Strengthen Your Feet for Power Aging with Dr. Courtney Conley

Exercise your feet just like you would exercise your glutes. Should I walk or should I strength train? It's like asking someone, should I sleep or should I eat? It's an and conversation. It's not an option to not walk. If you were to look down at your feet, the widest part of your foot should be your toes. When you think of balance, is it going to be easier for me to balance when my foot can splay or when my toes are compressed?

So we do all these things to our feet. We have all these foot problems because of the shoes we're wearing, but we're still wearing the same shoes.

We just chose to choose fashion over function. We have to have the conversation of trying to convince people to walk more. I know. You know, it's like it would be like telling a fish they have to swim.

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Thank you so much for having me.

I am so hoping this doesn't turn into my own personal foot therapy session, but it really could.

That's okay.

And I don't know. Well, there's so many things to talk about because I think people don't realize until their foot hurts, how much this just changes everything in your life.

It's a very true statement. Yes. I don't think people realize, for example, when their big toe hurts, that they can't push off of their foot, or every single step hurts. I always say, of all the musculoskeletal diagnoses out there, foot pain is the one that will really stop you in your tracks. You can still walk with low back pain. Mm-hmm. It's actually recommended. But when your foot hurts, it's game over.

Yes, yes. I realize that. Yeah. So we'll, we'll talk about that. But I think an interesting place to start is how did you become like a foot-obsessed doctor?

That is a great question. Yes. Um, I was a dancer and a triathlete in my youth, and that was kind of my issue was I had always suffered from foot pain. I had bunions develop at a very young age, neuromas, stress fractures. And so it was kind of my personal quest to figure it out. I don't think I realized at the time how important movement was for me mentally. It was, you know, through my darkest hours in my youth, I had relied on that pretty heavily to keep myself going. So when your foot hurts and you can't use the only thing that you have to kind of balance you out, it becomes, as people who are listening who have foot pain, a very difficult thing. I wanted to learn about all of this. And so I went to chiropractic school. I wanted to work on strength and movement at the foot and ankle. Unfortunately, we only had about half a semester. The solution to foot pain was, well, if your patient's feet hurt, here's a device, a foot orthosis. And if it hurts more, know a really good surgeon.

So— Oh.

It was a very different conversation than we would have anywhere else in the body. And so when I graduated, that's what we did. I worked in two orthotic labs and we made a lot of foot orthoses and I made them for myself and things would get a little bit better, but then I kept chasing symptom. And it wasn't until I, which sounds so obvious now, that I was like, why aren't we strengthening the foot like we're strengthening the rest of the human body? And that's what started all of this.

But here's the reality that makes me crazy. So my background is exercise physiology and biomechanics. Yeah. And what we were taught in school is if you had a bad back, to avoid extension. Yeah. And to only do flexion. And I'm like, but wouldn't that make it worse? Yeah. Wouldn't it make it worse? And I did pointe ballet and blew out my ACL. And I look at you and we are not supposed to be doing ballet, right? I mean, I also did gymnastics. You're not 5'2". Yeah. It's also the who are you gonna dance with? That's always been an interesting thing. But if you look at the field for so long, if you avoided the area, if it was, which is to me, the reason why you shouldn't do it is actually the reason why you must do it.

Yeah, you bring up a good point there with the lumbar spine. It's when you say to someone, well, you want to avoid extension or avoid flexion, that doesn't make sense. I always say with postures, you have to be able to get in and get out of them. You have to be able to move into all different types of range of motion. And of course, my, I always bring it back to the foot. Um, when you have people that will say we can't pronate, or, you know, flat feet are bad, that would be saying that I would only want the foot to supinate or be in a stiffened position. The system doesn't work like that. Tissues have to lengthen before they can contract. You have to be able to find these different ranges of motion. And I think to say to someone you're going to avoid a certain range is going to end up being detrimental.

Right. Well, I don't really even know how you would use the toilet, get out of a car, or do anything else in your life. So it's kind of like, kind of ridiculous when you think about it, but it was the presiding thing. So you went, and it's interesting and gives you a different perspective that you went to chiropractic school instead of going to be a podiatrist.

Yeah. It was all about movement. I, I wanted to, do things that I knew could be proactive instead of reactive. I was always very interested in, in that. And I knew how movement was really a saving grace for me, you know, physically, mentally, and emotionally. So that's kind of the direction that I was like, I think I can get what I'm looking for in this field.

