Dhru Purohit Show - A Shocking Predictor of Longevity and How to Improve It to Become Stronger for Longer with Courtney Conley

Episode Date: October 30, 2024

This episode is brought to you by Bioptimizers, Bon Charge, and Ollie. We don’t often think of foot health as a factor in longevity. However, falls, hip fractures, and early mortality statistics show that foot health is just as essential for long-term wellness as other factors we prioritize. Today’s guest has made it her mission to bring foot health to the forefront of conversations about optimal health, especially as we age. Today on The Dhru Purohit Show, Dhru sits down with renowned foot and gait specialist Dr. Courtney Conley. Dr. Conley discusses the most significant predictor of falls, lifestyle factors that weaken our toes, and how a sedentary lifestyle and modern footwear contribute to weakness, ultimately increasing the risk of falls. She also shares the qualities of optimal footwear, tips for gradually incorporating minimalist shoes into your life, and simple exercises we can all do at home to strengthen our feet. Dr. Courtney Conley is a renowned foot and gait specialist and the founder of Gait Happens, where she pursues her passion for helping people reclaim their foot function. She is also the owner and operator of Total Health Solutions clinic and Total Health Performance gym in Lakewood, CO, where she leads patient care focusing on restoring gait mechanics and resolving foot issues to enable easier, pain-free movement. Dr. Conley is a founding member of the Healthy Foot Alliance, an international team of practitioners dedicated to promoting the benefits of natural footwear and reducing the need for unnecessary surgeries by strengthening foot foundations and creating a stable platform from the ground up. In this episode, Dhru and Dr. Conley dive into: The greatest predictor of a fall (00:00:07) Factors that weaken our toes (4:00) Modern footwear and its correlation to falls (8:50) How a sedentary lifestyle contributes to weakness (14:05) The impact of improper shoes and bunions (15:50) Foot anatomy (19:45) The connection between foot health and brain health (25:39)  Three types of chronic pain linked to foot health (34:08) Dr. Conley’s journey (36:30) Informed consent for activities that harm foot health (43:20) Building toe strength for beginners, intermediate, and advanced levels (46:35) The shoes Dr. Conley recommends and her non-negotiables (58:04) The ideal number of daily steps (1:07:50) How to create lasting habits and behaviors (1:11:20) Setting up children and the geriatric population for success (1:14:50) Dr. Conley’s practice (1:17:50) Also mentioned in this episode: Dr. Conley’s Foot Health Programs   Dr. Conley’s shoe recommendations For more on Dr. Courtney, follow her on Instagram, Facebook, or her Website. This episode is brought to you by Bioptimizers, Bon Charge, and Ollie. Upgrade your digestion with enzymes! Go to bioptimizers.com/dhru now and enter promo code DHRU10 to get 10% off any order and free gifts for a limited time. Right now, BON CHARGE is offering my community 15% off; just go to boncharge.com/DHRU and use coupon code DHRU to save 15%. Want to give your dog the best in clean eating?Take the online quiz and introduce Ollie to your pet. Right now, Ollie is offering 60% off your first box of meals when you subscribe today! Just head to Ollie.com, use the code DHRU and you’ll get 60% off your first box of meals in your subscription. Learn more about your ad choices. Visit megaphone.fm/adchoices

Courtney, welcome to the podcast. It's a pleasure to have you here. You know, something pretty wild that I learned from following your content is that one of the greatest predictors of a fall as we age is the strength of our toes. Now, that information is going to be pretty shocking for some people, which is why I'm so excited to have you here because the truth is if you care about longevity, which my audience does, you have to care about the strength of the full. foot, especially the toe. So what are the top reasons that so many aging adults have poor toe strength? And why does toe strength matter to longevity? It's probably one of my favorite things to talk about. And, you know, I have a funny story to start here in that a comedian also got a hold of that statement. And he made a little, a pretty famous comedian. And he made a little clip about it.

And he said, you know, which I completely understand. We have all of these things to be concerned about from a longevity perspective, right? We have to worry about our diet and our nutrition and how much exercise are we getting. How in the world am I supposed to now pay attention to my toes? And it was kind of funny. And I really thought about it. And I said, well, if you think about the prevalence of falls, which is if you look at the statistics, one and four adults will fall.

When you have your PCP appointment, especially if you're over the age of 65, for example, one of the very first questions they will ask you is, have you fallen within the past year? And if so, how many times? It's that common. One of the biggest sequela's or one of the things that can happen when we fall

are hip fractures. In fact, the most common cause of a hip fracture is a fall. And if we look at what happens when we fractures, our hip, 25% of people who fracture their hip will be dead within a year, and 50% of those will have altered function after they fracture their hip, which is just astounding. When I was learning about all this, and I was looking at Karen Mickel's research, who she has done a lot of fall prevention research. And one of the studies she did was on looking at non-falling seniors in seniors who have fallen. And they looked at factors like quadricep strength, in ankle strength. And in both,

groups, those numbers came out pretty even. But when they looked at toe strength, the non-falling seniors had more toe strength than the falling seniors. And that was the biggest determining factor of who was falling and who wasn't. If you think about this, most falls, if I was going to walk towards you, for example, most falls occur at the initiation of gate. So I'm standing and I'm going to start to walk. This is actually a test that we'll use in my office. So I'll have some stand up against a wall. So your listeners can try this at home. You stand up against a wall and you want to lean into the wall, but don't smack your face against the wall. You can't like hinge at the hip. It's a straightforward lean. And I will ask my patience, what is stopping you from smacking your

face against the wall? And what stops you is your toe strength. There's a window. It's an anterior fall envelope where we should be able to move about four and a half inches forward. And it's our toes that stop us. The big picture here is if we have something that is easily trainable, like toe strap, which it is, and I'm sure we'll get to that, why are we not paying attention to it? The capacity, we lose this strength and it is the single biggest predictor of falls over quadricep or ankle strength, for example. That's incredible. Something so small that is so overlooked is so crucial to so many functions in our body,

which ultimately ties to longevity. So one follow-up question on that, which is give us a list of some of the top things that are creating a situation where some people have strong toes and are able to avoid a fall and avoid or put off a potential hip fracture and why other people are more likely to fall and end up, unfortunately, getting a hip fracture, which leads to all these downstream consequences. What are the things that make our toes weak? I think if you think about it from a muscle perspective, for example,

if you don't use it, you'll lose it. So, for example, if I wanted to get a bigger bicep, I wanted to go to the gym and strengthen my arms, I would do a full bicep curl. I would take my range of motion, I would lengthen my arm and curl. What if I went to the gym and I had a sling on my arm and did a range of motion that was half that range, right? So it would restrict my range of motion. It would restrict the length tension relationship of the tissue. Muscles and tissues weaken when they're not being utilized as they

should. So if you want to take this down into the foot, and this is where I'm going with this, One of I think the biggest factors here is what we're putting on our feet. So when we look at footwear, think of it as an equivalent to a sling on your arm. If I have a shoe that is restricting, I'm going to bring Eddie into the, Eddie always makes a showing here. If I am in a shoe that's going to restrict my toes splay, for example, it's going to what? It's going to change my muscle function. So if I don't use it, I'm going to lose it.

