How modern shoes reshape your feet, pain, and longevity

Dr. Courtney Conley 0:00 I want people to start thinking about their feet, because the implications it will have for longevity is massive. But there is plenty of things we can do for foot strength and performance. And you can actually do this at home, and I'm gonna educate you here. There's a lot we could talk about here.

Steven Bartlett 0:15 That didn't sound like a compliment.

Dr. Courtney Conley 0:16 (laughs)

Steven Bartlett 0:17 Dr. Courtney Conley is a world-renowned foot doctor...

Dr. Courtney Conley 0:20 Who's making people rethink everything they know about their feet.

Steven Bartlett 0:23 And the shocking truth about their shoes.

Dr. Courtney Conley 0:25 One in three people will experience foot pain, and it really starts to deter your physical health, your emotional health, your mental health, because you can't do most things. And I know this because as a ballet dancer and then a triathlete, I had all of the diagnoses, bunions, neuromas, heel pain, and not being able to walk and not being able to move, you can go to some pretty dark places. But when you look at the statistics, 5,000 steps a day can reduce the risk of having symptoms of depression and also reduce your risk of all cause mortality by 15%.

Steven Bartlett 0:56 Wow.

Dr. Courtney Conley 0:57 Here's a bigger wow. 9,800 steps can reduce the risks of dementia, so it's the most underutilized, easily accessible activity that most of us are not doing.

Steven Bartlett 1:06 What about footwear choices?

Dr. Courtney Conley 1:08 Footwear has such a big implication on our function. For example, around 70% of children are wearing shoes that are too narrow.

Steven Bartlett 1:17 I've got a range of footwear here that most people wear. So what do you think of these shoes?

Dr. Courtney Conley 1:21 You shorten the muscles in the back of the leg.

Steven Bartlett 1:23 What is the issue with wearing these?

Dr. Courtney Conley 1:25 So, they change the structure of the foot.

Steven Bartlett 1:28 What about this one here?

Dr. Courtney Conley 1:29 You're gonna make me start sweating.

Steven Bartlett 1:31 So let's talk about some good shoes then.

Dr. Courtney Conley 1:33 Okay, so these are the things you want to look for in a functional shoe. First-

Steven Bartlett 1:38 This has always blown my mind a little bit. 53% of you that listen to this show regularly haven't yet subscribed to the show. So could I ask you for a favor before we start? If you like the show and you like what we do here and you want to support us, the free simple way that you can do just that is by hitting the subscribe button. And my commitment to you is if you do that, then I'll do everything in my power, me and my team, to make sure that this show is better for you every single week. We'll listen to your feedback, we'll find the guests that you want me to speak to, and we'll continue to do what we do. Thank you so much. (instrumental music plays) What are we getting wrong? And at what stage in our life do we get it wrong? It feels like you have a little bit of beef with shoes.

Dr. Courtney Conley 2:18 A little bit.

Steven Bartlett 2:18 A little bit of beef. I've got a, a range

Steven Bartlett 2:20 of different shoes here, but what is it that we're being sold or told that is fundamentally not aligned with what it is to be a healthy, strong, happy human?

Dr. Courtney Conley 2:29 I always say that if we started with our children and put them in the right footwear, I'd be out of a job. Because that's when it starts. That's when the foot starts developing, and that's when we start to build strength and, you know, structure to the foot. And from a very young age, we start interfering with what goes on in the foot. And when you think about all of the things that the foot can do, it's why I'm obsessed with it. I mean, there's bones and ligaments, and the foot should be designed, it's designed to move.

Steven Bartlett 3:06 Mm-hmm.

Dr. Courtney Conley 3:06 The arch recoils, so it should lengthen, and then it should contract. There's four layers of muscles in here. So when we look at the function of the foot, we have to respect that, and I think footwear can deter the function of the foot.

Steven Bartlett 3:24 So is the, is the biggest risk, just make sure I'm super clear, that I will fall when I'm older? Is that the key risk?

Dr. Courtney Conley 3:31 I mean, I don't... I think that is one of the sequela of what's going to happen if we just don't start paying attention.

Steven Bartlett 3:39 Mm-hmm.

Dr. Courtney Conley 3:39 But when you look at function as a whole, things like walking, one in three people, and probably over the ages of 45, will experience foot pain.

Steven Bartlett 3:53 Yeah.

Dr. Courtney Conley 3:54 So other than low back pain, there's really no other diagnosis that you'll see those types of numbers. And here's the, here's the issue with foot pain. You can't do much. You can't go for a walk. You can't go for a hike. You can't do most things. You can't walk to the mailbox when you have severe foot pain. So it really starts to deter your physical health, your emotional health, your mental health. So i- it's one of those things I'm extremely passionate about, because it's not just about pain. It's about what happens when you can't walk and you can't use your foot.

Steven Bartlett 4:35 And is it, is the foot connected to the ankle, which is connected to the-

Dr. Courtney Conley 4:38 Correct.

Steven Bartlett 4:38 ... calf, which is connected to the back? Is there a sort of a whole body, um, holistic issue here? Is it all interconnected?

Dr. Courtney Conley 4:48 Yes, 100%. Especially when I see, you know, patients that have bilateral symptoms at their feet, so that would be both sides.

Steven Bartlett 4:58 Okay.

Dr. Courtney Conley 4:59 So for example, if I see someone with bilateral bunions-

Steven Bartlett 5:04 Which is the-

Dr. Courtney Conley 5:05 ... okay, which would be the bump on the inside of the big toe.

Steven Bartlett 5:08 Yeah.

Dr. Courtney Conley 5:09 Okay? You have to ask yourself, where is this abnormal load coming from?

Steven Bartlett 5:15 Let me just check my bunions.

Dr. Courtney Conley 5:17 (laughs)

Steven Bartlett 5:18 Yeah, check. Check. Yeah.

Dr. Courtney Conley 5:20 Right? Where is it coming from? Is it, you know, is it a, something that has to do with the pelvis, right? Because when I'm standing, if I tilt my pelvis forward, I should feel my arches drop.

Steven Bartlett 5:33 Mm-hmm.

Dr. Courtney Conley 5:34 So there's a direct correlation between what's happening at your hips and your pelvis and what happens at your foot. And when I were to tuck my pelvis, you should feel the arches lift. So when we start to see things happen at the foot, it's a window. It's a window to what's going on, not only at the foot, but everywhere else in the kinetic chain.

Steven Bartlett 5:54 When patients come to you, what kind of symptoms do they have that are connected to the foot?

Dr. Courtney Conley 5:59 Bunions, neuromas, hammertoes.

Steven Bartlett 6:02 What's a neuroma and a hammertoe?

Dr. Courtney Conley 6:04 So a neuroma is...... a nerve irritation-

Steven Bartlett 6:08 Yeah.

Dr. Courtney Conley 6:09 ... in between the toes. So the mo- the most common you will hear of is a Morton's neuroma. And that's typically in between the third and fourth toes.

Steven Bartlett 6:18 Okay.

Dr. