricted ankle mobility,

1:53:08 my body's going to help me and I'm going to extend my toes.

1:53:12 This is called extensor substitution.

1:53:15 So I'm lifting my toes up so that I don't what?

1:53:19 Trip.

1:53:20 Does that make sense?

1:53:22 So if I'm walking and I'm going through swing

1:53:25 phase and I can't clear the ground with my ankle,

1:53:29 my toes are going to scuff the ground.

1:53:31 So I'll go into a hammer position to clear the ground.

1:53:35 So again, with hammertoes, it's figure out why they're there and either work

1:53:41 on your ankle mobility or work on your foot strength.

1:53:46 I think that's information people need to know about

1:53:50 because those also can be a very big problem.

1:53:53 Somebody wearing a pillow under their feet right now, they're not walking.

1:53:58 We went into a lot of detail on a lot of things.

1:54:01 Yeah.

1:54:02 What would you say to them to get

1:54:04 that person started on the right track without overwhelming them?

1:54:08 First, have hope.

1:54:09 The foot is almost like a sensory organ.

1:54:13 So people respond very quickly when they get their foot on the ground.

1:54:17 Some really cool things happen in a short amount of time.

1:54:20 Take your shoes off, put your foot on the ground,

1:54:23 and just try walking around for just a couple minutes barefoot.

1:54:26 Even if you've had chronic heel pain, start small.

1:54:31 Try balancing on one foot with your foot on the ground barefoot.

1:54:36 Those are all little things to start to be able to do.

1:54:40 You will get a lot of sensory information,

1:54:43 <break time=“3.89s"/> the balance one is a really big key for me,

1:54:50 because I work with a lot of patients on decreasing their fall risk.

1:54:56 Even doing little things like that, we

1:54:59 talked about that leaning into the wall...

1:55:01 just to engage the toes.

1:55:03 Those are easy drills to be able to do.

1:55:06 All right, "Courtney," really enjoyed this.

1:55:09 We're going to link up "Gait Happens," your website,

1:55:11 your social media, your new book, everything in the show notes.

1:55:15 Thank you.

1:55:16 Thank you so much.

1:55:17 Thank you for watching.

1:55:18 Stick around here for this other great interview.

1:55:20 You don't want to miss it.

1:55:21 I'll see you over there.

1:55:23 Do you want pleasure now, or do you want something far better in the future?

1:55:27 So if you want pleasure now, eat the trifle,

1:55:29 eat the cake, but if you want a better future...

1:55:32 well, you've got to work towards that.

1:55:34 Let's put a lot more energy...

1:55:35 into thinking about a healthy