Which is actually even cooler when you think about it, because you're not isolated to the foot. And now you look at the foot and how it impacts the knee. Right. The back, everything.

Yeah.

Let's start off with just walking. Yes. And why do you think that walking is so misunderstood? And what's the, like, the fundamental thing that shocks you the most about that?

I think that it should be on every doctor's prescription pad. If you look at the research of what even a little bit amount of walking does, it literally stimulates every single system in our body. It's— I think what shocks me the most is that we have to have the conversation of trying to convince people to walk more. I know. You know, it's like, it would be like telling a fish they have to swim. As a human being, we are a biped. We have evolved to walk on two feet. So if we think about that as walking is as essential to human survival as things like breathing and sleeping, it becomes this physiological necessity. I like to reframe it like that because it isn't optional. It isn't one of those, "Well, I walked yesterday, so I don't have to walk today," which is, I think, there's the difference between our conversation of strength training versus walking. They're both mandatory.

Right. But you don't have to do, and you shouldn't— Right. —do resistance training every day, so.

But with walking, the research is It needs to be consistent. And that's what's so beautiful about it is it's a low to moderate activity that you can do daily that benefit every system in your body. So it, when I'm having discussions with my patients, it is, how much are you walking? What is your step count? What is, that's always part of our treatment plan.

Okay, well, let's talk specific prescriptions on walking. I'll give you an example. I had a client, morbidly obese, and the doctor wanted to put him on testosterone, and he was walking 2,000 steps a day. I'm like, you know, just if you doubled that, that actually is gonna impact your testosterone. That's right. So what I'd love to see is like, what is the typical person getting in right now in terms of, and then what's your prescription? And not just how much for the day, but also when, all of that.

I think you have to look at everyone's baseline. So where are they coming in along the walking spectrum? If you have someone that's at 2,000 steps per day, a little bit goes a long way. So if I'm at 2,000 steps per day, increasing by 500 steps per day starts to decrease all-cause mortality by about 7%. Which is insane.

Could you imagine if there was a medication that did that? That's right.

Right. If you get to 3,800 steps per day, you will start to see reductions in dementia, by not small numbers, that's 25%. We jump up to 5,000, you start to reduce the risks of depression. Taking your baseline and starting to increase. And when you think about how many steps to take in 5 minutes, for example, 5 minutes is about 500 steps. So just to put that into perspective, if you wanted to increase by 1,000 steps per day, you walk for 10 more minutes. That's also like— Doable. Very doable. But the magic, the sweet spot, is anywhere from 7,000 to 9,000 steps per day, which is very different than if you were to Google how many steps, because most resources still will tell you 10,000. Well, it's the Japanese pedometer company.

I mean, I think everybody knows that story, which here's the thing, it's great, it's an even number, it gives people a target to shoot for. I mean, I'd rather them go for 10,000 than 3,000. So from what I see in the research right now, it's somewhere 7,000 and up seems to be the— place to go. But, you know, I always think as long as you're not then— let's say you're going over 10,000 and you're stealing from, from true exercise, don't do that either. But I just want people to be aware, and I think if you measure it and monitor it, you'll do it. But I think it's more than just how much, right?

So there's a law of diminishing return, you know, and I'll have patients that will say, well, I'm walking 15,000 steps a day, which is great. And then my next question to them is, are you strength training, right? And if they say no, I don't have time because I'm trying to get 15,000 steps. And that's a very good conversation to say, let's dial it back. And now I've given you more time to explore other things.

The other piece I love about walking is that if we really start to monitor it, we can do it all throughout the day. Yes. And that's the other piece that's so important is not just trying to do it all at once. Right.

I always say, if you are, let's say you're a runner and you run for your hour in the beginning of the day. That doesn't excuse you from your walks throughout the day.

I want everyone to hear that because there's actually someone on the internet, I saw it, saying just the opposite. I'm like, you've gotta be kidding me.

Yeah. If you think about it just from, if you take it to the conversation of walking after you eat, so that's one of the best times to walk is within 10 to 30 minutes after you eat. Depending upon what you eat, you have an increase in your blood glucose. So we know that when we have activity after we eat, we have the pancreas and muscle contraction that's grabbing the glucose out of the bloodstream and putting it into cells to be utilized. So if you get your 1 hour in in the morning and then you're sedentary throughout the day and you're just sitting after you eat, the pancreas is working hard. Mm-hmm. The pancreas doesn't like that. So having these options of these movement snacks, we talk about that a lot in the book. Different snacks that you can do, with walking being one of them, 10 minutes after you eat, it is the lowest hanging fruit that we can do and so easily accessible. And what about weighted vests?

Yes or no? Yes.

I think that depending upon where people are, when you add a weighted vest, you're adding more loads. So for someone who's trying to get into— increase their heart rate, or they want to put more load through their system, Absolutely. It can be a great way to what we call amp up walking. We talk about power training and strength training and weighted walking, which can be— that weighted walking can be very beneficial for people. But for some, it's also, that might not be your entry point, which is also fine. So it depends on where you sit along that spectrum.

It wouldn't seem like that would be a great entry point for anyone. It would seem like something you do once you got this going.

Another thing to consider would be speed before adding load, because walking gait speed is very important. And in the book, we talk about how it has been discussed as being the 6th vital sign. So what I mean by that is when you go to the doctor, you get your temperature taken, your blood pressure, and if there's something wrong with your 5 vital signs, then it's a red flag to the physician saying, we might wanna look into this. This could be a problem for something. And what they have looked at was walking gait speed, because when someone is walking slower, so their cadence is slower, it can be a predictor of things like dementia up to 7 years in advance. We could look at why are they walking slower? Is it a balance issue? Is it a strength issue? And these are all proactive measures that you can say, okay, let's, let's take a timeout and figure this out. So before I would say, go ahead and start adding weight, how efficient is your walking? Can you walk for 30 minutes at a brisk pace? And if you look at the research, that's about 3.5 to 4.0 miles per hour, which is not slow.

4 miles per hour, I'm gonna make it easy, a mile every 15 minutes. Yep. And that would be easy to track on with you, with whatever fitness tracker you have. So is that the easiest way for someone at home to check their gait speed, or is there another test you like? Because let's be honest, Um, that's kind of my beef right now is no one's checking muscle quality, sarcopenia. No one's looking at these things. So likely they're not getting tested for gait speed at their doctor's office.

No. Step count too. How many steps are you taking per minute? So about 130 to 135 steps per minute. Mm. Okay. And when you add in hills, I live in Colorado.

I'm in about 8,000 feet of elevation. We're in Florida.

8,000 feet of elevation. You know, these are different conversations. Yeah. But that gait speed is important. And, you know, to maintain 4.0 or 135 steps per minute for 30 minutes, which is also, you know, we get into some fun numbers about reducing cancer risks at those numbers. I think people would find it a little more challenging than it sounds.

Yeah, that is one thing I've lived half time, like California and Florida have been both my, I go back and forth and gosh, I miss the hiking. Yeah. Whenever we're anywhere where we can hike, we are out there hiking. Yeah. So even though I'm hiking on my sore foot, I still do it.

Oh, we're gonna have to talk about that.

We are getting to it. I would love to talk about menopause. I've never heard anyone talk about this, menopause and feet. And the reason I'm asking about this is I was out to dinner the other night and my girlfriend was talking about her tender feet. I go, tell me about your tender feet because I have the foot expert coming on the show. So tell me about this. And she said, well, my grandmother had it too, or maybe her mother. She said it started like 2 years ago, right when she was going through menopause, right? She's not on hormones, not doing anything. Now she has these tender feet. And when she gets up in the morning, she says like, ow, ow, ow, ow, ow. I'm like, oh my gosh. And you're just living with this? What is going on? So is that something that's a hormonal shift? What's going on there?

I think if we looked at this first from big picture, we're all aware of sarcopenia. And how we lose muscle mass as we age.

And she's very fit, by the way, and exercises all the time.

You have to consider that that also happens at the foot. Your foot also loses strength. Your toe strength declines. When we look at sensory awareness and perception, these are some fun numbers. When you turn 50, the receptors on the bottoms of the feet that are designed to gather information, keep us upright and balanced. It takes 25% more pressure to stimulate those receptors.

Okay, wait, hold, hold on. Because I hear all these things, of course I always think, but not for me. Why is that? I mean, if you were really active, would that still be the same amount? Is that just aging?

And it's aging. It's— this is what happens when we age. We lose sensation in our feet and we lose strength. But the good news about that is that if we have these conversations that we're having, then these are the types of things we can work on. It's proactive, not reactive. If you do nothing, when, as when you turn 80, for example, that number jumps up to 75% more pressure necessary. So we shouldn't be asking ourselves, wow, there's a lot of falls. Why are all these falls happening? I come from looking at this from the bottom up, saying, why would we not pay attention to the one part of our bodies that are supposed to feel the ground to keep us upright and balanced?