So I think footwear in itself, and if you look at the majority of footwear out there, this is a big factor. I think this is one of the biggest factors of why so many of us lose toe strength, because our foot isn't in the right position and we're not being able to utilize the tissues as they were meant to be utilized. Then you can start to look at things like trauma. Why is one person's foot stronger than the other? Has there been trauma? Has their gait not been retrained? I mean, there's a very wide scope of why we start to lose strength from the ground up. You know, I think another thing to consider here also is how the foot feels. And I mean, feels the ground. Another kind of bonus as we age.

We have all these beautiful receptors on the bottoms of our feet, cutaneous receptors and spindles that are basically screaming, you know, they're gathering all this apharent information, this sensory information to tell our brains, hey, let me like have some really quality motor output. So as we age, the sensitivity of these receptors starts to decrease. So for example, when I turn 50, I lose 25% of the sensitivity of these receptors. So I start to decrease my sensation.

When I turn 80, I can lose up to 75% of the sensitivity of these receptors. That's a problem because if you can't feel anything and you don't have the strengths to control anything. Your sequela is a fall. When I talk about this, you always have to talk about the silver lining, right? It's not this doom and gloom. You know, we're all going to start falling because we can't feel or, you know, strengthen anything. But the beautiful thing about this is the neuroplasticity of the brain is that when we exercise the foot, foot exercises, wearing the right shoes, letting our foot feel the ground, not having, you know, so much cushion or support underneath the foot all the time that's deterring our movement.

When we exercise the foot, we increase circulation. This isn't just at the foot. This is just in general. But when we have increased circulation, we have increased nerve fiber branching, which means I can start to feel more, which shows I can decrease pain. And I think that is what is so exciting about this work,

is that all of this stuff, I always tell my patients, when we test your toe strength, and I use a little tuning fork, a 256 hertz tuning fork to measure the sensitivity of your foot, these things can be retrained. You can get a stronger foot. We can improve the sensitivity to your foot.

And I think that is so exciting. And I think it's a massive, you know, kind of mission that I'm on because I think it's huge in fault prevention. I appreciate you sounding the alarm on this important subject because there's a lot of statements that you just made. And if I could tease some of them out there, Just to make sure that I understood it, my audience understood it correctly, is that would it be fair to say that not in an alarmist way, but genuinely, that our modern footwear and the misuse of modern footwear for many people is leading to an earlier death? Is that an extreme statement or is that a fair statement to say?

I think that's definitely a fair statement to say. And, you know, this is catching fire of recently. but I'm currently writing a book and I've been researching this stuff and back in 1905 there was research of people saying hey you probably don't want to do anything that's going to compromise the function of the foot

because we're seeing things like Hallex-Valgus or Bunyan's in relationship to constricted footwear. So yes and if it's something is easy I mean I'm always saying function over fashion I mean I think that's probably what we have to wrap our heads around the most. It's so tough for so much. many people, and I will definitely acknowledge as somebody who has two sisters and my amazing wife and talking to my mom and so many of the incredible women in my family, I realize there's a

heavier burden for women. And my audience is probably about 75% women. We're going to get into all the questions that they've submitted to me for this conversation here. But at least we have to start off with the truth. So the first truth is the misuse and modern footwear that's out there that's primarily designed for fashion, including in extreme situations, the heels, which are so rampant in society, both for men's dress shoes, you know, the heels that are there, and then also, of course, for women's shoes that are there, high fashion, these things are contributing years in advance to something that ultimately could end up leading to a higher likelihood of a fall, which could put you in a situation where for many women and men, they never walk again,

and you decline rapidly downhill. You mentioned something else that was there, which is that they use it or lose it. How much of this problem is the general problem of us living in an increasingly sedentary society? I think that the stats are that the average person gets less than 6,000, 5,000 steps a day, which is considered sedentary. How much does that contribute? to this problem that you're describing here. Oh, it's such a good question. My book is actually on walking,

so I have some great stats for you. The average American gets about 4,500 steps per day. And, you know, one of the things I'm going to be talking about is kind of debunking the whole 10,000 step a day thing, because that was actually just a Japanese marketing campaign to sell a pedometer. When you look at the research of steps per day. If the average American, for example, is getting 4,500 steps, that means the 50% of us are getting less. And that is not acceptable. When you look at just increasing step count, for example, the research will show you that increasing step counts to even 4,000 steps a day, if you're not there, can decrease your risks of dementia. That is massive. Increasing step counts to between 6 and 9,000, very good research on decreasing your risks of cardiovascular

disease. The research is coming that just becoming a little bit more active than we are. We're not saying everybody has to go grab 10,000 steps because even if you just increase it a little bit, you're going to see better or less diagnoses of dementia, neurodegenerative diseases, less cardiovascular disease. And yeah, I mean, from a walking perspective, it is a low-hanging fruit and all of us can be doing more of it. Give us some of the top signs while we have our audience's attention that they're wearing the wrong shoes. And maybe even for some people, they've been wearing it for years. What is the type of dysfunction that you see in the office when you work with patients? What are the top things that you see that are going wrong with people's feet that immediately tells you,

hey, this person's wearing the wrong shoes. Yeah, I think there's a lot of things to consider here. I think the biggest, my biggest non-negotiable, as I will say, is how much width does the shoe allow for the toes? So there is a very big difference between a wide shoe and a wide toe box. Because you can go on to most company's sites and they'll say, oh, but we have this in a wide version. and the widest part of our foot should be our toes.

So that's where the splay happens. And, you know, this is not a trick question. If you were to balance and splay your toes or wear like a toe spacer, like which I wear all the time. I have little things here to show you. You have toe splay. Is it going to be easier to balance on a foot that is splayed versus if I took a rubber band and wrapped it around my toes, right?

People should be going, oh, yeah, that makes perfect sense. So when you look at a shoe, it should be wide at the toes to allow for that toe split. If it's just wide where the metatarsals are, right, or the ball of the foot, but it tapers at the toe, you're basically taking your toes and you're squishing them at the top. Or bunions, for example, if somebody is dealing with bunions, is that an immediate indication, whether they're aware of it or not, that, hey, we need. to be addressing your foot health, but a huge part of that is re-looking at what shoes you're using on a daily basis. Yes. You know, there's a big conversation of are bunions a result of footwear?

Are they a result of your grandmother had a bunyan? There's always that conversation. And the way I like to educate on that topic is that one of the things I love about the foot, is it's the only place in the human body where you can see a barrent load or abnormal load because you don't come out of the womb with a bunion. You don't come out of the womb with a hammer toe. In fact, you come out of the womb with this

little foot with a nice toe splay that's screaming. Every baby in the world wants to take their socks off, take their shoes off, to gather information to stimulate their nervous systems. So when we go and try to restrict that environment with footwear, you will start to see changes to the structure of the foot. If your grandmother or your mother has hypermobility, for example, that can be a predisposing factor for bunyan development because there's a lot of laxity to your system.

