Born To Walk: How To Reclaim Your Feet, Fix Your Pain & Transform Your Health with Dr Courtney Conley #629

If you were to take any system in your body, cardiovascular, musculoskeletal, nervous system, lymphatic system, endocrine system, every system is benefited from this rhythmic motion of walking. It is the most easily accessible, underutilized treatment that we have at our hands. It is what we were designed to do. We were born to walk. Hey guys, how are you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast, Feel Better, Live More. Walking is something most of us take for granted. We do it to get from A to B, we track our steps on our phones, we might even use it as a bit of exercise. But what if walking is far more than just that. What if quite literally your life depends on it? Dr Courtney Conley is an internationally recognized authority on foot mechanics and gait dynamics and the founder and creator of Gates Happens which provides evidence-based foot education for athletes, movement professionals and regular humans like you and me. She has over 25 years worth of clinical experience and has worked with a wide variety of organizations including the New York Yankees, New York Giants and the San Francisco 49ers. Her first book, Walk Your Life Depends On It, officially comes out on May the 5th. I have been fortunate enough to be sent an early copy and it is a fantastic read which is available for pre-order right now all over the world. In our conversation, we discuss why walking should be considered a physiological necessity, potentially on a par with sleeping and breathing, why Courtney believes that our feet are the most neglected parts of our bodies, and how modern footwear has put fashion ahead of function with some serious unintended consequences. We also discuss why our big toe might be the most important joint in our body, how our walking speed can predict our future health, and why even a small increase in daily steps can dramatically reduce our risk of cancer, dementia and depression. Throughout our conversation, Courtney shares plenty of practical advice such as simple foot assessments that you can do at home easy exercises to build strength and mobility and a clear framework for choosing better footwear for yourself and your children Courtney is such a passionate individual who wants to help as many people as possible reclaim the true function of their feet Her message is one of hope and empowerment. And I'm quite sure that this conversation will give you a different perspective about the importance of walking and inspire you to start taking a bit more care off your feet. In your brand new book, Walk, Your Life Depends on It, you say that walking is a physiological necessity that your body requires for survival. I think many of us know that walking is important, but it's required for our survival. That's quite a bold statement. It is. It is. When I was thinking about how I wanted to broach this topic, I want people to think of walking as not just exercise. If you think about human biology, it is built around locomotion. And I didn't say biology is built around locomotion, human biology. So when you add that word in there, we know that humans are bipeds. And when you look at what walking provides, which is this rhythmic, low-intensity movement, it's that that facilitates every system in our body so our musculoskeletal system our nervous system our lymphatic system our endocrine system all of those systems function based on the integration of walking and i talk about it in the book um as a trilogy yeah with breathing and sleeping and i think when you think of those three components and one could add eating as well they all have this symbiotic relationship so when one suffers the other two suffer so if i have a poor night's sleep for example my respiration rate could be higher i could be in a state of more more stress increased cortisol i'm not going to want to do a lot of activity because I'm tired. So if you look at that trilogy of breathing, sleeping, and walking, you can see how they all feed one another. And when they're all functioning well, we're optimized. Yeah. As well as you calling walking this physiological necessity that the body requires for survival, that comparison in the book to breathing and sleeping, I thought was brilliant, very provocative, but absolutely spot on. You know, and you've detailed a lot of this research in your book about what more walking does, cancer risk, dementia risk, all these kind of things. What's really interesting is you could reframe it, couldn't you? Instead of it being that walking more reduces your risk of these problems, you could almost look at it the other way and go, no, we're designed to walk. When we don't walk enough, we get all kinds of problems. Correct. In the book, I refer to it as vitamin W. Yeah. That if we start to view this as an essential nutrient for our survival, I think we take a completely different spin on it. That it's not just exercise, it's a necessity for our survival. You mentioned a few things earlier, the lymphatic system that gets sort of properly activated when you walk. blood returning from your feet. Yes. Well, that only happens when you're contracting your calf muscle, right? Which happens when you walk. Yes. So everywhere you look... Every system. You need walking. If you were to take any system in your body, cardiovascular, musculoskeletal, like I said, every system is benefited from this rhythmic motion of walking. is there a perfect or correct way to walk that's the question i get very often in my clinic patients will actually say to me i think i forgot how to walk and it's always very fascinating to me i think walking each person has a unique walking signature if you will because our walking gait can be influenced by many things. Your environment, past traumas. The other example I like to use is you can, if someone was going in for a job interview, for example, when they walk out of the room, you can tell if they got hired or if they didn't. I have a 14-year-old daughter. When she walks in from school, I can tell if she had a good day or a bad day. So when we look at someone's walking gait, I appreciate that. I think it's like a window to their nervous systems. And with that being said, you want to respect the uniqueness of someone's walking gait, but at the same time, I think we want to create efficiency. And that's what I think it's about when I'm working with improving someone's walking gait. How efficient can we make them? Because that will allow them to be on their feet longer, go for longer distances, and then get all of the benefits that happen when you have sustained walking. Yeah. I really like this idea that we're all different. We've all got this unique signature. And as you say in the book, a person's walking gate tells a story. Yes. You can tell that someone is happy, sad, confident, scared, in pain, or feeling like they're on top of the world just by watching them walk. Isn't that beautiful? It's gorgeous. I know. I love it. And I've tried this because I've been tuned into this through my own movement coach, Helen, over the past few years. And what Helen used to say to me is that, and it really reminded me of something in your book, is this idea that if she's watching someone run, it's like, does something catch my attention? Yeah. Like, if it's a smooth, efficient style for that person, nothing catches her attention. but when something's not quite, I shouldn't say right, if it's not as efficient as it could be, it just catches there. And that's kind of the case you've made in your book as well. You say, we've all got different walking gaits, but you can usually tell when something's like a little bit off, can't you? Yes. And some examples of that, for example, if someone were to walk, but only swing one arm. Yeah. That's something that a non-trained individual can pick up pretty easily and i'll even video my patients and i'll say what do you see here i'll say jeez i'm not moving my right arm it's little things like that walking is rotation we take advantage of forward momentum and this rotation that we get in our bodies so something as simple as looking at someone and saying hey start let's start swinging your other arm then it creates this momentum and And so it's those little things that I think can have a profound effect on creating that efficiency. What's going on in the modern world currently whereby something that is so innate to us as humans, the ability to walk and cover large distances on foot, why is it that we need help doing something as basic and fundamental as walking? Yeah, we don't think about it. I think when you start looking at, I think people think they might walk a little bit more than they do. Because one of the questions I consistently ask my patients are, do you know how many steps you're taking a day? And then they start looking at it like, well, geez, 3,000? And these numbers are pretty low. And I ask them, why do you think that is? And I think there's several reasons for that. Time. I think time is a big one. We've become very busy. And it's, can I fit this in? Pain. I have a lot of patients with chronic pain. And I don't think there's any other diagnosis in your body that will stop you in your tracks from movement, and in particular walking, than when you have foot pain. Yeah. The numbers of people with foot pain is very high. one out of three adults over the age of 45 will suffer from foot pain at least one point in their lives that's a high number that's a huge amount because of course when you're in foot pain you're not going to want to walk on it or go to the shops or you're going to want to get off it aren't you yes well why why do you think one in three adults over the age of 45 have foot pain at some point in our lives? I think the foot is probably the most neglected area of our bodies from a rehabilitative perspective. If you look at training every other part of the body, so for example, we'll use low back pain. If someone comes into my office with low back pain, we have the discussion of strength. Do we need to improve strength somewhere? Do we need to create stability to your system do we need to stretch do we need to mobilize and then we create this program that involves getting this patient a more resilient body let's make you stronger when someone comes in with foot pain our education has not gone down that road it has been well here's the foot orthotic foot orthoses here is a shoe with more cushion so instead of taking this proactive approach with hey this foot has four layers of intrinsic muscles in it many joints where range of motion can be improved and stabilized we should be having that conversation at our feet, not let me see what I can do so we brace that movement or inhibit that movement. And that's where I think we really have an opportunity here. Yeah, it's kind of interesting, isn't it? As you said, that's a really great comparison with back pain. What I'm interested in as well as that is the foot is how we as humans move around in the world. It doesn't make sense to me on an evolutionary or through an evolutionary lens that a third of us would have foot pain. Do you know what I mean? It's like, well, how could that have, how could our ancestors have survived or it would have been harder for them to survive if they had significant degrees of foot pain, which then meant they wouldn't go out and hunt or dig for tubers or whatever, whatever it is they were doing what do you think is going on like is it just our modern lives that are causing these foot pain evolutionary mismatch so we have evolved our foot has evolved to handle loads when we're walking our foot takes two to three times our body weight yeah it does not need arch support it does not need anything when it is functioning as it was designed because it is very strong and is very capable of handling these loads. So what happened? Why do so many people suffer from foot pain? And why do we see all these diagnoses? And I think a lot of that has been, a lot of that we can see with the development of footwear. And footwear was designed for protection. That was the extent of it. And then as you see with history, what started to happen was fashion kind of started trumping function and instead of footwear respecting the anatomy of the foot it did quite the opposite yeah and that's a problem and then you take footwear that doesn't allow the foot to function you take um not being able or being aware that this part of our body can be strengthened and mobilized and you kind of marry those two and we have an even bigger problem yeah what i was thinking about when you were just talking there courtney is i get this right because i had a problem and i've been wearing barefoot shoes i've been wearing vivo barefoot shoes now for i think 12 plus years almost exclusively apart from one wedding that i went to maybe seven years ago and i wore these italian dress shoes that i got married in and i thought how the hell did I ever do this it was horrid I felt so disconnected from the ground I thought I felt like the front of my feet were almost squeezed yes I would have been wearing this that stuff for years and I didn't realize yeah right but I meet so many people around when I who listen to this podcast and they'll tell me all the things that they've changed from listening which is wonderful lots of people will tell me how they started wearing barefoot shoes and and they've told me, and my back pain's gone, and my knee pain's gone, and my hip pain's gone, wherever it might be. But there's a lot of people who I meet who listen to this podcast who still haven't changed their footwear, which I understand. But the point I'm trying to make is, why is it such a hard sell for people to change or think about changing their footwear? It's fashion. It's society. We have, for many, many decades, that's what we have been trained to think is beautiful and to think is, you know, this is what we should be wearing on our feet. And what you see is not what you get. The footwear that is, most of the footwear that is designed today does not respect the anatomy of the foot. You know, I've talked to several people that have been in the shoe industry, and it's really interesting to me that a lot of the shoe designers don't have knowledge of how the foot functions, which is wild to me. You would think that that would be on their resume. I have a very good understanding of the foot anatomy. Thus, I can create a shoe. And that's not the case. The other thing, when you also look at not only fashionable footwear, like dress footwear, but when you look at the industry of what's happening with trainers and running shoes, for example, shoe companies respond to what people need and what they want. so a lot of the things that I will hear in my clinic, it's hard for me to walk. It's hard