Why are we not talking about this? I mean, why, why do you hear about falls and you hear about strengthening your quads and, and you never hear this piece, which makes so much sense.

Yeah. If you were to— this is a good kind of at-home test. If you were to stand up next to a wall and keep your body straight and try to lean into the wall as far as you can to get your nose as close to the wall as you can without kind of pitching at the hip. What you should feel stop you are your toes. It's your toes pressing into the ground that prevent this forward progression. When you look at falls, the majority of them can happen at the initiation of gait. So when I start walking forward, so if I can't feel my toes, if I don't have my strength there, then it's an indicator. It can be a predictor of falls. Karen Mickel has done a lot of research on this, and it's fascinating to me.

Can you get it back?

When you exercise in general, and when you exercise your feet, you increase circulation. Increased circulation increases sensory nerve fiber branching. So even with your patients with peripheral neuropathies, the one tried and true thing, as you know, is exercise. Exercise your feet just like you would exercise your glutes.

So it's not hormonal shifts, it's aging, or does hormonal shifts also contribute to this?

I think hormonal shifts also contribute. I mean, how could it not? Well, yeah. I mean, you have falling estrogen, you have changes in the fat pad of the of the foot.

You brought up shoes, and I still think of, like, the person who used to harass me the most about my stilettos, which I don't really wear that much anymore, was my best friend chiropractor in Palm Desert. And so now you've got— you're a foot-focused chiropractor. You must have a field day with people.

You know, I'm not going to win the conversation. I'm going to try to stiletto conversation. Tell people that you can never wear stilettos again. But what the conversation I do want to have is, if you are going to be in that type of footwear, pay attention to when you're not in that type of footwear. We can't wear footwear that restricts the function of our feet the entire time we're on our feet. If you were going to wear your heel for a couple of hours, in the book we have this high heel rehab that you would like a couple exercises to kind of combat what happens in the high heel. But then Put something functional on your foot for the rest of the hours of the day.

Well, would the best thing to be nothing on your foot, or is it better to wear something?

I mean, in an ideal situation, your foot's on the ground barefoot. Now, for people who have— my favorite way to explain this is, do you remember all of the articles that came out after COVID? And it was, don't walk around barefoot in your house because, you know, people are getting plantar fasciitis, and so you have to have shoes on all the time. Wow.

And I was like, I didn't see that, but I don't, yeah, I don't fuck with left feet. I'm in the pool.

And I was thinking to myself, man, they, they're getting it wrong. It, it's not that the going barefoot caused the problem. It's the fact that the majority of us, 1 out of 3 people over the age of 45 have foot pain. So a lot of us have weak feet because we don't strengthen them, we don't pay attention to them, and we're in the wrong footwear. So then when you go into an environment where you go from wearing shoes all the time to now wearing shoes none of the time because you're barefoot 100% of the time, yes, you're going to have a problem because it was too much load too fast.

If we were gonna design the perfect footwear, where would we start? And, and I would assume like it would be great if kids could just be barefoot at school starting out. But barring that, we can't be barefoot all the time. What's the next best alternative?

I think my non-negotiable is a wide toe box. So there is a difference between a wide shoe and a wide toe box shoe. Most sneakers, they'll say, well, this, this shoe comes in a 4E or a 2E. But if you look at where the width of the shoe is, it's at the ball of the foot. It is still tapered where the toes are. If you were to look down at your feet, the widest part of your foot should be your toes. And there's a reason for that. When you think of balance, Is it going to be easier for me to balance when my foot can splay or when my toes are compressed? When I go to push off of my foot, there's multiple times our body weight going through the forefoot. Does it make sense to have it strong and wide and stable or compressed with my toes together? So that's why we see the majority of injuries in the foot, uh, happen at the forefoot. So your bunions, your neuromas, your— all the issues that can occur because most people don't have forefoot stability.

So we do all these things to our feet. We have all these foot problems because of the shoes we're wearing, but we're still wearing the same shoes.

It was really interesting. And I was looking at the research for this because we were warned like many, many years ago, and we just chose to choose fashion over function.