If you think about it in this perspective, if you knew your grandmother had heart disease, right? You have a family history. I have the heart disease, diabetes. What are you going to do knowing that? Well, I might take preventative action like exercise more or watch what I eat. So if we know that, that my grandmother has a bunion, regardless if you think it's genetic or not, take the appropriate steps, which is allow your foot display. Don't alter the structure of your foot. And I think the key is with the kids. Start, start young so that, you know, you put me out of business. Let's zoom out a little bit. Give us a little bit of an anatomy of the foot. You know, you know more about the foot than anybody that I've met or heard of.

Help us understand these intricacies around the foot. In particular for our audience that's trying to understand how foot health is directly connected to our overall health of our body, our brain, and of course, longevity. What can you share with us? We have four layers of intrinsic muscles in the foot, which I don't think people think about that. Like, just in the bottom of the foot, there are four layers of muscles that flex the toes, extend the toes, splay the toes. And When we have a strong platform from the ground up, not only does it create efficiency when we walk, but it also provides this kind of stable platform for everything above the chain. When you think about walking, for example, when we walk, we have four to six times our body weight going through our foot.

Our foot was beautifully designed to handle loads. In fact, that's when people say, well, does my foot need an arch support? It doesn't if it's splayed and it's strong. But when you start altering the mechanics of the foot, whether it's through footwear or what have you, then yes, you're going to need to support because your foot isn't strong enough. And you're altering what that foot looks like within the shoe. So, you know, from a strength perspective, we have a lot of opportunity here to get stronger. I think, you know, the other thing to consider is how much the foot moves, mobility. The big toe is, you know, to me it's the most important joint in the body, but I'm a little biased.

We need to have 40-ish, you know, 40, 45 degrees of range of motion out of that big toe. That thing better be moving well in order to progress forward when we're walking. And so when we start to get a stiff big toe, you're going to steal range of motion from somewhere. And so that's when you can start to see changes in people's gait. You know, if we were to look at things like ankle mobility, walking up and down a stair, sitting into a chair, getting up and off of a toilet. You want to talk about longevity, it requires foot and ankle strength and mobility to get up and off of a chair. And I think these are things that we forget. get about and they have a profound effect on not only what's happening today, but down the road.

With the feet gathering and the toes gathering so much information about our surroundings, and you've already talked about the fact that incorrect footwear, which is what most people are wearing today, and we're going to get to what better recommendations you have for footwear in a minute in a minute. But with the feet gathering so much information, is it fair to say that when we numb it through this sling, to use your term, you know, this very cushiony footwear that bunches up our toes and causes a lot of restriction, that there's less information that's coming to the body and especially the brain. So is there a relationship between foot health and brain health? That whole conversation of cushion in, I view the foot

is a sensory organ, you know, that it's, we want to be able to feel as much as we can. In the more sensory information that we can beeline to our brains, the better motor output we're going to have. The areas of our body that have the most, what I call real estate in the brain for sensory information are the hands, the feet, and the lips. We have the most receptors, sensory receptors, that can send information to our brains and a lot of them live within the foot. So it doesn't make sense. to me why we would want to dull that or decrease the sensation. I think when you look at balance, balance, walking is single limb support for 40% of your gate cycle. So walking, you know, you need to have good balance to walk. If you were to think about walking or, excuse me, balancing with your

foot on the ground, not having any material, if you will, your barefoot on the ground, versus balancing standing on a cushion or a pillow. Even my patients in significant amounts of pain can always balance better when their foot is on the ground because there's nothing interfering with what they're feeling. And so it brings up a very controversial topic, I think, which is cushion and footwear. You know, I have a lot of patients.

They'll say, I have knee pain and I need to wear these cushioned shoes. I always talk about a time and a place in having a shoe spectrum, if you will. Because if I were to sit here and tell everyone, you need to be in barefoot shoes all the time and this is an always or never type of situation, you're going to lose a lot of people because most of us have not had our foot on the ground.

Most of us do not have strong feet. Most of us have not put our foot barefoot on the ground. So for me to say that to people would be a disservice. But what I will educate on is that if you look at a pie chart, for example, on one end of the spectrum where I would like to see the majority of, you know, the pie chart, is a shoe that allows your foot to get stronger. When you're in a more minimal shoe with less cushion, you have more load. going through the foot, more load going through muscle, tendon, ligament, bone. And I will tell you, and most people would tell you when they first start wearing this,

it's not as comfortable. Right? It's like, why would I go and wear this shoe that's, you know, very thin and I'm walking around and it's not comfortable? When I can wear this cushion shoe with a nice toe spring, and my answer to them is nobody gets a free lunch. When you cheat the system for a long time, expect there to be some type of sequela. Have a larger piece of your pie chart wearing a shoe where you can, you know,

get stronger. And then when there are times where you want to hike for longer distances or walk on a manmade surface, you're in a museum, help yourself out and wear a little cushion. It's okay. I want to share my own little anecdote on this topic and then I want to hear your story. And my audience is very curious about your story around this. But for years, I was having this chronic knee pain that I just thought that was coming from, okay, I'm in my mid-30s. now I'm in my later 30s. And then one day I had a dear friend of mine visiting the U.S. from the UK, Dr. Rungan Chatterjee,

and he has a relationship with one of the barefoot companies. And he was saying, you know, I had some knee pain as well too. And when I switched to these barefoot shoes, these minimal shoes, and there's a whole bunch of them that are out there. In this particular instance, he was talking about this one particular brand called Vivo Barefoot. And he said, why don't you try them? And I'm always somebody that loved being barefoot. You know, I loved being barefoot.

As a kid, as a, in middle school, in high school, it's any opportunity I could. I would love to be barefoot or I'd love to wear sandals, something that didn't interfere too much. I actually genuinely felt more grounded as an individual. And because I'd been wearing these very cushiony shoes for such a long period of time, I thought, okay, I'm willing to try this, but how is that my foot could be dealing with my knee pain? And I switched to them.

And in my particular instance, they actually felt great right away. And then within a matter of week, this chronic knee pain that I especially was happening on my right side just started to go away. And then it's never come back since except when I go and I'm luckily to be invited to a wedding. I'm always happy to go to a wedding, and I have to wear dress shoes, and I'm dancing all night on the dance floor. That same knee pain from wearing these very tough shoes with the heel that are constricting my toes, that pain that has been gone for years, all of a sudden comes back. And I can tell you that I've heard this story with so many individuals, including many of my audience, members. And I'm sure you've heard some version of this too as well, Courtney. I'm not one of your

patients, but what would you presume was going on based on these patterns that you've heard from me and other people that have come to you? I love these stories because, again, it's very counterintuitive. And I love, it's like challenging people's biases because we've been so biased to think that this cushioned footwear and more support is going to be better. And if I had a penny for every time I heard one of those stories, I can probably retire. When we think of footwear and what happens when our foot, when we're walking, for example, our heel bone has been designed. It's beautifully designed to feel the ground. So we have receptors in the heel that tell us, for example, how heavy we're hitting the ground. How far away from our bodies we're hitting? Are we hitting real hard?