for me to push off. My father just had this conversation with me. He said, you know, Courtney, I was walking around the mall, and it was really difficult. I feel like I couldn't push through my foot. He's going to be 80 this year. Now, instead of having the conversation of, hey, Dad, if you can't push through your foot, These are the exercises we're going to do. We're going to work on your calf strength. We're going to work on your foot strength so that you can start to regain your power when you walk. The shoe company says, hmm, well, he's having difficulty pushing through his foot. So let's just create a shoe that rockers him forward. So we make it easier for him. Correct. So now this shoe looks like a boat. So he puts this shoe on and he says, Courtney, this is great. I can now roll through my foot. Why would my father, who doesn't have this type of knowledge, think anything other than this must be a great idea? And where I challenge him is that if you don't use it, you're going to lose it. so the rocker shoe it does help in the short term is that fair to say his perception of this problem where he can't push off is initially getting better the problem is there's an unintended consequence which is his feet are going to get even weaker because they're not being used the shoe's doing the work and that shoe can be beneficial for someone who has, for example, a fusion of their big toe or some type of, you know, surgical intervention. But outside of that, your foot is very capable of being retrained. Your strength is very capable of improving. And those are the conversations we need to be having because I don't want my dad walking around not having the strength and power to be able to propel him forward. Courtney, make the case to someone who's listening to this who doesn't have any foot pain. You know, pain is a, it can be a very powerful motivator to do things, right? Yes. Because if you've got pain, you want to be out of pain. But if someone is listening to this and they're not in any pain and they've been wearing thick, cushioned shoes their entire life and let's say, I don't know, they're in their 40s and they're functional. Let's say it's a woman. They wear high heels when they go out. maybe they wear high heels for work, and they're not experiencing pain, how do you convince or inspire people who are not in foot pain to focus on their foot health? This is where I really get excited about this conversation, because I think this is where healthcare is going, and hopefully people are being more aware that we should be proactive instead of reactive with our health. And instead of waiting until there's a problem, because oftentimes by the time there's a problem and you are experiencing pain at the foot, this has been there, it's been building, there's been problems for a long period of time, and now movement is deterred. So I always like to have the conversation of being proactive with these things. I think the other beautiful thing about the foot is it's the only place in the human body where you can start to see aberrant loads or changes. So what I mean by that is if you were wanting to, I had knee pain. You have to take an x-ray or an MRI. Is there arthritis? Is there some type of tear? But at the foot, if you see a bunion, regardless if it's painful or not, if you see hammer toes, if your toes are more narrow, so the widest part of the foot should be the toes. Yep, everybody starts looking at me. I'm looking at my feet now. I think I'm okay, but you can tell me later. So if you see these things, we know that changes in the foot, bunions, hammer toes, increase our risks of falls. It changes the stability of the forefoot. It changes the strength of the foot. So that's what I encourage people to do. Take a look at your foot. Are there things that shouldn't be there? Can you do exercises like lifting your big toe, having toe dexterity? These are all things that can be very good indicators of good foot health, which will also have implications of the kinetic chain. There's a whole section in the second half of your book where you go through these exercises, these self-assessments that we can all do. And it's interesting. I've been paying attention to my foot health, I would say, for a good 12 years now. and this morning as I was finishing reading off the book there was an exercise I think it was calf raise single leg calf raises but in essence it was great because you put some songs in there which have a 60 beats per minute cadence and the one I chose because I loved the song was Landslide by Greenwood Max put it on put my stopwatch on and try to see how many I could do on the beat basically and I was you know as I said to you before I had just come back literally from four days skiing and it was you know difficult steep off peace terrain and my legs are crushed but still I thought I'd be okay but I think I only managed 24 in a minute and I was like that's less than the average that you would expect at my age I thought what the hell like I was really shocked to see that now yes Could fatigue from the last few days of playing a role? Maybe. But I think that's going to be so useful for people to just assess where they are. I love that chart. It's a research that looked at how many single leg calf raises one should be able to do per decade. Yeah. And it is one of the assessments I do with all of my patients. And I get very picky not only about can they do it, but can they do it on the beat? What does the height of the calf raise look like? Are they able to push through their big toe or they kind of look like they're going to sprain their ankle? There's a lot of information that you can get from watching someone do a calf raise. And unfortunately, the majority of my patients, when I pull out that chart, sit well below which they should be able to do. You say majority of patients, as well as Joe Public, you deal with a lot of elite athletes. Do you also see elite athletes fail or not do so well on these tasks? Oh, yes. This is what the elite athlete conversation, I think, is so fascinating to me. And as a good friend of mine, Jay Duteri, he always says this. We are building jet engines of bodies. So we're getting stronger. We're getting faster. We're lifting more weights. We're training power on paper airplanes of feet. Yeah. and that I think is so very important because our feet take on the loads of our body so we want to get faster we want to get stronger you have to pay attention to that strength below the knee and so when I have worked with players in the NFL and all over these professional sports I always look at these assessments and I'm sitting here going these are the elite the top of the top and they're using their bodies very well without using the third that's producing the most power and speed and agility so you're probably thinking you're doing this well yes and you're not looking after your feet if we could just do 20 minutes a day on your feet that's right you could unlock all kinds of potential yes and i guess we're in a generation now because one of my favorite bits in the book is when you talk about how footwear changed maybe 100 years ago. Was it Bill Hoffman? Yes, Dr. Hoffman, yes. Dr. Hoffman, yeah, and how he was sort of raising the flag back then. We've been warned. Hey, listen, this is going to cause a problem. But a lot of the top athletes now have grown up, of course, with, you know, poor footwear. Yeah. You know, overly cushioned, you know, maybe pronation support, heel lifts, all this kind of stuff. And what's also really interesting is that I've had the privilege of talking to Elliot Kipchoge twice on this show, the guy who's regarded as one of the fastest marathon runners of all time. And I know he wears the modern super shoe for running. But actually, when he was growing up and training, there's a lot of barefoot, it was minimal footwear. So probably at the formative years of his life, he probably was living a lifestyle that grew strong, functional, wide feet. Do you know what I mean? Yes. And I think when you look at his running gait, he is an elite, elite runner. It's a beautiful, beautiful running gait. And I think we need to pay attention to that. The shoe in that case is icing on the cake because he has these beautiful mechanics. When you take most runners and, you know, recreational runners who don't have his speed or there's his grace, if you will, that's an entirely different conversation when they're wearing a shoe like that. And I do think that when growing up and you have your foot on the ground and you're running and you barefoot, barefoot, you start to adopt a different running gait. And I think that's important to consider. Yeah, it's a bit like, away from sort of physical health and foot's health, we know for our emotional well-being later on in life, our early childhood years are really important. Yes. Right? What are the messages we get when we're young kids? You know, what are our attachment bonds like with our adult caregivers maybe your parents if you're you know or whoever is in your life we know that that can have implications when you're 30 40 50 and i'm kind of seeing a similar pattern with you know our feet and this kind of foundation upon which we interact with the ground i wonder if you know kipchoge was the example i just used now but perhaps if we as a society really focused on the first 15 years of life and said, right, for our children, we want to make sure that we teach them about good foot health. We put them in the right shoes, maybe not overly cushion them or whatever. Maybe they'll build such a strong foundation that I'm not saying they can get away with poor shoes later, but it probably insulates them somewhat later. Would you agree with that? I think that's our biggest opportunity is with the children. So what would you ideally do for a child in Sizzle Footwear. Today's episode is sponsored by Vivo Barefoot. Now one of the simplest ways to improve your whole body health is to start with your feet. Most of us don't realize this but 95% of us are born with healthy feet and by adulthood 77% of us have foot problems and a big reason is the shoes we wear. Modern shoes are rigid, narrow and over-cushioned, they disconnect us from the ground and weaken the very muscles that support our posture, balance and movement. That's why I've been wearing Vivo Barefoot shoes for well over a decade now. They're the opposite of conventional shoes. Vivos are designed for fit, flex and feel, to let your feet do what human feet have evolved to do. When you free your feet, you free your whole body. And studies have shown that wearing minimalist footwear like Vivo's can increase foot strength by up to 60% in just six months, improving balance, natural posture and the way in which you move. If you've never tried barefoot footwear before, Vivo make it really easy to do so. They offer a 100-day money-backed trial so you can wear them, live in them, move naturally. And if they're not for you, you just send them back, no risk at all. So if you're curious to reconnect with your natural movement in 2026 and give your feet the freedom they're designed for, Try Vivo Barefoot and get 15% off your first order by heading to vivobarefoot.com forward slash livemore. Free your feet and the rest will follow. Today's episode is sponsored by Peloton. Now we all know that moving our bodies more is good for us. But despite that knowledge, many of us find it hard to actually implement. and that's where the new Peloton Cross Training Bike Plus powered by Peloton IQ can really help. It's built for fitness breakthroughs with real-time insights and endless ways to move and you can go from cycling on the Bike Plus to strength training off it with one smooth spin of the swivel screen which offers endless ways to train for a well-rounded routine. While you lift, Peloton IQ counts reps, corrects your form and suggests new weights so you're always making progress towards your goals And Peloton's movement tracking camera provides real-time feedback so that you can train safer, lift smarter and make every move count more With over 15 types of workouts, expert instructors to keep you motivated and a personalized plan tailored to your goals The Cross Training Bike Plus takes the guesswork out of working out So that you can move freely and let Peloton handle the rest Let yourself ride, lift, stretch, move and go explore the new Peloton Cross Training Bike Plus at onepeloton.co.uk that's O-N-E-P-E-L-O-T-O-N.co.uk and please note Peloton All Access membership is required to access all Peloton content and applicable features on your Peloton hardware. If you think of the foot as a sensory organ, if you will, because there are thousands and thousands of receptors on the bottoms of our feet. The same amount of real estate is the hands and the lips in the brain. So these are sensory powerhouses, if you will, that are gathering information from our environment and telling us how to improve, how to improve our motor outputs, how to move. So with kids, their little nervous systems are developing. So when their foot is on the ground and they're gathering all of the sensory information, whether they're walking on grass or sand or all different types of materials, their brains are developing. Their foot is developing. And so when we interfere with that, if you watch a baby crawl that has a very stiff shoe on, for example, their foot's range of motion is restricted. If I had a very rigid shoe on and I'm crawling, I can't go into plantar flexion, you see? It's so obvious. For people listening, Courtney's got up at the moment a model of the human foot. And you just see how much complexity is there and how much potential movement is there. You think, yeah, of course, if a baby is crawling with a stiff shoe on, it's going to lock down a lot of those joints so there will be a compensation. Yes. And if you look at any baby on the planet, the first thing they do is take their shoes off. They take their shoes off. They take their socks off. They want their foot to gather information. And I think that's so important as that foot is developing six, seven, eight, nine years old. The foot needs to feel. So for a parent listening to this, right, because we need to and we will address at some point for people who have maybe got foot problems or have been in inappropriate footwear for a number of years, you know, of course, they're going to be listening going, well, you know, is it too late? Can I do something about it? And of course, it's not too late. And there's many things you can do to retrain your feet. But let start with this blank canvas If there are some new parents listening I want to say new parents parents of maybe babies or young kids what are some common things that you would recommend that they do or don do with their children to protect the health of their feet