And we— I used to say that. I used to be like, you know, suffering through these shoes and literally I'd do events and we'd have a shoe cam on the shoes. Like it was a thing. Yeah. And the pandemic changed everything. I was like, what the heck was that? Like, what are we doing?

And you know, if I think if we again, get back to that conversation of it's okay if you wanna wear this shoe for a couple hours, great, but you cannot. Wear that type of shoe over and over and over again without a reprieve. But you can't find—

like, I think of it more as the heel, but really it's the heel's not the biggest problem. It sounds like the front of the shoe, the toe box, is the big problem. And really, I can only think of two shoes out there that have a wide toe box like you're talking about, you know, Mark's Peluvas and then Vivo.

We define the difference between a functional shoe and a minimal shoe because those are different categories. So when you asked about the footwear, the wide toe box is number one. The second feature in a functional shoe is having a low to zero drop. And basically what that means is that your heel and your toes sit on the same plane. The research will tell you at a low drop, it's about 6 millimeters. If you look at most footwear out there, most brands, it's 8 millimeters, 10 millimeters, which raises the heel in relationship to the ball of the foot. And then the third is the amount of cushion underneath the sole of the foot. So functional footwear, you still get some cushion, right? If you're standing on concrete all day long, you want a little bit of cushion underneath your foot. Minimal shoes, that's your Vivo Barefoot. That's wide toe box, zero drop, and thin and flexible sole. You can— your foot feels the ground. And those are two different categories because the more cushion underneath the sole of the foot, the less you feel. You got to earn your right to wear a Vivo Barefoot.

We should be going barefoot as much as possible.

Yeah, small doses. I'll tell people if they're in traditional footwear, which is 95% of the shoes out there, start small. 5 minutes a day barefoot around the house. See how you feel that night and the next morning, and then you can slowly start to add time. And that goes for most people. There are very few patients of mine that I will say, "Don't do that," regardless if they've had chronic foot pain, because for years they have been deloading their foot, and you have to load. If you look at all of the research now about foot and ankle and its relationship to the rest of the body, the foot has to lengthen, so it has to be able to pronate to absorb shock. When the foot pronates, I have better ankle dorsiflexion or ankle mobility, and that leads to what's happening at my knee, my hip, and my low back. Wouldn't the orthotics stop that then? Depending upon the type of orthotic, you do not want to eliminate arch compression. So yes, a lot of the orthoses that we see when they're very stiff and they're very rigid, we're going, This might not be the best call here.

Every time I've tried one of those, they have bothered me. Yeah.

And there is, you know, a time and a place. And I work with people—

What's the time and place for that?

The materials have to be right for that foot type. Sometimes they need to be a little bit softer. If you were to look at acute diagnoses, so someone who has acute heel pain, so plantar fasciitis, there is lots of research that says when you deload the tissue, the symptoms will get better. Here's, here's the problem. You can't just dispense this foot orthotic and say, okay, here you go. This is going to deload your plantar fascia and we'll see you in 10 years because that's when I see them. They're like, I'm like, why are you wearing this? They're like, well, it helped with my plantar fasciitis 10 years ago. So there has to be that exit strategy of going, we're going to deload the plantar fascia, but we're going to strengthen all of the muscles that support the plantar fascia so that you can get out of this thing.

So let's talk foot exercises. Yes. Like the next thing, the next frontier for the routine. First of all, like at the gym, would you be better off than using a minimalist shoe? Yeah.

To have a different tool for the task at hand, I think is very important. We need to consider that with footwear, especially in the gym. Even if you are walking around in a maximally cushioned shoe, I would, I would really encourage you to rethink that when you are in the gym. When your foot is on the ground, you have all those receptors that are telling you how to stay upright and balanced. When you're lifting heavy loads, like a heavy deadlift or a heavy squat, you have to feel your foot. You have to push through your foot so that you can stabilize your body above the foot. When you stand on a cushioned shoe, you are interfering with the information that's going to your brain. And if you've ever seen somebody in the gym trying to lift heavy in a maximally cushioned shoe, I'm just like, oh my gosh, because they're— it looks like they're on a pillow. They can't feel the ground. So then it compromises the information going to their knee and to their hip.

I would assume On Clouds are a disaster. They're so cute. Yes. Yes. You're like, ah.

Yes. If you're going to introduce yourself to minimal footwear, do it in the gym.