So it's, again, the foot is giving us information on how to walk, if you will. So when we have cushion or something that's interfering with what my heel should be feeling, can I hit the ground hard and hot and heavy? Yeah, because I can't feel anything. So when we think about knee pain, for example, if I'm walking and or running and my foot is striking all the way in front of me instead of close to my center of mess and I'm hitting hot and I'm hitting heavy and I don't have any information coming to my brain, then I'm going to have more ground reaction force going up through my knee and through my hip. When you take away the cushion

and you take away the support, if you were to walk outside on the concrete right now with no shoe on, you would adopt a softer gait, right? You would maybe graze your heel. In all of those things, create a more efficient walking gate. And then my foot can pronate or unlock. Then my lower leg can internally rotate. And then everything above the chain starts to do what it's supposed to do. And so when we start interfering with that, then you can start to see these things. Hey, I have knee pain.

Well, are you hitting the ground too hard because you can't feel where your foot placement is? Because that's a possibility. Is it interfering with your sensory acuity because you can't use your appropriative system because the balance is being altered? So there's a lot of things that happen when you put more stuff between the sole of your foot and the ground. Before we just touch on your checklist for, you know, appropriate shoes, knowing that people may not be wearing barefoot shoes or minimalist shoes all the time. You've already made that caveat clear. Help us understand, just like I had my chronic knee pain, give us a list of other things that you see people coming to you with,

that they're complaining about X. But when they get to the root of it, the downstream issue, and they fix their foot health, they get stronger, they get the right shoes, that thing starts to go away. So I had this chronic knee pain. What other examples do you see out there that are tied back to the feet? Ankle mobility is very important. We need to have it to walk.

We need to have it to sit up and down a stair. When we have restriction in our ankle mobility, we're still going to get from point A to point B. We're just going to steal it from somewhere. So if you look at the three most common places to steal it from, one would be, I'm just going to pop my heel up early when I'm walking. So we call it an early heel rise. So that could lead to things like ball of the foot pain, right?

So neuromas, any type of four foot pain because I'm loading too soon. It could lead to things like planar fasciopathy, Achilles issues, because I'm altering load. I'm lifting my heel up too early. The other thing that could happen is I might hyper extend my knee. So if my ankle was restricted, I might straighten up my knee to propel forward. So patients will. say the back of my knee hurts. My knee feels unstable when it has nothing to do with the knee. It has something to do with their ankle mobility. And if you wanted to take it one step further,

low back pain, if I have someone who cannot dorsi flex or move their ankle when they walk, they'll sometimes just use their body weight to progress them forward. They'll tilt forward so they can have gravity help them. And then they'll tell me they have low back pain. So three different areas of the body. Heal, they can have heel pain or forefoot pain, knee and low back, all stemming from a lack of range of motion at the ankle. And that's just the ankle. You know, we have a big toe. All of these things can have, you know, can present itself with compensations above the foot and ankle. And so when you allow the foot and ankle to do what it's designed to do, more movement variability, you have, you know, better options.

options for motion and less pain. Can you talk a little about your story and your history of foot health and how that led to this calling where you are here dedicated to help people address their gait to ultimately end up living a happier and healthier life? Yeah, I'm kind of on a mission with this stuff. I grew up, you know, as an athlete, I was a dancer. I was in point shoes a lot. I started to form bunions at a very young age.

As a ballet dancer, that's correct. As a ballet dancer, yes. And then I, you know, stopped doing that. And then I was a runner. And then I became a triathlete. So a lot of, you know, time on my feet, poor, poor ill-fitting footwear. I never paid attention to strengths or mobility at my foot. I just never did.

I never even knew to do that. And so I was in pain and I was like, you know what, I'm going to go to school. And, you know, for selfish reasons, I think when we have, you know, we're always trying to fix something. So it was like a personal quest of mine to figure out like, I want to maintain my activity. And so I went to school. And we had, I think, half a semester. of foot and ankle education.

And it was basically, if your foot hurts, wear an orthotic. And if it hurts bad enough, go get surgery. And those are really the options. And what's crazy is with all the patients that I see today, those are a lot of the options that are still available. I went and I was offered in orthotic, and it didn't work, so I was offered surgery.

And I just don't accept that anymore. Because there's way, way too much we can do. So I kind of went on this, you know, self-exploration. I worked in two orthotic labs. I was constantly trying to like tweak my, you know, own orthotics, get people to help me. And nothing, you know, I'd have a little bit of symptom relief, but nothing really started changing things until I started viewing the foot like I viewed everywhere else in my body. I would, you know, strength train my legs, my upper body. and I would never strength train my feet.

And so when I switched gears and started doing all that, things got better. And I was like, I need to tell a lot of people this. And I think the bonus on the other end of that is walking to me, one of the reasons I live in Colorado is if I don't feel good up here, if I'm having a bad day, I go walk up that mountain. And if I'm still having a bad day, I'll just keep walking. And so walking for me is my piece of mind. it centers me, it grounds me, I think it makes me a better mother, it makes me a better boss.

When I don't and I'm not able to do those things, everyone around in my sphere, I think, suffers. And it breaks my heart when I see patients that can't be able to do something as simple as going outside and taking a walk, not only for their physical well-being, but their mental and emotional well-being and it's coming because their foot hurts, I want to help people not have to experience that. That's powerful. You know, only because you mentioned it and a few things that I want to tease out from your story, are you familiar? I'm sure you're familiar with the work of Francine Shapiro, EMDR. Yeah. Would you mind just, could you share a little bit with our audience who maybe might not be familiar about how things like walking are like deeply connected into like us feeling good.

Well, from what I understand, I've been doing a little research on that actually for the book as well. And correct me if I'm wrong. Didn't she develop EMDR when she was actually out going for a walk? Yes, that's correct. There's there's so much that can we can look at and gain from simply walking. it's such a low-hanging fruit. And if you look at all the research that we've talked about today, from dementia to cardiovascular disease, to looking at the strength and capacity you can get from the ground up by walking,

I'm just so, I want to encourage people to look at that and say, this is an underrated form of exercise. I want walking to be viewed as a physiological need, like breathing and like sleeping. not as this is something, you know, that I can do if I want. It's a physiological necessity. And it's something that I think is inclusive, not exclusive. There's not one person on this planet that cannot use walking as a form of calming things down,

amping things up, whatever they need it for. You know, and obviously we have our compromises with things. but I think for the majority of people, it needs to be something that we take seriously. You know, another part of your story that I want to talk about, and it's a little bit controversial, but I want to get your take on it. You know, there was a long history where parents who had their often young boys playing football, tackle football with helmets, there was not the awareness that, hey, some of these really hard hits, even from a young age, could be contributing to poor brain health, overall health over the years

when they're repetitive. And there might be some young men especially that could be more predisposed. And until that conversation really started and families had sort of informed consent because most kids were too really young, they just wanted to play and put in the sports, do you think that there is a parallel example to that to sports like ballet or young pageantry where you have very young kids in high heels, girls, of course, often, where you are causing so much damage to the foot that from a young age, young women especially, are developing these foot issues like Bunyan's, like you developed, that could have lifelong impact.