We get a lot of calls into the office about flat feet. And so parents are very concerned with their child's flat feet. That is common in young children. They have flat feet. Their bodies are still developing. And that can be associated with knock knees or the knees are coming together. And so they'll say to me, do we need some type of foot orthosis or does my child need a brace? They need sensory stimulation. So we will let children go barefoot as long as they can so they can gather information to improve motor outputs. And the shoes that we do put on our children's feet should respect the anatomy of the foot, meaning a thin and flexible sole so the baby's foot can move, so the toes can extend, so the ankle can dorsiflex or bend, the wide toe box so the toes can splay. It's really interesting when you see even young children's feet who have been in restrictive footwear, you will start to see that change I was talking about, the formation of little bumps on the inside of the foot. That should not be there. Because what's interesting when I hear this, Courtney, is problems in the foot go up the entire chain in the body. Yes. Right. So how many cases of injuries later on in life, even as teenagers, you know, back pain, hip pain, knee pain, neck stuff. How many are actually downstream consequences of that that our feet don't move properly? So you lock something up there because of the footwear you wear and then it just goes up the chain. Yes. My patients, when I see them, I always say, I wish it was just a foot problem because it would make things easier. But it never is. It is never just a foot problem. What do you mean? You mean if it's something further up? Yes. Neck pain, low back pain, hip pain. I'm always assessing their entire bodies. There's a person behind this diagnosis of heel pain. so you can't just look at the heel because there's so many other factors that are driving how that foot is hitting the ground so there is certainly is a correlation between what that foot is doing and how those loads and ground reaction forces are going up the rest of the body yeah so like i'm no builder right as this will make very clear but let's say you're building a house and we're talking about the foundation the feet are the foundation of the inside body right like building a house on sand. Yeah, or you're building a house, let's say it's uneven at the bottom, and therefore, let's say it's a two-story house, you're like in the bedroom going, hey, the ceiling is, it's not flat, right? We need to do something, we need to get someone to fix the ceiling. It's like, yeah, but of course the ceiling isn't flat, because your foundations aren't right, right? So it's like, why don't we fix the foundations first, and maybe this will naturally correct itself. Yes, or you're going to have to keep fixing the ceiling. Yeah, exactly. And you're not going to ever get the result you're looking for. So in practical terms, I think what you're saying for a child is, in the house, keep them barefoot as much as you can. Does that mean without socks as well? Anytime there's an interference between the sole of the foot and the ground, you change the sensitivity of the receptors or the amount of pressure that simulates these receptors. Sock obviously is going to be better than, say, a very thick sole. but when the foot can feel barefoot, that would be ideal. Okay. So keep them barefoot as much as the ground. Obviously, if it's super cold, you might want to put some socks on, but if so, as thin as possible, I guess you would say. What about when that child is going to leave the house? What are the key things? I know you've sort of touched on this, but I just want to make sure the point has landed. Should they be wearing shoes, and if so, what shoes? Yeah, I think it's, you know, there's so many kind of layers there. I think the environment is important. In certain parts of the world where children are used to being barefoot more often, the transition into minimal footwear or barefoot footwear tends to be easier. But in other cultures where, you know, shoes are still worn inside or, you know, they're not used to barefoot, there's a different conversation there. When we look at footwear for children overall, thin and flexible sole. So again, you want the sole to be able to move like the foot moves. And just for people who feel that they're not necessarily trained, because of course sometimes the sole staff will tell them something different to what you're saying, Courtney. But is it as simple as them just feeling the sole? Roll it up in a ball. Roll it up in a ball, because that's what the vivos I wear. Yep. You can just roll it up. Roll it up. Squinch it right up. Twist it. Which basically means that your feet can do what your feet want to do without the sole negatively influencing it. Yes. Okay, so thin and flexible sole. Wide toe box. That's kind of my non-negotiable. The wide toe box is really my number one because when you start to taper the toes, you change what the foot was designed to look like. so you know I know this is obvious to you and to a degree to me but you just think about whether it's guys or women like women with high heels and these really narrow soles men's dress shoes with these pointed soles I mean we're quite literally deforming our feet that's exactly what we're doing that's exactly what we're doing I say that I almost have to catch myself because that can be seen as quite an inflammatory comment to people, but that's what we're doing. We're wrecking our feet by trying to shove it into these things. It's like, what other body part would you do that with? You wouldn't. And be okay with it. Yes. Marketing's powerful. It is. And it really, I love when I hear my patients say, well, that really makes sense, and you've given me hope. Like, this is not a hard conversation. If you really think about this, Yeah. This is not, wow, that sounds odd. It makes sense. It makes sense. And that wide toe box is very important for not only the development of a child's foot, but also an adult foot. And then the heel, the other factor with the footwear is having the heel and the toes sit on the same plane. So you don't want the heel above the toes. Correct. When you have the heel above the toes, you're changing how the foot is feeling the ground. So you're shortening the Achilles and the calf complex. You're putting more pressure through the ball of the foot. And now you're putting more pressure through the ball of the foot when it looks like a point. I mean, if you guys are watching, you know, if you're listening to this, maybe just have a quick look at the YouTube version of this video because just put that up again, Cody, because it's crazy. You've got this gorgeous, you know, who do you quote? You quote Leonardo da Vinci in your book, the human foot is a masterpiece of engineering and a work of art. Yes, it is. Right? It looks gorgeous there. Yes. And you're just scrunching it up and squeezing these beautiful joints, which is the high heel shape, right? Yes. And this is really, I think, is really fascinating. When people say to me the foot needs arch support, if my foot looks like a foot so for example when the toes are wide and splayed and strong and I go to push off when I'm walking this foot was designed to get stiff and to be strong to propel us forward now if I take this big toe and I squeeze it together when I go to push off I lose the integrity of the foot. So you're changing the dynamics and the forces going through the foot. To me, that is, it doesn't make any sense. Which is why, of course, when I was in, you know, wedding season with my mates, as it were, it's not uncommon for, you know, my wife or her mates or my mates at the end of the night to say, you know, want to take those high heels off. Oh, yeah. As soon as possible after the wedding. Yes. Yeah. Okay. So two big non-negotiables for you. You say number one, and this goes beyond children. This is now adults as well. When we're choosing our footwear, you want a wide toe box and you don't want this drop. No, sorry. Was it a thin and flexible sole? So if I had to put these in order, and there's a reason for this. Yeah. The wide toe box, the sole, the heel and the toe sitting on the same plane, and then the thin and flexible sole. This is where I was going with adaptation. Okay. The thin and flexible sole component is difficult for people to get used to. If they have not been walking around barefoot, if they don't have a lot of experience with their foot on the ground, because thin and flexible can also be a little uncomfortable for someone who's not used to it. Okay, so I like this. So you're saying there's a way to progress. Yes, and that's very important. Because a lot of my patients live in cities, for example, and they've been walking around in poor footwear. For decades. For decades. And so if I said to them, if we have this conversation, and it will make sense to them, so they'll want to go all in. They'll say, give me a minimal shoe. And I said, well, hold on. Yes, I want you in a wide toe box. But you've been walking around in a trainer that has a 10 millimeter drop. That's a high heel in my world. So to drop you down to zero and put you in something thin and flexible, that'd be like me telling someone to squat 100 pounds this week and 200 pounds next week. It's too much load. Which is, of course, where some of the critique comes. Yes. At, you know, any of those come as barefoot shoes or minimal shoes, whatever you want to call them, because we're looking at people who've spent decades in poor footwear suddenly they try and go and run a half marathon yes in a barefoot shoe and go oh you know i got injured yes barefoot shoes are a load of rubbish it's like well wait a minute wait a minute you need to transition perhaps okay according just to make sure this is landing with everyone right so So, in my head, there's almost, well, two or three categories of people we need to be thinking about, okay? One is children. So, assuming your child is born and there's no issues, what we're trying to do is not create issues for them in the future. So, as much as possible, do the things that we mentioned so far. Yes. And I think also for parents, it's also understanding that your child might play football. They might be on ice skates. It's okay. Yeah, exactly. It's okay. They're going to be in certain footwear at times because that's what the task requires. It's when they're out of that footwear, that's when we want to make sure that they're in minimal footwear, functional footwear. But yeah, that's really reassuring, okay, for people. So yeah, wear the football boot with studs when you're playing football. Yes. No problem. But just don't wear them all the time. That's right. Which, of course, they wouldn't do with that. But I think what you do see a lot these days is you see a lot of these premium running brands, which are, I won't necessarily mention the name of one of them, but they're very, very thick, cushioned running shoes. and you could just about well, I'd love your perspective on what you think about these in a verse commas running shoes but I think one of the problems is that people are not just wearing them for running, they're wearing these floaty, heavily cushioned shoes for work for walking around the airport, for going to the supermarket, it's like well maybe that's the case for wearing it when you run, although you may have a different perspective on that, but don't spend the rest of your life in it as well Yes. There's a different tool for the task at hand. You know, your running shoe, your trainer is not your strength training shoe. Yeah. If we go, let's talk about strength training for a second. I'm in a gym and I'm carrying heavy things. Yeah. Your foot has to feel the ground. It has to be strong and stable. if I was going to deadlift for example or heavy squat I don't want to be squatting or deadlifting with a lot of weight in my hand standing on a pillow that would change the pressures going through my knee and through my hip it would basically your body's sitting there going wait a second I need to I need to feel something. Connie that's such a provocative analogy standing on a pillow everyone kind of gets that right you wouldn't do that in the gym you wouldn't stand on a pillow and try and do this stuff you'd want to feel the ground give you traction and you know get that feedback why is it okay then to run on pillows depends on what type of runner you are i guess um i want to say pillow i'm talking about these thick, cushioned soles where, frankly, you can't feel the ground? There's always a trade-off with footwear. So if we look at cushioned footwear, for example, when someone puts that on initially, they say, wow, this is comfortable. I have a lot of protection. You are getting protection. There's a lot of material between the sole of your foot and the ground. But here's the trade-off. You compromise sensory acuity. What does that mean? You compromise sensory information because there's an interference between all those beautiful receptors on the soles of the feet and what they are trying to feel when you put a lot of soul between your foot and the ground. So if my goal is I want to help someone's balance, my dad, I want to make sure he doesn't fall, Does it make a lot of sense for me to make that harder on him by putting a lot of material between what he's supposed to be feeling and the ground? So we need to think about those things. Is your goal to walk 10 miles on a trail? And does your foot not have the capacity or strength? Do you need more cushion in that scenario? Possibly. But keep this in mind. you will compromise what you're getting, what you're feeling from the ground. So you have to ask yourself that question. What are my goals? It's the cost of comfort, right? That's right. We can see the cost of comfort in other areas in life. If we drive everywhere, comfortable in our heated car with our favorite music playing, wonderful. But if we keep doing that and don't move our bodies, there comes a cost. We get that. If we use our phones for everything and, you know, get all our shopping delivered and our food delivered to us, very convenient. Yes. But there's a cost. Yes. And I love the way that that also applies to our footwear. A nice cushioned shoe, beautifully, you know, you bounce and go, oh, God, this is nice. But you're switching off your nerves, your proprioceptive kind of inputs to the body, your balance. So are you aware of the trade that you're making when you purchase your footwear? That is my goal, my mission in life, is to just get people to start thinking about the foot like we do everything else. All those examples you just gave, if we took those examples and applied them to the foot, we would all be asking ourselves that question. Yeah. Let's go back to these three groups of