Okay. This makes a ton of sense. Well, so then let's go over to my foot because again, I told you when I was in my early 20s, I was teaching aerobics in Japan and it was a Sunday in a little small city where no one spoke English. So this is a backstory. And the other backstory was I was at UCLA and They'd hired me to go to Japan and my parents said they would disown me if I went. So this is also important cuz I had nowhere to go back, right? Like, so I was taking the, the quarter off of UCLA, going to Japan. How fun. And so I'm out there teaching aerobics and it's a Sunday and I'm goofing off and I'm doing acrobatics cuz I did acrobatics for years. Do a roundoff flip, land and hear crunch. And they take me to the doctor. No one speaks English and they put a cast on and I'm thinking, This is ridiculous. I just sprained this. And you should walk off a sprain anyway. So I go back and I get the cast off. And I also knew that if I didn't teach on this, I was going home. But I couldn't go home. Like, there's no way I was going home. So I literally taught for like 2 months holding onto a chair. Then I go back to California and I go back into my regular UCLA thing teaching aerobics. Then I go back to Japan to do a dance video. Step down, miss the step, reinjure it, think I sprained it again. I remember it turning black and they stick acupuncture needles in it and wrap it up so I can dance on it. This is the state of it, right? Took like a year for me to be able to sit in like any kind of position with my knees out without it hurting. And I don't think about it again for a while. And because I'm mainly focused on my torn ACL on my right side, right? So, you know, I've got a bigger pain over there. And then probably 10 years ago, my son was like, "My foot hurts." And I'm thinking, you know, my foot hurts too. Come to think of it. So I go to the foot surgeon in town, which is the wrong person to go to because they cut. And the foot surgeon goes, "Oh, you broke your foot." I go, "Oh, I guess they were right." Right? He's looking at it. He goes, "Yeah, this is really bad. You gotta have your foot fused." And I'm thinking, there's no way I'm having my foot fused because Like, how could I balance on my foot if it's fused? Like, that's terrible. So the first thing I did was one of my buddies, Dave Asprey, says, "I have this great doctor in LA and he fixes, he's the stiletto celebrity doc to the stars so they can wear their shoes." I'm like, "Perfect, that's what I need." And he goes, "I'm gonna shoot you with a little Kenalog and lidocaine. It will not degenerate the joint. It'll just keep the pain at bay." I'm like, "Great." For years it worked. 3, 4 years, it worked great. Sprint treadmill, running, hiking. I'm like, perfect. And it would wear off every like 4 months. And then the final time I went to get it done, didn't work. Then I went and saw a friend. He's like, hey, your ligament's about to tear. And I'm like, uh-oh. So now we've been doing stem cells, Regenekine, all sorts of stuff. And it's gone from feeling like I was being stabbed to I can move on it, walk on it. And it's about a 4. I have very high pain tolerance. I'm like, I can live with a 4. I'm just trying to be careful of, can I jump? Like, you know, jumping and sprinting. I'm like, ugh, can I do it? Is it stupid? So this is where I am right now. And I've been specifically like making sure that I'm barefoot as much as possible and going up on my toes and pulling my toes up to me and all that kind of stuff. But that's what I want to look at is, so what would someone do? I'm the worst case example of all of this with the severe osteoarthritis. But I do not want it to stop me.

Is the majority of the pain at the ankle?

It's very interesting. It moves all around. And this morning I was saying to Tim, I go, "Gosh, it moves all around." He goes, "Well, you wear different shoes." And you—

and I'm like, "Oh, true." I think when you look at those types of chronic injuries, you have to really go back to the basics. And that's where the anatomy becomes very important at the foot and ankle. Can the foot change shape? So can you— are you able to elongate your foot, to evert your calcaneus, so to get the arch of your foot to lengthen? I'm testing. And then can you also get it to stiffen? So it would be, if you were standing, for example, and you were to rotate to your right, you should feel your right arch lift and your left arch drop. And so when you rotate the other way, the opposite should happen. That's the first basic thing that I look for. If your nervous system— and this is what I have found to be so interesting— when someone's nervous system is in fight or flight, or there's been trauma associated with it, or surgery associated with it, the foot is a feeler. It's a sensory organ. So if I'm standing and I sense instability in my system, my foot is going to help me. So it's going to try to create stability, and you will toe grip, where the foot is in this constant state of, I don't want to let things relax. You cannot unlock your foot. You cannot dorsiflex your ankle if you're constantly gripping your toes. You can't do it. So those are the kind of basics that we'll start with. Can you get your foot to relax? So that it can change shape. So do you have to start with that?