How do you see that conversation today? And what do you want parents especially to know about these decisions of what activities and sports and things they're putting their kids in well-intentioned, but they may not understand the repercussions? That's such a good question. And I'm very glad you asked it because I think, as I educate on this material, one of the biggest things that I'm going, that I'm, that I'm, that I try to do is not instill fear amongst people with what they're doing. And I think especially with parents with children,

when they're in ballet or they're in football and they have footwear, for example, like cleats or ice skates or point shoes. It's the task that is necessary to do that sport. On the other side of that, It's the awareness that comes both before and after. If we're going to have our kids in footwear that's going to restrict their feet, right? And potentially be a contributor to Bunyan's, for example. When they're not in the point shoe or they're not in the cleat, that's when it's time. Here's the pie chart. Let's go back to that shoe spectrum.

They wear shoes that allow their toes display, for example. that allow their foot to bend and move. And I think that's how we work around saying, hey, rather than we don't want your kids to do ballet, we don't want your kids to wear cleats. That's not reality. And nor do I agree with that. I mean, people always ask, well, how should I sleep?

I'm like, sleep. I don't care if you're on your back, on your side. If you rolled up in a ball, get seven to eight hours of sleep. And it's how I feel about movement. Like, you got to move. You want to wear a cleat and run and play football? Great. You're moving. And it's outside of that environment. You know, simple things. I'll tell my 13 year old when you're brushing your teeth, balance along your right foot for a minute and balance on your left foot for a minute. You know,

keeping it, you know, fun and not making it a thing. And I think that's really important because and we use things like, you know, these words are very important. I don't want to instill fear. Like, if you do this, this is what's going to happen. It's let's just see how we can work with people's behaviors and create as much success as we can outside of the cleat or the point shoe, for example. So let's take that theme back to the first question and idea that we started all this podcast with, which is you gave us a list of the top reasons that people,

people have poor toe health and overall foot health. Take us from beginner. We've already talked about the shoe topic and we still, you know, we're teasing it out a little bit, but we're going to get into your shoe rules that are there. You've already talked about the wide toe box. That's a non-negotiable. There's a few other things that are there and some brands that you've recommended over the years. And you have a full list that will link to your website as well.

But take us from beginner to now more. advanced in terms of people getting serious about training their feet and their toes the same way that they want to get serious about it like doing strength training. So what's the beginner way that we can start building up to stronger feet and toes? And then what's the intermediate? And is there something for the advanced individual? Yes. So when I'm first evaluating someone, the first thing I want to see that they can do is have good toe dex. can they move their toes and their feet like they can move their hands so for example i'll have them stand and i'll say can you lift just your right big toe can you lift just your left big toe

without the other toes coming up can you lift your four toes can you lift all your toes and spread them and reach them forward and oftentimes people will not be able to do this it's like there's a connect between what I'm telling them to do with their foot. They're trying to do this. And their motor output, there's like static on the cell phone. They are not getting a clear message on how to move their foot. You have to start there. You have to start with just driving information to the brain.

And it's always interesting because typically on the side of the foot or the side of the body that I will note pain. so if someone comes in with heel pain, for example, almost always, they don't have a good toe dexterity, they don't have a good strength, there's just a high correlation between can their foot do what it's supposed to do and symptom. So that's kind of entry level stuff. Then we'll look at things like toe strength.

In my office, I have, it's a dynamometer, so you can actually look at the strength of the toes. So our big toe, we should be able to, able to produce about 10% of our body weight. Big toe is that's the when we're walking. Our majority of our body weight is going through our big toe. We better know what it's doing. We better be able to feel it. And we better be able to have strength to be able to push off of it. Then we also can measure the strength of the four toes. If they're not hitting those numbers, and I really like that test because it's an objective measure. Pain is a poor objective measure.

You break up with your girlfriend. You have a bad night's sleep. Your pain. is going to be higher. But objectively, when I look at your toe strength, what is it today? You're going to do this stuff. And then what is it tomorrow? It's a good measurement for me moving forward. So then we can look at things like banded toe work. And then as they start to get stronger, we want to make movement meaningful and functional. If I'm working with a runner, then I want to make sure they have a lot of calf strength because now those numbers that I mentioned, four to six times your body weight going through your foot when you walk, they jump up to 11 times your body weight when you run.

So doing banded toe exercises isn't going to cut it. You have to progress. So things like calf raises with load. And if you want some fun numbers, if you were to look at there's a return to run, Dr. Peter Maliaris has done research on this, a standing single leg calf race, half your body weight six times. So you're standing. So this typically people will be doing this at a home gym or a gym.

and they're holding weight, right? And they're standing on one foot, and they're now trying to do a calf race. And you should be able to do half your body weight. Half your body weight six times. Or building up to it. Is that an entry level or is we want to get to that place? Obviously, every person is going to be different.

But is that like a goal or is that like, hey, we should all at least be able to do that. If we don't, then we need to go and find somebody to work on our foot health, a professional like yourself or your team. to help us correct some imbalances that are there. That's cool. That's like return to sport. Okay, got it.

I have a chart that looks at, and I can send this to you, so you can put it in the show now. It says each decade of life. So in our 20s, males should be able to do around, this is body weight stuff, around 40 single leg calf raises. And I get picky because if it looks sloppy, if the timing is off, then I call it. But in our 20s, men 40,

women a little bit less. And then each decade, there's research that will say, this is how many calf raises we should be able to do. And I will tell you, in the 25 years I've been doing this, there are very few people. And I mean from a professional athlete to, you know, all across the board, that can rarely, rarely do I see those numbers hit. And that's body weight. Because I just think from the knee down has been so ignored from not only a perception perspective, but also strength. So being able to assess single leg calf raise, toe strength, all very, you know, I think easy ways to assess in build off of.

Some of that advice is things that people can do if they come and see you in person and to get an assessment. Is there the, I'm going to loosely call this, that at home do it yourself version of assessing and then for most of our audience, that's just working on making sure that they get there at least, you know, 8,000 steps a day because they realize they're a little bit more sedentary or they're just starting to train for the first time in their life after not prioritizing it.

People like my mom who listens to this podcast, I'm cheering her on. I see her working hard at LA Fitness with her trainer. What are the things that they could be doing, exercise, assessment, or even just basic things to make sure that their foot health and toe health doesn't fall behind as they're starting to put attention into becoming stronger. Yeah, I think so at home. Obviously, most people do not have a toe dynamometer at home to measure those exact numbers. But I will have, you know, you'd need two people. You'd have someone sit in a chair, have their foot directly underneath their knee.