people I had in my mind. Children who have got healthy feet, let's try and not do stuff that messes their feet up. Correct. Then the second category of people for me was people, I guess, who were well. Maybe they don't have, you know, in a verse comes a problem like a bunion or plantar fasciitis or, you know, foot pain or whatever it is. But they realize that, you know what, I'm not wearing the best footwear for me. And as I get older, I better start paying attention to my feet. and then I guess the third category is people who do have established problems from the modern world, maybe from inappropriate footwear so I want to make sure I keep those three groups of people in mind throughout this conversation you've mentioned how to choose footwear for children if you're in that second category I can imagine many people listen to this podcast they're pretty well, they're trying to look after themselves, they're interested in their health and they're realizing, I've not really thought about my foot health, but I don't want to have a fall when I'm older. I don't want to have other problems. So let me start paying attention. And let's say they're used to wearing modern, cushioned, supported footwear. Help that person understand what to do. And I think what might be useful is this distinction you make in the book of minimal footwear versus functional footwear. And if someone, it's been really interesting to see my practice change too, because years ago it was, people would come in with foot pain and say, hey, can you help me with my foot pain? But now I think because this education is becoming more widespread, I'm seeing people in the second category. They're like, I know I haven't been wearing the right footwear. I don't necessarily have problems in my feet, but this makes sense to me. So what do I do? so we will run them through the assessments of their foot how does it move do they have dexterity do they have good strength and then based on that we will talk to them about footwear if i put them into a minimal shoe which those requirements again are wide toe box zero drop so heel and toast on the same plane and thin and flexible sole so those are the three criteria for a minimal shoe yes and could you just top of your head mention some brands which qualify as minimal shoe vivo barefoot yeah bilenka yeah zero these are minimal correct okay we will have the conversation of duration so i always say you have to earn your right to wear minimal footwear. Okay. Because there are more loads going through all of your tissues, your bone, your tendons, your ligaments, your muscles. This is a good thing. Yeah. This is when we get stronger. But again, taking everything we know about the human body and how we would train the human body, we have to apply that to the foot. So it is slow. You're going to wear this shoe for five to ten minutes a day. you're going to see how you feel that night. You're going to see how you feel the next morning. If things are good, you slowly add time. But if you wake up the next morning and you're like, hmm, my heel's a little sore. You wait. You wait. But it was not the shoe's fault. That was one of the, you know, with the pandemic, I saw all these articles come out. You know, people don't walk around barefoot at home because you're going to damage your foot. and I'm going, we have the message wrong. It's not. It's not wrong. That's the most ridiculous statement. I mean, if you just look at our history as humans, we have walked around barefoot for the vast majority of it. It is ridiculous to think that walking around barefoot at home for most of us is damaging our feet. It's kind of messed up. It is. I don't get it. I think the biggest argument that people will say is, well, we weren't designed to walk on man-made surfaces. Okay. And what do you say to that? Okay. So if that is the argument, you can still put your foot into its functional position here. Enter functional footwear. Okay. So minimal footwear is maybe what, is that the ultimate goal, would you say, for people? But is functional footwear a bridge? Yes. Okay. I think more people will live in the functional footwear kind of area. Ideally, as their foot strengthens and they can transition, you can move into a shoe that is going to require more out of you. But the functional footwear is where I take everybody. Is that like a transition? Yes. It's wide toe box. But that's the same as minimal, isn't it? Yes. Okay, so you've still got wide toe box. That's my non-negotiable. Okay, so that's in both minimal and functional. you have a wide toe box. That's right. So, okay, put another way, don't buy a shoe that's going to deform the front of your foot. Yes. Okay. Yes. I mean, that should... It's kind of basic. When you say it like that, it's like why on earth would you compress the front of your feet? Correct. Okay, so wide toe box. Yes. Then what's next in this functional footwork? When we talk about the heel to toe drop, functional is low to zero drop. So six millimeters or below, and that's what the research is saying. We've done the studies, and low to zero drop is six millimeters to zero. Okay, so minimal footwear is zero drop, where the heel and the toe are on the same level. And you're saying when you're transitioning, perhaps go to a functional shoe where there is a drop, but it's just not very much. Correct. Okay. Especially if someone has had plantar fasciopathy or heel pain or they have a history of Achilles tendinopathies where they have some type of issue where we know we have to work on strength and mobility. You don't want to take them down too quickly. So it's, hey, let's try this. Let's try this zone. And then the functional footwear is where you can play with variations of stack height. So that's how much cushion is under the sole of the foot. So in functional footwear, you still will have some cushioning, maybe just not as much as you're used to. Yes. So a lot of the footwear, there's companies now where you'll see stack heights of 55 millimeters. I mean, this is gigantic. That is a significant cushion under your foot. So these brands that are aware of the anatomy of the foot, so respecting the toe box, dropping the heel a little bit, but still giving people some of that cushion that they often seek because their foot hasn't felt the ground in decades, that's a nice lane to sit in as they start to transition. What are some of the brands that sit in the more functional footwear category as opposed to the minimalist? Today's episode is sponsored by The Way. 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To take advantage, all you have to do is go to thewayapp.com forward slash live more to get started and begin your journey towards peace, calm and purpose. what are some of the brands that sit in the more functional footwear category as opposed to minimalist there's not many ultra running is that altra altra yeah topo athletic yeah notice there's a newer brand but there that's what i think happened here when this conversation of minimal footwear is not new all right in 2007 the Vibram five fingers we were having these conversations um and people got real excited about it and they went from zero they went from over here into minimal and people were saying well I have you know my foot isn't ready for this and they were saying my calf hurts or my foot hurts and again not the shoes felt the fact that we didn't build capacity but this lane of functional footwear didn't really exist so people either said you're going to be in this real aggressive shoe or you have minimal got it and so that's where i think this education and these brands are saying hey people do need this might be a lane for some people to start in could we make the case courtney would you agree with this let's say we turned the clock back 150 years or even 200 years we wouldn't need any of this stuff because our feet would just be stronger yes but because we've been in inappropriate footwear as a society for so long now for some of us if we want to do the work of restoring our foot health we need to gradually transition i mean some people can clearly go to minimal footwear straight away if they're careful they have no problems but for some people you're saying you might be better off going to this halfway house first and you know we're talking decades decades of people's feet um getting weak this doesn't happen overnight so that second category that you mentioned with people that don't have any symptoms or pain i have plenty of patients they can walk around in cities and minimal footwear with no problem but that third category and i sit in that third category because because that's how I got into all of this. I have bunions. I've had neuromas. I've had all the things because my foot structure has changed due to me not paying attention. Can you tell us a little bit about your story? Sure. One of the things I found really interesting in the book is that you seem to understand the benefits of walking for you quite early on. And from what I remember, you used to walk regularly because you knew it helped you until you started to get problems in your 20s, I think. Yes. Movement has always been my therapy. I didn't realize it at the time when I was growing up, but it was my, you know, through some pretty dark times, I didn't quite know what I was doing, why it was so beneficial for me, but any time that something was going on, I'd just walk, and I'd keep walking until I felt better. and I grew up as a ballet dancer in pointe shoes and then I transitioned into the triathlon world and my feet were just perpetually shoved into footwear that was restricting its motion and I developed bunions and neuromas I've had stress fractures I pretty much had all the diagnoses that my patients come to see me with and which is of course why you do what you do to Yes. Right. And walking became very difficult. And that was very hard for me because I didn't have any other coping strategies at the time. I was young. I'm like, I can't walk. And you start to see this cycle of what happens and you see how depression and anxiety can set in very quickly when you can't move your body. and so as a personal quest I just became I was like I have to I have to get a hold of this and so that's what started all of this so to get back to that footwear conversation I because I have structural change in my foot now albeit it is much better there are no symptoms there 80 of the time i'm in minimal footwear but i know i have that bunion if i'm going to be standing on concrete if i go to a concert and i'm not walking per se i'm just standing still i know i still want my foot in that wide toe box non-negotiable i'm okay with my heel being in toe being in the same plane. But if I'm standing in one place, I want a little stack height. And that's where I live in the functional category. So I have this huge spectrum. And I think that's important for people. We are not saying 100% of the time, you need to be doing this. We're not going to, you know, that's not how we should be educating. It's live along the spectrum. Dance over here for a little bit. This is where you're going to get stronger. But it's okay. You can live here. Keep your foot in its functional position. But where you can't live is in footwear 100% of the time that is restricting your function and interfering with your sensory acuity that's going to affect your longevity. Could we take that principle, let's say, for a woman? If a woman, let's say, lived 90% of their lives in good footwear, but on a Saturday night to go out, they wore high heels because they like to, right? They like the way they're looking at it. You know, I'm not sort of criticizing that at all. I'm saying a good, strong, functional foot, I'm guessing, can tolerate being in different kinds of footwear now and again. If the vast majority of the time you're in the correct footwear. Yes. I tell women, go for it. If you want to, if that's what makes you feel good, that's powerful. Yeah, exactly. Just when you get home, in the book, we have a high heel rehab. Yeah. You're going to wear high heels, do these things. You know, I used to still have my occasional high heels in my wardrobe, but about six years ago, I also was going to a wedding. And my fiance, I put on my heels and I sat there for a second and the look on my face, he looked at me, he goes, please take them off because you're going to complain all night long. And from that moment on, I have not worn a pair of heels because the second I put my foot in there, I'm just like, oh, no. So. What did you wear? I wear sandals. Is that hard? Like if you're going somewhere where you have to dress up, like do you find it difficult to go, yeah, but – because there is this sort of – I won't say an expectation, but there is a sort of thing you wear at certain events, right? Yes. You know, it's such a good question. First, when I first started doing this, there were maybe a handful of companies that made minimal footwear or appropriate footwear. Now there's many. So the options are much greater. But I think about this. When we get dressed, we want to feel confident. That's the goal. We want to feel confident and comfortable on our skin. For me, being able to walk with confidence and feel strong and feel stable, a lot of that comes from how I'm interacting with the ground. Yeah. So I feel like I'm walking more confidently and I look more confidently when I have my foot on the ground. Yeah. Could someone make the case that if you have well-functioning feet, let's say you have the time, knowledge and discipline to spend 30 minutes on your feet each day. I expect very few people listen to this, have done that or will do that. But let's just do a thought experiment for a minute. if all the tests that you write about in the book you know the lean to wall test the credit card toe strength single leg calf raise single leg balance test right let's say you worked on all these things and your feet your toes your calf muscles were functional and strong if that was the case could you argue that you can you can kind of wear whatever footwear you want because it's really your feet function that determine the vast majority of the outcome And you know because I guess what I trying to get at you could for example someone could listen to this I go alright you know what I heard wrong and bang on about this for a number of years but you know I wasn't sure but Courtney's persuading me right I'm going to get into this and they may go to a functional shoe or a minimal shoe but if their feet are not working well it's not necessarily going to correct that by going into a different shoe, is it? They could still have issues with the way their feet interact with the ground unless they do some of the rehab work. Do you see what I'm saying? Yes. The priority is the foot itself. It's what you put into the shoe. Exactly. You