Because I just jumped into the other— the other stuff's the fun stuff. Yeah. And literally, I was working with someone, they're like, okay, try to pick up— I forget what toe— and I'm like, okay, could we just do some lunges and step-ups and something else? Anything?

But the answer to that question is I get pretty picky about form when it comes to the foot. So a perfect example of that would be to do a calf raise. A single leg calf raise. Depending upon which decade of life that we are in, we should be able to hit a certain number. I like to keep every— like, if as a general point, 30 is a great place. Now, if you do your calf raise and your heel on the injured foot is only coming up halfway, for example, compared to the good side where you're coming up all the way, there's a problem there. So it's— you're cheating the system. If you do your calf raise and you start leaning into the wall, that's also cheating. You're not using your foot and ankle, you're using momentum. When I see those things, let's say you can't do your calf raise and anchor the big toe down, then I know we need to work on the muscles that are going to help us do that.

You definitely are a foot expert. Yeah. And I've been around with podiatrists, and I've never heard anyone. I was listening to some of your interviews going, oh my gosh, this is quite something. Okay, 24-hour foot clock. What is this?

It's the shoe conversation. Okay. So it's, if you're going to be in traditional footwear or non-functional footwear for X amount of hours in the day, then make sure that the other hours that you're on your feet, you're in functional footwear. Okay. So that's how we can kind of divvy that up and make the conversation more digestible for people.

I was telling you the story of how I went to a body worker and he's looking at my feet and he said, "You have to wear toe spreaders." Yeah. He didn't really explain anything beyond, "Go get these yoga toe things," which I did. Most painful thing I ever did. Now I think I got like the advanced yoga toe spreader, but let's talk about those. Are those something we should wear? Why? And how do you avoid the situation I got in, which I think the advanced toe spreader— Yes, I have one right now.

Hold on there.

Yeah, those are the ones I bought after the big jewel painful things.

I think it's probably one of the easiest things to implement for people that have poor toe splay. It just has to be done again at the right dosage.

Who would have good toe splay?

So if you can lift up all your toes, you should be able to spread them and see daylight between each toe. So each toe you should be able to spread out, and some people cannot do that.

Actually, a lot of people— I was gonna say, this some person over here can't do that.

If you think about it, especially if we've been in footwear where the toes are not allowed to splay, we shouldn't be saying, well, this is weird, why can't I do that? If we couldn't do it with our hands, we would panic. It's the same concept at the foot. Genetics is one thing, but environment is something else. So With the toe spacers, they help align the toes. If your feet are not used to splay, it's like your toes are rubbing against one another and you can form corns and calluses. And those are so gross.

Corns. It's like that. I remember my grandmother had corns and I was like, ew, gross. I mean, it's like the visual in your mind as a little kid, you know, they're painful.

And so on my weaker foot, when I started wearing them, I think I lasted 10 minutes and that thing was thrown across the room. And now I wear them all day. All day? I walk, run in them. Yeah.

Oh, do you have them on when you are wearing shoes?

Yeah. Oh, I wear them in all my shoes with a wide toe box. Got it. If you try to wear a toe spacer in even a wide shoe, you're gonna hate it and it's gonna be very, very painful. Because the— a way to assess that too, by the way, if you were to take out the factory insert of your shoe and put the toe spacers on and then put your foot on the factory insert, if your toes expand beyond that factory insert, they're going to get squished in the shoe. And what are some brands of shoes that we should be looking at in the functional category? So this would be wide toe box, low to zero drop. So you have Altra Running, You have Topo Athletic, you have Notice, Peluva even, they have the wide toe box, and Peluva still has some of that stack height, the cushion underneath the sole of the foot.

It does? Mm-hmm.

Oh. When you go into minimal footwear, these are your Vivo Barefoots, your Zeros, your— you have those shoes, the minimal category, the most difficult part of that shoe to transition to is because it's because it's so thin and flexible. And you gotta, you have to earn your right. In a minimal shoe, that's where all the research lies, your foot gets stronger, but it takes time. And it's not as comfortable. Yeah. So people are like, well, this isn't comfortable. When you put on a maximally cushioned shoe that has a toe spring on it and you start walking, you're like, this is, this thing's great. Why would I not want to wear this all the time? Nobody gets a free lunch. You put something on your foot that's basically rockering you forward, you're gonna pay the price for that down the road. So that's why you gotta have shoe spectrum. You gotta have both.