And then you would take a card, like a credit card, for example, and you put it underneath the big toe. You try to pull the card out and the person who's sitting in the chair tries to press the card down. Obviously, you're not going to get a number here, but you should be able to feel tension in the arch of the foot because you're engaging the muscle in the foot. Then you can take that credit card and you can put it underneath the four toes. Can someone keep that card? Can they feel tension in their feet? foot. By the way, fun fact here, the muscle that presses the four toes into the floor, flexor digitiform brevus, weakness in that muscle is a very big predictor of plantar fasciitis.

When we look at these things like strength of the big toe, strength of the four toes, not only are they creating a better environment for our foot, but they can also be very impactful on preventing diagnoses at the foot like heel pain. So that's something you could do at home. That lean test, right? You know, you'd have to go get a little, one of those little laser construction laser things, but you put it on your belly button, you lean into the wall. You want a difference of four and a half inches.

Okay, so you're standing against, you're standing upright. Yes. And you're leaning towards the wall, but you're not smacking your head into the wall, right? Yes. And if you think you are, just put out your hands and obviously brace your fall, right? We don't want anybody getting hurt over here. And your goal is with the strength of your toes and the muscles that are supporting them in the feet, you're trying to lean enough like Michael Jackson style, not all the way down, right?

You're trying to lean enough Michael Jackson style to have what you're saying is lean forward at least four and a half inches. Four and a half inches is what we're looking for. Okay, got it. And for some people, they might only be able to do an inch. And that's fine. If they start there and then how do you build it up? Is there a protocol of how often you might be able to do that to strengthen that?

Is it 10 minutes of that activity a day? Is it, well, what's your recommendation? If we were doing banded tow work, for example, because it's lower load, right? You're just using a band. I would say like 40, 50 reps on the big toe, 40 on the little toes. And you're doing that every day. It literally takes maybe two minutes, three minutes. So in your wind down routine as we're all getting ready for bed and trying to lower our heart rate to have a good night sleep, just in your room with the lights dimmed or your red lights on.

If you're trying to protect your circadian biology, you could just be doing a little bit of this on the floor while you're talking to your wife, your husband, your partner, just reading a little bit. Do you have a video of you doing banded footwork for people who like really need an instructional? Yes. I have a ton of videos. I've actually designed like a whole 12-week fit-feet program because these are the questions we get. So we start with awareness. Then we look at banded stuff.

Then we look at more balance. Then we look at strength of the entire chain. So it really progresses nicely. You know, other little easy wins are like keeping a ball underneath your desk when you're at work because you can roll the bottom of the foot. You can take the ball and extend your toes. All these little things help immense. and, you know, I think another very low-hanging fruit.

If we were looking at how do we implement getting our foot stronger? If you are new to the whole minimalist shoe world, I would start small like 10 minutes a day. And you go and put on a shoe that's minimal, where your foot can feel the ground, the soul is thin and flexible. is bendy. The toe box is wide

and you start by a 10 minute walk because there is research. Sarah Ridge did a bunch of research we're just wearing a minimalist shoe showed increase in those intrinsic muscles

of the foot. So if you wanted to do nothing else, go slowly and just start with 10 minutes a day. You will get sensory information. You will start to form foot strength. And then you can see how you feel that night. You can see how you feel the next morning. If things are going pretty good, you slowly start to increase your time. You increase the pie chart. So that more time ends up with you in an environment where your foot is helping you or your footwear is helping you, not deterring your function.

And I think that's a, you know, for people who don't want to be like, well, I have to do X, Y, and Z, that's an easy one right there. That's great. I love that recommendation. That's something that everybody can do. Since you were holding up a shoe, and for those that are listening that are not watching on YouTube, Courtney was holding up a shoe and you were bending it. Give us some of the other properties and just repeat it again of what we should be looking for. Is there terminology that we should be looking for? and I think you have a list of the different brands that are out there that you recommend.

Is that correct? Yes. I think one of the most common questions I get asked is what type of shoe should I wear? It literally, in my evaluations, it's not only this gate assessment and physical assessment, but it's also a shoe consultation because people need to know what type of shoe. What is their entry point? So when you look at footwear, my non-negotiable, like I said, That is the toe box.

So I want a wide toe box, different than a wide shoe. I want the toes to be able to display. It will improve stability and it aligns the foot better. It aligns the toes better. Yeah, a lot of the big shoe brands that we all know, some of them rhyme with Mikey and other things like that. They all have wide shoes. But again, you're talking about a wide toe box that's different than that you're

just wide shoes, just so everybody's clear. It is a very different animal. I wish they had different names for it because they're not even the same, remotely the same. You know, in some of these companies, as before mentioned, one in particular just came out with a toddler shoe. And in the research, in the way they're selling the shoe, they're like, we are going to, we've paid attention to the research.

And this shoe will help your child's foot develop. It has a wide toe box. It has a thin, flexible soul so that the foot can move. I mean, there's many joints. When the foot can move, we have health to our tissues. So they designed this toddler shoe that was like, it's wide, it's thin, it's flexible. It's going to help development. And I'm like, why are you stopping at the kids?

Then why do you have to like change you with all of us adults going back to rigid and stiff and narrow? And what do you think it is, right? there's always a, is there a big shoe conspiracy or is it just economics? You know, when a lot of people look at a lot of these minimalist shoes and I hear from the females in my life, often they'll say, even though they hear my story, countless stories out there, they've heard you on Peter Atia's podcast. They'll visually look at the shoe and I'll say those look like clown shoes. I'm not going to wear them.

I'm sure you've heard that many times before. I mean, even my brother, I mean, my family, like my brother was in New York City and he's like, I will not wear those shoes. And so this is why, you know, I talk about having the pie chart, you know, and like the shoe spectrum, because if we're going to win the, if we're going to win the fight here and get people stronger from the ground up, I have to meet people where they are. Start small. Like, I told my brother, just get a pair of these shoes.

and wear them to the park with the kids. That's all I'm asking you to do. You don't have to wear them out when you go out at night. You don't have to wear them to work. Just start with a little bit. And then what happens is I can usually keep my mouth shut because once you put your foot in an environment where your foot is comfortable,

where you start to get stronger, then my patients tell me, you know what, I started wearing that shoe longer. Or things started to feel better. And then I don't have to fight the fight because they make it, they make it easier. But yes, I mean, it's the function over fashion thing. I mean, my 13 year old comes home and she's like, you make me wear these platypus shoes and all the other kids get to

wear, you know, and I'm like, but she now, I don't say anything now. And I let her choose. And the days where she's going to go play outside or she has sports after school, she never wears the fashion shoes. And I think we know which ones those are. She'll always pick the wider toebox, the shoe that's more comfortable. And that's where I think the win is, because you can't argue comfort and there's nothing more comfortable than a shoe that's going to allow your foot

to be in its natural position. Yeah, one trick that I always have for my friends that are getting serious about strength training, resistance training, for the first time in their life, they're in the gym, that's often a great place to introduce these barefoot and minimalist shoes because, first of all, they'll realize that

if they're working with a trainer, almost every single trainer that I've met in Los Angeles that knows what they're doing is wearing one of these shoes. Yeah. They're wearing the minimalist shoes. All my trainers have worn them, and they're all hip to that idea. And they see how much better they perform,

my friends who are getting serious about strain training, even if they're completely beginners of the space because they see the balance that plays a role in a deadlift or a leg squat, the stability that's there, the ability to have range of motion for the ankle and not be so claustrophobic like some cotton, so like some coffin or a cast, and then people start to bite the bug a little bit.