have to pay attention to that. The shoe is icing on the cake, like I say to my patients. It's icing on the cake. Pay attention to what you're putting in the shoe. So Kipchoge with excellent foot function and strong feet from childhood, well, he'll probably be all right in anything. I was just going to actually use that example because in my runners, if they want to run on race day in their super shoes where they get their running economy, fine. I'm not going to win all those battles. But when they're training and they're practicing and they're trying to become the most efficient runner and the strongest runner, you're not going to be training in your super shoes. I want your foot to get strong. I want your ankle to get strong. So, again, having this shoe spectrum, work in an environment that's a little more challenging so that when you go and put your foot into your super shoe, now you have this strong, resilient system. Maybe your running gate mechanics are better. So those are all the things that I like to think about. It's you can't cheat the system forever without thinking that there will not be a consequence. What about these cultural ideas that we pick up? Right. So take me, for example. So, you know, you don't know much about my history, but I used to have really, really bad back pain in my 20s. had time off work couldn't lift my baby boy when he was born you know really affected my quality of life in a massive way now i've subsequently realized there were multiple contributing factors to my back play including emotional things about you know having to carry the weight of my father was very sick and you know i was the person in the family is but i guess the medical son who was kind of semi-in charge of all that care. But there was also a physical component, right? Because I think with chronic pain, you know, this stuff's multifactorial. It ain't just one thing. But on my journey to being completely pain-free, which I've been for many years now, there was this amazing guy, Gary Ward, who's a really good friend of mine. I found, do you know Gary? Yes. Yeah. I basically, I found this guy and he was like, I think he's going to be able to help me. And I went down and I studied, I took his anatomy and motion courses, I think it was the first doctor to do his courses and It's a great course. It's brilliant. And Gary said to me, this is back probably in 2011, 2012 he's like, your right foot is not working properly. Or, you know, he didn't exactly say that, but that's my colloquial way of trying to describe it and he gave me some foot exercise. I said, oh Gary, I've got a flat foot. He said, no, no, wrong. Listen, your foot is stuck in pronation. Pronation is not a problem, but we need to help it get out of pronation. That's right. He gave me a couple of exercises for my white foot. I remember doing them. I was walking up, I was like, where's my fat pain gone? It was the first time that I was like, wait a minute. How my white foot is functioning is contributing to my back. So that was kind of, it was really interesting for me and that in many ways started off my journey with, oh, my feet is really important. As I said to you when you came to my house this morning, I said to you 12 years I've been wearing Viva's, but I think it's longer because my first time I bought them was in, I think it was October 2012 when I made my first Viva Barefoot purchase. So what we're looking at maybe 13 and a half years now. People will say, yeah, okay for walking, maybe okay for running if you've trained, but for lateral movements, you need supportive footwear. Well, here's the thing. I took up paddle about six months ago with my son. Do you know paddle? Yes. So quite a lot of lateral movement. I wear my Vivos playing paddle. I have no problems at all. So we have these, and again, I'm used to wearing minimal shoes. I was going to say barefoot, but I like your definition of functional and minimal. So I would say minimal shoes. What's your take on that? Maybe I can manage it. Maybe some people who are not used to it will need some lateral support. But what's your take on that? Because the belief system is, yeah, but these modern sports, you need lateral support. What would you say? Again, going back to if we just think about the foot like we think about the rest of the body. If I was going to train my shoulder and strengthen my shoulder, would I only train it in flexion or extension? Wouldn't I want to train it in internal rotation and external rotation and abduction and adduction? so when we talk about the foot one of the foot's most incredible capabilities is it is its ability to invert and evert which is this motion so the foot going in and then it going out the foot moves in all these different planes of motion so rather than avoid these movements we train into them We don't say, hey, your foot's flat. We need to avoid pronation. We want to find pronation. We want to get you to control pronation. You've sprained your ankle. That doesn't mean go get a brace and never allow your ankle to go into inversion again. That's life. That's environment. You have to train the brain to see inversion again. So I'm a very big proponent of training the foot, especially into inversion and eversion or lateral motions. I think that's very important. So are you saying that obviously I've chosen to, so I think it's the vivo barefoot motus that I use when I play paddle. But could we argue that, well, listen, when I'm doing my foot work, away from the paddle courts, I'm training all these movements. But if I wanted to play in a traditional tennis shoe, or I don't know, I haven't seen paddle shoes, but I'm guessing they're similar to tennis shoes with lateral support, that's fine as well, isn't it? You know, there's so much research coming out that the, you know, shoes don't cause the injuries, and there's so many layers. Yeah. There's so many layers. You can't blame footwear for injuries. That would be, there's other factors. It could be sleep. It could be lack of strength. It could be you just want to give your body the best chance you can. And that means creating resiliency, which means training your foot like you would train the rest of your body. And then when you put it into a shoe where you say you're going to play tennis or you're going to do that, just play. Have a good time. Yeah. Put what you need to put on to go and have fun. That's right. Some people like playing in minimal footwear on a tennis court. Great. And some people don't. And some people don't. Also great. Yeah. But just pay attention to your foot. Make sure your foot is strong and mobile. Yeah. I remember this as a kid. I used to go to India every other summer for six weeks to see my grandparents and my family. And I remember at my maternal grandparents' house, they used to live in a block of flats on the second floor. and because it's hot in the day every day at about 4 p.m there was like three or four um sort of blocks of flats around there all the kids would kind of congregate downstairs at about 4 p.m and do all sorts of stuff and yeah i'm on holiday playing with my cousins and my young cousins say we're gonna play football so i'd go down with my shoes on and they're all playing football like full-on barefoot so obviously i take my shoes off and it's a little sore for me because i'm not used to it but then by the end of the summer you're like yeah there's no problem you see them properly tackling sliding whatever completely barefoot and we would think in the west we think you can't play football like that and i'm not at all suggesting anyone does that but it does show you how resilient and adaptable our feet are when we start to use them right that's right give them what they need Okay, so if it's the foot function, that's the most important thing. That is the most important thing. Which is what Gary would definitely say. Yes. I think Gary's viewpoint would be if your feet function well, you can probably get away with anything. But I think a lot of us, in fact, how... Think about it like stacking behaviors. Yeah. If you don't pay attention to your feet and you don't strength train your foot and you don't mobilize your foot and you're wearing foot orthoses forever and you're wearing restrictive footwear, you're putting a lot of things not in your favor. Yeah. You see, it's this stacking concept. So we have to do something. Some people choose to just wear minimal footwear. There's studies saying if you just wore minimal footwear, you will improve the strength of your foot. Yeah, 62% increase in just four months. and that study I think University of Liverpool was remarkable because it's like if you're someone who goes to the gym right if someone could tell you you could get a 62% increase in your biceps or your quads everybody's in yeah but the crazy thing is that you're not actually doing anything you're just wearing minimal shoes so your feet are naturally getting a workout you know it's crazy It's like it's kind of free money sitting there for some people. You know, I was doing the research for this book. I was looking at so many studies and a lot of them were delineated in what happens when you wear this type of footwear versus what happens when you do these exercises. And I would love to see more research where those conversations are combined. Yeah. The and conversation. What happens when you wear functional or minimal footwear and you exercise your foot? I think that would be – but for those who are saying, hey, I would just prefer to wear minimal footwear, you will get benefit. There's others say, hey, I'm going to work on strengthening and mobilizing my feet. Great. Do something. Okay. on that topic then of doing something there are so many tools in this book for people to think about doing right but let's start to stratify it let's say someone's listening to this Courtney and they're like yeah I'm not sure about changing my footwear but I'm interested in improving the health of my feet. What are your sort of top daily, you know, three, four times a week? Like, what are some of these top drill stroke exercises you would recommend people start doing? I think the first thing is, do you have good foot awareness? Most of the time, people have not paid attention to how their foot feels. And so that's where we'll start. So we'll have people keep their four toes down and can you just lift your big toe okay hold on so if I keep the four toes down and just lift that big toe now I know because I've done this before with Helen that um it's different on my left and right yes so on my left foot for example I can keep my toes down a lift at my toe on my right one my second toe starts to come up yeah okay what what I know you haven't examined my feet but is that common and if so why does that sort of happen it is common and what's i think very interesting is a lot of the times when i see that the foot that has poor dexterity or poor awareness will often be the side where you'll start to see symptoms that's true with me for sure so pay attention to that also when you're lifting the big toe i also look at how you're lifting the big toe. When you lift the big toe, does it deviate away from the middle of your body? So think of a bunion. If I was going to lift my big toe, my toe should go straight in the air. If you lift your big toe and it goes towards your second toe, muscle, muscle weakness, because there's a muscle that straightens the big toe. Can we just pause there on bunions a minute? Because bunions are so common. And as you said, you experienced them, I think, in your 20s. I have a couple of questions around bunions, which I guess relate to this exercise. Number one is, are bunions a modern problem? Okay, so do we get them in traditional societies, to the best of your knowledge? And then if so, once you have a bunion, is there anything you can do about it? um yes so let's let's attack the first one the first one um one of the studies that i found so interesting in regards to hallux valgus or bunions when i was researching the book was there were scientists who looked at centuries and they said in the 12th and 13th century versus the 14th and 15th century. And they dug up the skeletal remains, and they noticed that in the feet of the men in the 14th and 15th centuries, there was more of a prevalence of Hallux valgus. And what is Hallux valgus? Bunyan. Yeah. There was also happened to be more fractures in that population as well. Now, we can't make the correlation that a bunion is directly a cause of fracture, but I thought that was interesting. So when you look at those two areas, what changed in the 14th and 15th centuries? Why, when they looked at these skeletal remains, was there an increased prevalence of Hallux valgus in that century versus 12th and 13th? The Medieval Times. and it was the introduction of the Krakow and the Poulain boot, you know, the very pointy medieval boot. Right. That was worn mostly by men because we think of bunions today. For women. For women. That is so interesting. It is. I've never heard that before. I would argue, is it really a female problem? Now it could be because the female footwear is very different. These are all just things to think about. Well, there was a very powerful story in the book about, was it a female air hostess who came to see you? And, you know, she's just required as her job, you know, they have to have a minimum heel height as parts of her job. Yes, it's so upsetting to me. Yeah. I've written so many letters to airlines. Have they ever written back to you? No, not yet. Not yet. Well, but your book, the podcast you appear on, the more, all it takes, I realized, all it takes is for someone in a position of power at one of these companies to have experienced the problems themselves. So ultimately, that's what changes things, right? As humans, when it affects you, suddenly you're motivated to do something about it. If you were the female CEO of Pitca International Airline Company, and you experienced this and ended up at your clinic, you might go, hey, this is crazy. We're going to change our policy. But until that happens, it gets tricky, doesn't it? Yeah. She said to me, she goes, you know, I wish we took care of our feet as much as we're supposed to take care of our passengers. I said, that's very fair. But just on that, if there is an air hostess listening to this, Courtney, who, for her job, has to wear heels, you're still, I guess, going to argue that, well, not argue, you're going to perhaps make the case that when you're not at work, you need to be really paying attention. And maybe when you're walking, I don't know, maybe when you're on your break on a long flight, get the heel. Do you know what I mean? There are things that you would recommend they do to mitigate the downside. They have changed. There are several airlines now where they used to require that