So what about the toe shoes, like, you know, the Peluvas that Mark made? Would it be, 'cause that's basically doing toe spreading for you, right?

The reason I love the Peluvas is 'cause I don't have to wear my toe spacers. It's probably the one shoe I don't have to wear my toe spacers.

Well, I have a bunch of 'em downstairs, all the cute colors, everything. Everything.

So, and they've done a good job because they've put some cushion underneath the sole so that it's a little more comfortable for people. It's a similar concept to the Vibram FiveFinger, but the Vibram FiveFinger didn't have the cushion or the stack height.

I have a couple rapid-fire questions for you. Ready? Ready? Yes. Is walking enough for longevity?

When you think of the question between, you know, should I walk or should I strength train? It's like asking someone, "Should I sleep or should I eat?" It's an and conversation. The thing about walking from a longevity perspective is the consistency and the daily habit that it has to become. It's not an option to not walk. We have to look at walking as this necessity, like breathing and sleeping. It's this stimulation to every system in our body.

Love that answer. What's the most damaging daily habit for foot health?

Not paying attention to them and wearing poor footwear.

Most footwear is poor footwear. Yes. Just to clarify. So you talked about the feeling, the pressure that changed with age at around 50. Are there other things that happen as we age to our feet? Are these things that you talked about with the hammers and bunions and corns and all these things, Do these tend to happen later in life or could it happen anytime? And are there any aging, aging foot situations?

Yeah, I mean, all of those diagnoses are typically associated with a foot that is getting weaker. So you'll start to see bunions forming as we age, hammer toes, claw toes, the toes start to basically shrink. As we age too, what happens is the foot starts to get stiff and rigid. So when we're younger and we have a bunion that's more flexible, so I can move my big toe, I get excited about that. I'm like, okay, let's do something about this.

Of course you get excited about that.

But when I have patients come in and it's— they're in their 70s and now their bunion is no longer flexible and it's underneath their second toe, this is a different conversation because now their toes aren't flexible. Now they're structurally stiff and rigid. And these are the, you're probably gonna need surgery. Mm-hmm. You're probably gonna need a shoe that rockers you forward because the foot can't change shape.

What's the biggest misconception about foot pain? That you have to live with it.

I think people, when they think their foot hurts, it's, I have to wear a foot orthosis, I need a very cushioned shoe. And that is not the case. Uh, the foot doesn't need arch support. The foot is well designed to handle the loads of walking. When it is strong and mobile. When the foot isn't and you compromise what the foot looks like by taking the toes and tapering them together, then yes, a foot does need arch support. But in its environment where we can build strength from the ground up, the foot doesn't need arch support. It doesn't need all this stuff. It just needs to get stronger.

You're giving me lots of foot hope. Yes. What's the fastest way to assess someone's longevity by watching them walk? Speed.

If we're talking longevity, speed. How fast can you walk? Walking, we were, you know, as humans, we were designed to be endurance walkers. It should be, you know, we like getting out there and it's easy and it's efficient. And when you see people struggling to put one step in front of the other, uh, there's a very big difference between two 60-year-olds, for example, and one who can walk at a fast pace and one who cannot. And you will see their overall health be very, very different pictures.

Okay, this is the perfect final question then. What are the first 3 steps to improving walking today?

Take your shoes off and take a look at your feet. Stand and feel your foot on the ground. Can it change shape? Can you get your arches to lift and to drop? Can you walk around your house barefoot for 5 minutes? Can you let your foot feel the ground? Do you have good mobility through your toes? We lose power faster than we lose strength. Right. Where do you think you get most of your power from when you're walking and moving?

Your foot and ankle. Boom. Yes. All right. So for everybody who's now enthralled and wants to make sure they have foot and ankle power. Yes. Where are all the places that we should send them?

Gait Happens.

And I'm going to put that, by the way, jjvirgin.com/gaithappens. I'll put all of these things, but Gait Happens.

Yes. We have a fit Feet program. It's 12 weeks. How cute. How to get your foot and ankle stronger. There's a bunion webinar specifically. A bunion webinar. Yes. There's information on toe spacers. There's information on, you know, jumping, depending upon where you are on the spectrum. But there's something there for everyone just to start to understand how important this stuff is.

All right. Everything will be at jjvirgin.com/gatehappens. Yes. And what an amazing interview, like totally enthralling, I must say.

Thank you so much. I really appreciate it.

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