I have some friends that will only wear the minimalist shoe when they train. And I'm like, okay, if that's all I can convince you to do, that's good enough. And maybe one day you'll evolve your thinking from that. It's like better than nothing, you know? It's like, it's better than nothing. Yeah. Do you want to just mention because people are listening. They might be working out. They might be somewhere. People forget to take show notes sometimes. But they'll remember, just do you have any favorite brands that you feel like you want to at least give an honorable mention to that come up regularly?

And I'll add one more component. The other thing that I think that's happening is these brands are all working very hard. And the design and the fashion is getting so much better than it was even like five years ago. Like, there's friends of mine that have minimalist shoes where I'm like, that does not look like a minimalist shoe. And it looks fashionable and it's also obviously functional. I know you have a role to play in the community where you're not trying to play favorites. But are there any brands that you feel like at least giving a mention to? I want to kind of speak to this shoe spectrum. In the truly minimal shoe world, which is thin, flexible sole, wide toe box in what is called a zero drops,

so the heel sits on the same plane as the toes. Shoes like companies like zero. This is a Belenka. I have bunions from my dance careers and things like that. So everyone who kind of follows my work, that's one of the reasons why I do all of this. This is one of my favorite brands because it is one of the wider at the toe.

I have shoes here for it because you were going to ask me that. Wildling is also, These guys are great. This is a great shoe. I mean, this is a, I'm rolling this thing up in a ball shoe. People will adapt. They will be able to get, and people look at this sometimes. I can't believe.

I could never wear that. And my response to them is your tissues and your bodies will adapt. They get stronger. They will start to move better. It's just time. Vivo barefoot. That's kind of your OG. You know, so this is my like, if I can't be barefoot in my gym,

this is one of my favorites to wear in the gym. Moving along the spectrum, if this is newer for you, my non-negotiable is the wide towbox. So brands like Ultra, ultra running in Topo Athletic, they still put your foot in a wide toe box, but they might have more stack height

or cushion underneath the sole. So that might be a nice transition into different footwear, into more functional footwear. So Topo, for example, has wide toebox, but they also have a 5 millimeter option, a 5 millimeter heel drop. So the heel would sit 5 millimeters higher than the toes.

So if someone has really poor ankle mobility, and they come into my office with an Achilles issue, then I'll get them in the wide toe box. I might start them in the five, I'm working on shoes or icing on the cake. It's what you put into the shoe. That's very important. If using going out and buying a shoe is going to solve all your problems,

you got to think again. So we have someone that's in a 5mm drop. We work on things like foot strength, loading for the Achilles tendon. Their foot starts to feel better. Then I can drop them down into a 3 or even in a 0. And then we can get them in the minimal shoe world. Why?

Because I have more load going through my tendons when I'm in a minimal shoe. What makes tendons healthy? So it's this beautiful progression where you can grab people and put them in a safe environment where they feel safe. They're controlling things. And as they start to get stronger and as they start to improve their mobility, then you can really start to work them down the spectrum. And that's where I think you get that payoff,

where their function is just spot on. You know, you mentioned something earlier that I'd love to just come back to now that we've addressed the topic of shoes. And you mentioned the idea that the history of the 10,000 steps a day was really this thing that came out of a Japanese marketing campaign for pedometers. And yet it is, in the zeitgeist, and you do often hear people because it's a round number, that just loosely

say, like, it's something to shoot for. It also helps slash doesn't help that, as you mentioned, most people in America, their average steps when they track, and people are still so surprised, there's even people that are listening today that think that they're getting more steps than this, but when they actually track, they see that their average steps in a day are 4,500. So, even if it's from a marketing campaign, maybe it doesn't have any real science, is that something that we should shoot for? And if it's not,

what should be something that we can shoot for knowing that walking is one of the most basic aspects of something that we don't want to lose as we get older, not just in our ability to do it, but in the quantity of steps and range we have in our life? What do you recommend to the people that follow you and the patients that you work with in terms of what should be their target? I think you bring up such a good point is people don't know unless they're tracking the amount of steps they're taking per day. Because there will be days when I'm in my office and I'm like, I feel like I've been moving back and forth all day and I'll be at the end of my day and I'll look down.

I'll be like, wow, I've only had 3,000 steps today. Even though I've been busy, you don't realize how lack of walking you actually. actually get. And I would argue that any increase, if you can find your baseline, so what would be your baseline over the week during both a weekday and a weekend? Increasing it by just a thousand steps a day can have profound effects on your health, both from a cardiovascular perspective, as well as neurodegenerative dementia's. In 10 minutes is about a thousand steps. When I get home from work. If I know I've only had 3,000 steps, you bet my dog, Hallex, we're going for at least a 20-minute walk so I can get two more 1,000 steps. So being cognizant of that,

I think is really important. And I think it's attainable when you look at the numbers we're really trying to hit. I mean, when you get to 3,800 will be days, decrease your risk of dementia by 25%. 3,800. We're not asking for 10,000. If you wanted to hit 10,000, which I'm all for, you decrease your risk of dementia by 50%. So point being, if you keep, I love this kind of spectrum idea, wherever you are, if you just increased it a little bit, you're going to get benefit. And that's how I think we make this attainable rather than saying you got to hit 10K every day because there are benefits at less.

What are the top lifestyle hacks that you recommend to the patients that come in to see you who maybe are more on the sedentary side where they're like, listen, I believe this. I want to prioritize the barefoot shoes. I want to prioritize the activities. I just need some suggestions. Call them for a lack of a better term, lifestyle adjustments, lifestyle hacks to make sure that I get my just choice. general activity and step count up?

What are your go-toes in terms of things that make this a habit so that people can keep those steps up for the long term? I love that you said habit there because I think even when we're dealing with patients and people and pain, it's not necessarily a magic exercise that gets people out of pain. It's changing behaviors. It's changing, you know, incorporating easy things that become a habit. So from a walking perspective, if we know that in just 10 minutes, I can grab a thousand steps, you have to make it organize your day.