there's a small heel worn both in the airport and on the flight. Some of these airlines have changed. Now they only have to wear the heel on the flight so they can wear different footwear when they're walking through the airport. It's kind of interesting, isn't it? Yes, very. Because I guess what is the thinking? I guess the thinking is whenever you see one of our, I guess we're talking about women at the moment, female air hostess, they're going to have a certain look, right? The goal of any company of an airline, I would think, is customer service. You want your flight attendant to, you know, be interacting with your passengers and be happy and be, you know, confident and comfortable. if they're not comfortable and anybody who's had foot pain you're not walking around with a smile on your face yeah, you're going to be more reactive less forgiving when you get asked for something for the 500th time on the flight or whatever okay, so basically I think where we're up to at the moment is sort of saying traditional societies we don't think have bunions we think, well, I don't know if that's the case you're making, but certainly in the 14th 15th century, it looks as though... There's this increased prevalence. Because of footwear? Yeah. Okay. And then there always is the argument with bunions about, are they genetic? So, my mom had a bunion. My grandma had a bunion. So, that's why I have a bunion. And there are certain factors. We can say connective tissue laxity, hypermobility. There are factors that are inherited that would make a foot more likely to have a bunion. But this is always my argument with that. If you went to the doctor and they ask you for your family history, do you have a history of cancer? Do you have a history of heart disease? And you say, yes, my mother had heart disease. What do they tell you to do? change your lifestyle change your lifestyle so when someone says my mom has a bunion or my grandma has a bunion what i'm going to tell him to do change your lifestyle change your footwear start strengthening your foot it's not a just because now you have you are going to have bunions have the conversation of education what can you do empower the person to make that change for themselves. Yeah, a couple of things go through my mind there. First of all, number one, we're talking about earlier on in this conversation, how do you motivate people to start caring about their feet if they don't have a problem? And it could be if your mum or your grandma or your dad even had bunions, so maybe you have a genetic predisposition, right? It's not your destiny, it's just a predisposition. Correct. Maybe that's even more of a reason to go, wow, I saw how much pain or discover what my mum was in. I don't want that to be me. Let me get onto it. So number one, it could be a motivating factor. The other thing that has come up several times to me during this conversation is the similarity between the way you look at the feet and the way that, let's say, I might look at physical health. So let's take type 2 diabetes, right? We know that by the time you get a diagnosis of type 2 diabetes, the process and the physiological changes that led to it probably started five to ten years prior to that so you've got this long period of time where you're living your life your sugar hasn't quite gotten to the diabetic range yet but it doesn't mean things are good and you made that case earlier on with the feet right just because you're not in pain at the moment you know by the time they come and see you with their problem in their foot that didn't start the week before that has been building up because of your lifestyle and your footwear and how you treat your feet for maybe a decade right so there's this latent period where you could intervene there's also a similarity in terms of what you just said which is people will say sometimes oh you know doc yeah but my my dad had diabetes type 2 diabetes no of course i'm going to get it so Hold on a minute. Your dad may have had a genetic predisposition, but I can guarantee you if you eat in this way and you keep your weight here and you do this sort of exercise, whatever it might be, you're not going to get it. Yes. Do you know what I mean? It's an exciting time. Yes, it's an exciting conversation. It's one of empowerment. Yeah. And I think people get excited about that, that there's something that you can do. It's part of the journey, if you will. and that's why I love when people say oh you've given me hope because that is what it's about your whole book is a message of hope actually I think it deals with everyone I love the way with footwear you you take this very nuanced approach saying well it kind of depends depends where you currently are yeah right um you take this approach with walking which we haven't gone into in depth your build program which you know maybe we'll get to say maybe we'll have to leave it for part two but this idea that actually look sure our ancestors made them 15,000 plus steps a day but let's not make the aim for 15,000 or 10,000 put you off even if you can increase from 2,000 to 4,000 steps a day you're getting better fare so this message of hope I think comes through in all of your work which I'm sure comes from your own experience personally with yourself and with dealing with patients for so many years I think that's where it comes full circle with the foot strength, footwear conversation and walking. Because I think that's such a great question. How do you convince somebody to pay attention to this stuff when they don't have foot problems? And that's where I think the integration of the conversation of walking. because if you were to ask someone if something would deter you from walking in the future, what do you want to do when you age in your 80th decade? What do you want that to look like? There's not one person that would say, I don't want to walk. Yeah. They might, you know, it might vary as far as strength training or this or that, but every single one of my patients has always said, I want to be able to walk, whether that's with their spouse or their friends or their children. And that's where the foot is the biggest player in that conversation. Yeah. It's pretty, it still gives me chills. I like, it's such an important conversation. Yeah, it really is. And of course, it's your foot that interacts with the ground. It doesn't matter how strong your biceps are. When you're 80, like... Got to be able to walk. And you're going to want to walk. Okay. Going back to these practical exercises. So I sort of took you off on a bit of a tangent on bunions. it's okay so let's just finish on bunions for a minute then so we're basically saying we think they are a modern condition you I think got bunions in your 20s so a couple of questions then do you still have bunions and do you think that the work you're doing what are you hoping, are you hoping for a reversal of the bunion or are you hoping that actually even if it stays like this I'm going to still have functional pain-free feet as I age? I think that's a great question. When I look at my foot, what is the goal? I used to have a lot of pain that was affecting my walking and my movement. Yeah. If you were to say to me, what is more important for you? That aesthetically you get rid of the bunion or that you don't have pain and you can be more functional? That's a very easy question. less pain, more function. When you have early intervention with bunions, mild to moderate, we can see the change in the foot. The bunion might decrease. In my case, I was more on that moderate to severe end of that. So I still have my bunion. If anyone looks at my foot, now it looks a lot different. Is it better than it was? It's better than it was. The biggest difference, I think, when you look at my foot now, versus 15 years ago, is 15 years ago, it looked like skin and bones. It looked like an atrophied foot. You could see the metatarsals. You could see just how thin the foot was. I still have the bunion, but my foot is beefier. It's bulkier, has more strength to it. And that, I think, is a very big difference. If you think about that, you know, the muscles in the feet are just like the muscles in your bicep, for example. If I did a thousand bicep curls, my bicep's going to get bigger. When I start to strengthen my foot, you will see changes in the foot. And so a combination of strength and paying attention in the right footwear, my bunion no longer bothers me. Do you wish you didn't have a bunion? I think it's part of the story. so do I you know that's kind of why I asked the question it's like because yeah I just I just I really wonder your perspective on that because I guess in many ways if you didn't have the bunion you probably wouldn't be sitting here in the studio today and it also all the other diagnoses the neuromas that I've had and it reminds me when a patient is sitting in front of me also that you know i've been there and i understand and i do know that it can be cause a lot of problems not only physically but mentally and emotionally so i there's a connection there that i'm grateful for so that i can empathize and understand to some people when they come and see you need a manipulation in their foot because some you know Maybe the joints are stuck or locked in certain places and the exercises are not enough. Or perhaps a manipulation can free up a joint, which makes it easier to do the exercise. Yes. Well, often, for example, the calcaneus, the heel. When we walk, there's a reason we are designed to graze that heel. Because think of a pole vault. It hits the ground. It initiates pronation. So it starts to evert or open, and that's our beginnings of shock absorption. So oftentimes patients will have the joints will be sticky, if you will. So we'll get in there and we'll mobilize the calcaneus. We'll get the foot to move. And then we say, just like you mentioned with Gary, go do these exercises. Drive it home. How much time do you think people could realistically spend on their feet per day? or what, let me phrase it another way. What is the, for the time pressured busy person who likes listening to health podcasts and every week has different things that they could be doing to improve their health and wellbeing. And then they hear, oh my God, now I need to look after my foot health as well as everything else, right? Yes. What is a reasonable minimum that they could spend a day on their feet and get benefits? Yes. I've heard this often. I'll tell my patients, start with 10 minutes a day. And we have designed things that you can literally do when you're sitting at your desk. So that toe yoga, for example, you can do it sitting at your desk. You can lift all of your toes and spread them and reach them forward. You can walk around barefoot for five minutes. All of these little things count. You know what's crazy to me? and I guess this is clearly it depends what your starting point is but as someone who literally lives their life barefoot certainly in my house it's crazy to think that yeah, spend five minutes barefoot that counts of course it does count yes, it's an entry I've had many patients when they get out of bed their foot goes into a slipper they will wear some type of sandal even in the shower so the foot never sees the ground why is that for grip? pain because once for example someone with heel pain if you were to google heel pain you will see a lot of cushion um don't you know don't let the foot feel the ground so for years you'll have people deloading their foot deloading taking load away tissues need load we know that we know tendons need load we know muscles need load so you can't deload something forever this is a problem isn't it's a vicious cycle right you want people spending more time barefoot at home at the same time if you spent decades not looking after your feet through no fault of your own right you may be in a situation now where like that patient where you get up you put something on you go in the shower you need something yes these are downstream consequences they're not the cause it's like let's go upstream and try and prevent that happening in the first place. And then on the other side of the spectrum, you'll have patients that have been walking barefoot, and we'll tell them, hey, when you're in the gym, grab a kettlebell that's half your body weight and do your calf raises. That's a lot of weight. Wow. The foot can handle it. The foot's strong, isn't it? Peter Malieris, I love his research, And there was a study that he did looking at Achilles tendinopathies and the strength that the foot can actually produce. And in this study, he mentions doing six single leg standing calf raises, holding half of your body weight. And if you were seated, one and a half times your body weight. Okay. that's a lot of weight and what happens if you do that that was a kind of a healthy runner can do that's how much force that we can do i.e. basically our feet are not fragile weak structures that's very very strong we're not utilizing that strength we're not loading them up enough in fact we're doing the opposite we're trying to protect them and stop them doing any work by putting them on pillows every day and these cushioned, overly cushioned shoes, whereby they don't have to work. Yes. The cost of comfort. Again, load the foot like we would load everywhere else. When we started talking about the beginning exercises, toe yoga, spreading the toes, things like that, then you can move into resisted exercises. Let's say you're doing banded work. then you move into more loads farmer's carries holding heavier weights so it's like progressive overload for any other part of the body exactly but you're also just now paying attention to your feet yes okay let me try and get back onto the practical thing I'm so fascinated by this topic you know I think we've got at least three podcasts well I'm here for it because this I'm so interested and I've experienced the benefits myself so I want to spread this with the world and say you know it's funny my wife when i started wearing vivos i don't think for i'm gonna guess three or four years she wouldn't wear them yeah she's like i don't like the way they look right but she has pretty much i think been exclusively in them now for maybe eight years yeah you know i think one i think once you get and again listen yes if you've a better sponsor this podcast but this is not about that this is about you know you mentioned many brands so far right with i just want people to start paying attention to their feet and if they're interested start experimenting with functional shoes whatever brand you want minimal shoes whatever i don't yeah yeah for me personally my journey has been with vivo so i've got that experience um and i'll tell you one thing on a star note i've always loved about galahad who's the founder of vivo is that he always used to say to me like I want to see the day where there are loads of barefoot companies barefoot shoe companies like he I love his mission I love exactly it's community it's about it's a bigger conversation yeah it's not about their company yeah he's like we're not the enemy like the enemy is big shoe right he wants to see thousands of barefoot and minimalist footwear companies because that then and it normalizes it. It becomes the new norm for people. And going back to the societal conditioning we were saying before, I know for a fact there are top world-famous athletes who will wear barefoot minimal shoes where they're not on camera because they know the benefits, but they have signed multi dollar deals with big brands so when they being shot And again I not criticizing or judging anyone I just saying marketing is mega powerful And a lot of these top end athletes, they know the benefits. When they're not being filmed, they wear this stuff. You're seeing a lot more of it. Because at the end of the day, also, that's their careers. Exactly. They want longevity in their careers. And so the more this information gets out there saying, hey, this does make sense. Yeah. they're going to do what's necessary. What they need to do. Yes. So in terms of practical exercises, okay, we were getting somewhere where, and I pushed herself into bunions, but you said you can look at your big toe and how much it's able to come up off the ground. Extent, yes. Okay. Let's say someone does that. What are they looking for? If they can lift their toe, can they lift it straight, and can they repeat it? and what if you know and I'm guessing you want symmetry in both feet ideally if one foot can do it better than the other what do they do about that? Practice. Okay, you just practice. Just practice. And a lot of the times it's very frustrating for people to not be able to lift their toe. You'll see their brains going they're lifting their hands or they're trying to rock back onto their heels. basically compensating in whatever way possible you know and it's eventually when they can start to do it it's very exciting you know that's a that's a big deal it's it's driving information to your brain okay so everyone listening to this right now is able to do that at home and assess can i do that and if not practice okay so that's one exercise that can do what's another one of your kind of favorites that people could start thinking about each day? I think one of the, because I'm such a fan of toe splay and toe strength, I will always look at, can someone lift all of their toes? So keep the ball of your foot on the floor. So the ball of the big toe, the ball of the little toe in the heel, lift up all of your toes. When you do that, you'll see the arch of the foot increase, keep the arch of the foot and try to spread your toes. You should be able to see daylight in between each and every one of your toes. Can you do that sitting down or has to be standing up? Sitting, standing. Do you want to have a quick look at mine now under the table? I would love to. Right? Okay. I'm always the girl at the parties that's on the floor looking at everybody's feet. Okay, so I would say we'll make this relatively quick, but okay, left foot. Yes. I've lifted it up, and now I'm spreading. I can see, well, maybe not between my fourth and fifth. Well, I'll let you do the assessment. That's my left foot. My right foot, I don't think this is good. Lift it, splay it. Yes. Okay, talk to me. Okay. Let's talk about the little guy who people think he's just there to get broken on furniture. True. The pinky toe, when you see the fourth and fifth toes, oftentimes they're curled under. Yeah. This is muscular imbalance. There is a muscle in the foot that extends the toes, and there's also one that curls the toes. So when we become flexor dominant, footwear, foot weakness, we can't extend the toes. So that exercise is very good to start to get that splay. For people who've had neuromas, where there's an inflammation in one of the nerves in the feet, the toes will actually start to split. If there's a sign where the second and third toes, for example, the toes will start to split because the body's making room for that neuroma. These are all little things to pay attention to. You have to be able to lift the toes and spread them and splay them. So these exercises, they're assessment exercises and they're therapeutic exercises. I love that. Yes. Can you do this? Yeah. And if you can't, practice. Yes. Interesting enough, had you been here five years ago, you would have seen very different feet. So as you said before, it takes decades of, I guess, abuse to these feet to get them a certain way. It's probably not going to reverse in six months. But it's well, well worth it on the other end. Yeah, exactly. I had a really cool experience since I've been here. I was at a workout class in London, and I'm sitting there having coffee, and someone said to me, Dr. Conley? And I turned around and I thought he was in the running class that I did the day before, but he wasn't. And he said, I just want to thank you. And I said, oh, this is an honor. And he said, I had patellar tendonitis for a very long time and I started doing your foot exercises that I saw on Instagram and YouTube. He's like, paying attention to my foot has significantly helped my knee pain. He's like, I no longer have knee pain. And I'm like, this is my heart. It was, those are the stories I live for because I hear them all the time, whether it's your foot or your knee or your hip or your back. Paying attention to this part of our bodies has such a massive implication on every way all the way up the chain. Yes. How beautiful is that? But they didn't even have to go and see you in your clinic. Yes. Of course, it's great if people can. Isn't it so wonderful that you can just pop a video out on Instagram or YouTube and someone 3,000 miles away from where you live consumed it, did the exercises, and suddenly their knees better? That's awesome. It was awesome. I mean, it was so great. Okay, so we've got toe going up. Yes. Big toe, sorry, going up. And I haven't mentioned yet, but I wrote this down because I thought it was, I've never heard it put like that before. in your book you say the big toe is possibly the most important joint in your body and you've got a bias of course but I thought that was great and you say it's more than just a joint it's a demonstration of how far we've come as humans in movement, resilience and evolution that is beautiful can you just sort of explain that for us if you look at how the big toe has evolved and how important it is in bipedal locomotion. It is the part of our bodies that stabilizes us as we move forward. It's the part of our bodies that we propel forward when we have good range of motion at that joint. So I'm going to get a little technical here. It's okay. The range of motion of the big toe, if you look at how much range we should have, studies 60, 65, 70, so in the higher range of motion there. 65 to 70 degrees off? Off the ground. Off the ground. So that would be extension. Yes. In a walking gait, we need about 40 to 45 degrees. Okay. To have efficiency. So walking is considered a mid-range range of motion activity, meaning our joints go to a certain range of motion, but we don't take them to its end range. Okay? If someone has a restriction in that big toe, so let's say they only have 20 degrees, you will not only see symptoms at the foot, but you will see symptoms at the knee, at the hip, and at the low back. And how common is it for people to have issues with that big toe? It's probably second to heel pain, probably one of the most common diagnoses I see. And of course, you're seeing people who are struggling, right? So you're not necessarily seeing the general public health in the population. It's slightly skewed because people are coming in with a problem. That's why this assessment is so important. That first one you mentioned where you keep the four toes down and you see how far you can lift the big toe up. If you do that and there's a pinching in the top of the joint, so let's say I go to lift my big toe. Yeah. And you're like, wow, it's kind of pinching at the top of the big toe. You need to pay attention to that because something is going on that's saying, I don't like extending. It's not to be ignored. That's the key thing, isn't it? It's not to be ignored. Because you do it, don't just switch off and go, oh, screw it, I'm not going to pay attention. It's like, no, no, you're storing, you're kicking the can down the road, as we'd say in this country. Yes, and here's the next layer to that. Oh, my big toe hurts when I extend it. You go buy a shoe. And then you buy a shoe that doesn't have a lot of flexibility in the toe box. And you put the shoe on and you say, great, my toe doesn't hurt at all. It's not pinching. Yeah. And so they say, oh, great, I'm just going to wear this shoe all the time. So then they come home, they take that shoe off, they walk barefoot. Oh, there's the pinching again. I better go grab my shoe and now wear it in the house. And now that joint is not even getting to the range of motion that it had. And then we start to lose more and more range. You see this cycle there? Yeah, if you don't use that, you lose it. It's funny, this weekend I was just with my sort of best mates from uni. One of my friends was talking about his mom. Yeah. Who, you know, she lives by herself. and we just said, yeah, we might have to move somewhere where there aren't stairs. And all I said to him is, you know, I said, I think about this a lot, like, stairs are difficult for some people as they get older, but what I've seen so many times is, of course you don't want anyone to fall and hurt themselves, but the problem is there's a cost to security, isn't there? You remove the stairs, and suddenly they're not using those muscles at all anymore like i remember when my mum used to go up and down the stairs it's like she's you know it would be slow it would take a while but i'm like this is good she's like using her quads not only going up going down magic you know having to really control the descent and i wasn't giving him advice you know you know i'm sure there'll be an ot an occupational therapist you know fantastic profession who'll be properly assessing what needs to be done but you know what i'm saying you don't want people to fall you have to get a little uncomfortable yeah you do and i have a story of that in the book where i had a patient who was told to sell her house and buy a ranch yeah and i hear that a lot and i would rather have the conversation especially with movement variability there's so many different ways we can move so rather than have the conversation of you can't do this, how can we get you to do that? I think the squat is a very good example. Yeah. You can't squat. Don't squat for whatever reason. Sitting on a toilet, sitting in a chair is a squat. So we have to train instead of saying don't do that. Yeah, so wouldn't it be nice? And again, I'm not saying, you know, there's amazing healthcare professionals out there who are probably doing this already. But just that mindset shift, just be very careful before you make your life, in inverted commas, more safe and easy. There is, as you said before, there's a consequence to everything. Yeah. You know, you choose a certain footwear, there's a consequence. Yes. Just be aware of that. That kind of relates to walking, doesn't it? I mean, I don't know what your take is on this, but to my understanding, or certainly to my knowledge, the complexity in walking for a human being to walk still hasn't been able to be replicated by a robot. To my understanding, I mean, maybe that's changed now, but it just speaks to what a phenomenal movement just walking is. It's very complex. It's very complex. We don't think about it because it's just something that we do, like breathing. Yeah. But it's a very complex movement. There's a lot happening between what we're visually seeing, what we're hearing, our vestibular inputs, what we're feeling. So we're gathering all this information and we're integrating it. And to see a walking gait, I think is, you know, I could study it forever. Yeah. Because there's a lot of information you can get. It's just a practical exercise. We can't cover all of the ones that are in the book. We mentioned a few things so far. There's a couple I just wanted to bring up. One I've already mentioned, that single leg calf raise. Yes. That you have in the book a table at different ages. What should you be able to do? And I think that's an exercise probably like the ones you've already mentioned. that can be an assessment tool and a training tool. So you do it. What are the cheats that people do without realizing it? Because I think I was doing one without realizing it. So you're on one leg. You're lightly touching the wall. Yes. Why is it important that you lightly touch the wall? It's not balanced. We're not looking at balance. We want to have a little bit of control. Okay. And how high should you come up? When you look at the height of the calf raise, You want to get to the ball of the foot. And when you look at the ball of the foot, it should be flat on the ground. Okay. So oftentimes when I see someone do a calf raise, when they get to the ball of their foot, it's almost like it looks like they're going to sprain their ankle. Okay. So that's telling me, hmm, have they ever sprained their ankle? Do they have poor eversion strength? Can they not get to their big toe? do they have a pinching at the big toe that's preventing them from getting to the ball of the foot you know it's funny Courtney you're saying that you saw some uh I mean I'm aware of these issues already then I'm working on them on my right foot yes but that's where I've always had my symptoms I used to sprain my ankle my right ankle I used to play competitive squash as a teenager and every you know with not you know with with alarm and regularity i was spaying my right ankle there's you know there's probably you know was it the foot problems that caused the sprains was it the sprain that has caused issues that i haven't properly rehabbed probably a bit of both who knows but but it's interesting isn't it yeah you can always whenever i'm assessing someone's gait you can you can tell the gait of someone with chronic sprains it's their foot has you know The ligaments heal. The proprioception, how they feel the ground, that is what also needs to be retrained. Yeah. And so that's important. Getting them to feel where their big toe is again. You can see that in a calf raise if they don't have that good control or strength. Yeah. So height is one. You'll see people try to bend their knees. You'll see them try to... You want a straight leg. Straight leg. Through the foot. we're not