I'm going to do 10 minutes in the morning and I'm going to do 10 minutes at night or at lunch. After eating, great time for walk. If you wanted to amp up that walk, try to keep your mouth shut, right? So nasal breathing when you're walking. and that brings a whole other kind of component to things. If you wanted, if you're introducing minimal footwear, have one of those walks with the footwear on. You know, there are so many benefits to just blocking those two pieces of time out.

And I think it's an easy, I think it's an easy when. I love that idea about walking after meal because we've talked a lot about the benefits of helping with blood sugar balance. and one of the easiest things is, regardless of your diet, is just walk after a meal. And it's nice because we tend to forget if we just randomly say, well, I'll go on two additional 10-minute walks in the day. If we don't have anything to anchor it to,

it's so easy for us to forget. But if you say, hey, after I eat, if I have a lunch break for 30 minutes or an hour, whatever it might be, I'm going to take 10 minutes. at the end, finish up a little earlier, and just go on a quick little loop around the office or a quick little loop around the neighborhood. And you get the blood sugar impacted that. You get the step count impacted that. Not to mention, you get the mood boosting from being outside in that sense of feeling the progress, which was something that you were talking about earlier. My favorite time

for walks is sunrise. It's like my thing. My daughter's still sleeping. I wake up and I'm outside. 165 days a year. And it literally, the days if I miss it, it's like, I just feel it. And I think when you get into those little habits, it becomes, you do start to feel so good. And I really think if we looked at walking as a physiological need, like we sleep and like we breathe when we focus on our breath and we make sure we get seven to eight hours of sleep, we feel better. And if something as simple as walking can start to facilitate and make us feel so much better and it's so easily accessible for everyone, 10 minutes a day. And, you know, as the sun's rising, it's a, it is an easy one. According to the context of this conversation, we've covered so many things. Is there anything

that you feel, especially for the individual who is at the beginning stages of wanting to prioritize foot health, toe health that we didn't cover. Just wanted to give you an opportunity. And I know we covered a lot. So the answer maybe no. But is there anything else that we did not touch on that's important for people at the beginning stages to know about? I think looking across population with kids, I just want to stress how important that is

with our kids. Because I think that's where we really have an opportunity. They haven't been on the planet long enough to hopefully start to have. structural changes within the foot and things like that. So if we can implement some of these things, getting kids in footwear that allows their foot to develop naturally the way it should, I think we will save a lot of problems in the future.

And then on the other side of that, looking at our geriatric population, I think, and unfortunately, we tend to treat geriatrics with, like, kids' gloves. Like, you know, they should be doing cherry yoga. That's like, no, weight train, strength train. From a foot perspective, take the shoe off.

It's okay. Walk around your house for five minutes. Small little novel stimulus to their brains can be extremely important, especially if we know how important it is to stimulate receptors on the foot and improve trips, toe strength to prevent these falls as we age. And I think that would go a really long way. Before we talk about your clinic and some of the other great things that you're up to, just want to get your perspective on one other aspect.

How bullish, not bullish, are you about the grounding movement? So on one hand, of course, people are outside putting their barefoot on the earth. Do you think that there are healing benefits to that? Are they overblown? Are they overhyped? Are they underhyped? What is your own personal opinion on that topic? You would end with like the most controversial topic in like the barefoot community.

Here's always how I answer these questions, right? The people who are big believers in the whole grounding, like my foot is on the ground, they feel better when they do it, right? Or they wouldn't be doing it. They feel that when their foot is in contact with the ground, they can feel the ground that they're getting a positive impact to their health. If I'm on the other end of science going, there is no science for grounding, who am I to tell them to stop doing something that makes them feel better? So with the grounding perspective, there is a very large camp that will tell you that putting your foot on the ground and having this grounding effect will benefit your health.

I'll tell you this, it's not going to hurt you. Go outside, put your foot on the ground, have your kids put their foot and different sand, grass, quads. gravel and see how you feel. Yeah, well, I definitely feel, I definitely feel better doing it. I don't know how much science is there, but I definitely feel better doing it. It brings up the whole like, you know, and I don't know if this is something we want to get into, but placebo, I'm a big fan of, and I'm not saying grounding is placebo by any means, but when people come into my office and they tell me something is making them feel better,

It's my job to educate them on the science that I know of, right? Like, I don't know if this is necessarily healing your tissue per se, but if it's helping you feel better, fine. But do these other things that I know are going to help, you know, load your tendon, for example. So I think there's a fine line there. Talk about your world. You and your team have a bunch of different incredible things you do.

You mentioned some courses. of course people come to see you in person. So talk about that a little bit and who are the type of people that come and seek you out? I have an office in Colorado. As far as who comes, it really, it is varied between kids, young athletes. Typically when they're too young, though, like three, four, there's a lot of development. So I think parents can get a little, when they see on social media, like my kids' feet are flat. And it's like there's a lot of development.

still happening there. Younger kids, 8, 9, 10, but then on the other end of the spectrum, professional athletes. And I think that's one of the reasons, you know, anytime a movement starts to gain, you know, there's more research. It's starting to gain heat. It's typically because there's some funding or there's some big guys in the room going, hey, there might be something on to this, you know. So you'll see a lot of professional teams right now, you know, training barefoot, taking their shoes off. So we do see the spectrum of someone who simply wants to walk around the block without pain because they've had foot pain for X amount of years versus performance. I want to improve my performance. And yeah, so we've developed kind of two separate

avenues for people because we have a lay person where you want to get out of pain. So we have fit feet programs like I mentioned where you can really work on the strength of your feet. We have a shoe course where it talks about assessments that you can figure out what type of shoe you should be in, things to do to prepare yourself to transition into a more minimal shoe. For the clinician, we have gate assessment courses and, you know, kind of all across the board there. But yeah, if our website, we have everything for the individual, like, do you want virtual work or do you want to do something more on your own? Fantastic. Well, we'll link to all those in the show notes below. So please do check it out. And I can't wait for your book to come out.

The topic of walking is something that we've extensively covered on this podcast. And every time we talk about it with somebody who truly is an expert in this area and on the cutting edge, there's always something new that I learn about it that gets me even more excited to make it more of a priority in my life. Because a layperson like everybody else, I'm not an athlete, but I am prioritizing my fitness and my strength training. And I do care about longevity. And I get to interview great people like yourself. And there are times where even I get busy. And you look back at your average on your Apple Watch and you're like, wow, my average has dipped down this week. I've only been getting about 7,500 steps instead of my normal like 12,000 steps and hearing

those little tidbits about just how important walking is for brain health, avoiding dementia, our mood. It reinvigorates the idea in this modern world that kind of keeps us sedentary that it's something that we need to prioritize. So I can't wait to have you back on when the book is ready if you'd love to come back on. Dr. Courtney Connolly, this was fantastic. Thank you so much for coming on the podcast. We'll link to all your social media.

and your website below in the show notes. It was a pleasure and an honor to have you here on this important subject. Thank you so much. Hi, everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me.

And it's the number one thing that you can do to support this podcast is share with a friend. Share with a friend who would benefit from listening. Number two, before I, go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter and it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way,

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