trying to gain momentum and lean into the wall and you've got some of these videos on your Instagram have you? and we'll shoot some after as well and put them on mine when the podcast comes out so people can see that so you can assess that if you're not where you want to be or even if you are you can work on that get better at it the one maybe that I wanted to finish off with is the single leg balance test and what I found really interesting is, well, in that section, you make the case that when you're walking, is it 40% of the cycle you're on one leg? Yes. So you have to be able to balance just to walk, right? But you were saying in that section, which I found fascinating, the feet contain four types of receptors to help you, I guess, feel the ground and feel where you are. And then you said this, and this got me, probably because I'm 48, right? you said however in the fifth decade of life i thought fifth decade of life okay i'm not 50 yet i think she's talking about me i think i'm in the fifth decade of life you need 20 percent more pressure to simulate those receptors yeah okay so talk to us about balance why it's so important for walking and what is the relevance of that stat that when you get into your 40s you need much more pressure to simulate those receptors again thinking about the foot like we think of the rest of the body we know when we age sarcopenia is a factor we lose muscle mass yeah so we also that also occurs at the foot so we have a foot that's starting to decrease strength when we turn 50 all of those sensory receptors on the bottoms of the feet those also start to dull if you will so it takes 20 25 percent more pressure to simulate those receptors when you say 50 it's the fifth decade your 40s or is that your 50 years old so 50 oh i'm good i'm good i've got a few more years left hey i'm rocking at the moment yes this is the conversation so we got to convince you that you need a bit attention to this now um so in the fifth decade when you turn 50 you start to lose sensitivity to these receptors. This is how quickly things escalate. When you turn 80, that number is 75%. So the feet, they kind of dull. They dull. Here's the good news. Guess what increases sensory nerve fiber branching in the foot? Movement and walking. There you go. Exercise. Increases circulation. increases nerve fiber branching, increases sensation. So here's the hope conversation. We are all going to age. But when you strengthen your foot and you can improve the sensations at your feet, you're going to be able to walk well, you're going to be able to walk long, and you're going to decrease your risks of falls. That, to me, sign me up for that. Yeah. have you had cases in your clinic of people with neuropathy already so maybe they've had high blood sugars maybe they've been diagnosed with TARBs maybe not or they've got peripheral neuropathy from some sort of illness where effectively the nerves aren't working as well as you would want them to have you had patients who've come in like that and the exercises you've recommended have helped improve things? There are so many treatments. Neuropathy is a difficult diagnosis, as you know. There are a lot of treatments that help, or so they say help, neuropathies. And they very well might. My patients that I have seen, they really struggle. But the one thing that has helped these people consistently is exercising their foot, increasing circulation to their foot. And then they can add all the other things, the red light and their supplements and everything else that they're doing. But if you don't have that component of exercise in conjunction with, I think you're missing a very big factor there. Goes right to the start of this conversation. Walking is a physiological necessity that your body requires for survival. And arguably, it becomes more important as you get older. Yes. When you look at as we age, too, there is a dramatic decrease in the step counts that you will start to see as people age. And that's what I want to encourage people to do. You don't have to get to that 10,000 marker. Even at 3,800 steps, 7,000 steps, you start to see these reduced risks of dementia and depression and cancer. It's like this sweet spot. And we don't want to lose that capacity. Yeah, the stuff that maybe we won't get time to talk about today. but I found fascinating in the book this idea that, you know, it's not just walking. It's, you know, you have all these kind of things like roll the earth away, walk faster. When we walk taller, it lowers cortisol, improves memory. There was a thing about walking softly. And I stopped and laughed when you said that we've all got that family member that you can hear coming a mile away. A mile away, you know, stomping around upstairs. I'm not going to mention any names, but you were sort of saying how they might have a heavy heel strike. and how you can correct that. But also, I think you were talking about how there's research showing that as you get older, your walking speed goes down, and it can predict dementia by seven years. I was just going to say, we've got to talk about walking speed. Yeah, let's do it. There were a couple researchers in 2009 that proposed that walking speed should be the sixth vital sign. Yeah. So when we go to the doctor, we get our blood pressure, our heart rate, our respiration rate, our oxygen saturation. These are all vital signs that are taken at the very beginning of your appointment to see, hey, are there any red flags here? Is there anything going on with these vital signs that we need to be aware of? Because they will be predictors of a problem down the road. walking speed should be in that category because that slower cadence when you see someone walking slower you need to start saying why are they doing that you can predict dementias by this slow cadence up to seven years the research will say does that mean a good annual practice or regular practice for all of us is to keep an eye on our walking speed. Absolutely. To go around my block when I was 40 took me, I don't know, I'm just making it up, 30 minutes, right, let's say. If when you're 45, that is taking you 36 minutes, for example, I mean, that's probably quite a big decline, even 32 minutes, right? What does that mean? I mean, because there's so many inputs to walking speed, aren't there? It's not just one thing. it could be muscles yes nerves maybe you know your visual you maybe your eyes yeah there could be all kinds of factors that's why it's such a good that's why it should be in that category of vital because why am i walking slowly is it because i'm starting to lose strength and power that's a problem we can address it am i afraid am i starting to lose balance that's something that we can address when we identify it? Is it slow cognitive decline? Are we seeing cognitive decline? Because we know walking helps with cognitive decline. So just by looking at the speed of someone's gait can open up a lot of doors for opportunities for us to be better treating that patient. So if you were to walk, we want to see that number of around 120 to 130 steps per minute. And it's not just, can I do this for a minute? The research, when you look at cancer risk reduction, for example, it's 30 minutes of brisk walking. You're moving. and so it might be great if you can walk around your block at that pace but we need sustained speed and I think that in itself is such a good thing for people to focus on I'll have patients get a metronome they can get it on their phone listen to that beat and have every footstep match that beat and i think you will find it's not uh as easy as some people think it is it's absolutely mind-blowing the other thing that i just wanted to add there is that maybe links this to your foot exercises one thing i've experienced when i go and see helen is that but she measures me every time i'm there so you will walk on the treadmill at a certain pace what often happens is that when we identify the exercises for me to do sometimes it's just literally five minutes a day yeah right i'll do them five minutes a day for four weeks and then you know i might go back because my whole body efficiency has improved i'm not trying to walk faster but i'll go on and go hell and this feels really slow so i'm at the same speed as i was maybe six weeks ago when it felt yeah that feels really good yeah i.e my walking gait is improving not because i'm trying to improve it but because i'm working on my feet and my other movements i mean do you know what i mean it's power like that is something also that i think we forget is walking at a brisk pace is power training and that is we lose power faster as we as we age than we lose strength and that i think we need to pay attention to. What's the difference between power and strength? So if I was going to be training strength in the gym, for example, slow, heavy loads, power is how fast can I move that weight with a speed component? So for example, if I was going to do a lunge, if I was power training, I would go down for three counts. One, two, three, and then try to shoot up as fast as I can. we need that power and that is one way to do it is by walking with a fast clip that's exciting to me I feel like we're just warming up Courtney I've literally got so much to talk to you about I feel we're only 10% of the way there but I need to be respectful of your time what have we covered so far? we've covered so much we've made the case of why walking is not optional it is essential as essential as sleeping and breathing right so you've made that case we've spoken about walking speed we've spoken about the need to look after your feet choose the right footwear and in terms of practical exercises we've talked about you know assessment exercises that can also be therapeutic so how far does your big toe go up how many calf raises can you do on the second in a minute um single leg uh balance tests we've mentioned single leg calf raises yes i've already mentioned calf raises okay we mentioned a lot so far which hopefully has got people interested you've also helped people uh understand how they might want to choose better footwear for their lives so i think that was really interesting right at the end of this conversation what I hope is the first of many conversations for that person Courtney who has listened to us so far and has had the realisation they've never ever paid attention to their foot health they've basically neglected it for the vast majority of their life and they're perhaps wondering is it too late for me to do anything about it what would you say to them? It's never too late. It's the beautiful thing about neuroplasticity. Our brains love novel stimulus. They love to learn new things. And I think that's such an encouraging point is that it is never too late to drive new information to our brains. If you have never put your foot on the ground, if that's where your journey starts, start there. If you're more into this journey, you can always add more loads, walk faster. So there's somewhere this conversation is very inclusive because you really can find anywhere along the pathway to start here. And I think walking should be viewed. It is the most easily accessible, underutilized treatment that we have at our hands. it should be on every physician's treatment protocol it should be on every physical therapist you know do these exercises because it's something that our body is craving to do as a human it is what we were designed to do was to walk we were born to walk yeah corny honestly i think you're doing incredible work the book walk your life depends on it is absolutely fantastic honestly I'm such a fan of your work and what you're putting out in the book. We didn't get into your beautiful foot health kit today. Maybe we'll do that next time. But can we just quickly go through what is in this? Well, there's the book, of course, but your company or your clinic is called Gates Happens. Yes. Where's that based? Colorado. We're pretty much online, though. It's more of a... See, online? Yes. And this foot health kit that you have, that you've very kindly gifted me, and I can't wait to look at it. what is in it and how does that help people you know we had the conversation of gosh you know now i need to strengthen my foot it becomes this thing so what i wanted to do was make things very easy for people yeah um i have been wearing toe spacers for probably seven years consistently throughout the day the only time you will not see them on my foot is when i'm sleeping why not when you're sleeping uh i'm always my sleep is my priority and so i'm like nothing's on my feet i'm focusing on sleeping when you're wearing the toe spacers and you're actively on your foot the tissues in the foot are moving so they have um certain devices that you can wear when you're sleeping that will work passively right so they'll work on stretching the foot um these are designed to be worn actively so you wear them and then you get on with your life correct fascinating thing um on my weaker foot when i first started wearing these after about 10 minutes i wanted to throw them across the room because then my toes were rubbing and it was so uncomfortable because i didn't have toe splay so it takes time but now i run in them i wear them all the time i saw you when you came to my house you put your shoes off you had the what are they called the toe spaces yeah you had them in yeah but you've got this little ball is that what is that to roll the sole of the foot? The sole of the foot. But the reason I wanted that size was because we will also work on range of motion at the big toe. So that's another one of those drills that we'll do on how to improve range of motion at the toe. Maybe we'll shoot a little video on that now and see. But okay, so for anyone who wants to get one of these very exciting kits, which I'm actually very excited to see, oh my God, how am I going to incorporate these into my life? these are just on the websites? Yes, on the website, GateHappens. And on social media, people want to stay in touch with you and keep up to date with your content. Where is everything? Everything's GateHappens. G-A-I-T. Not G-A-T-E. Well, listen, Courtney, honestly, I love what you're doing. I love what you're putting out in the world. I really appreciate you making the journey out to the studio, and I hope to have you back here very, very soon. Thank you so much. I'm so grateful to be able to share this message. It really is so important. So I can't thank you enough. Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember, when you teach someone, it not only helps them, It also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday Five. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I'd be consuming, and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. 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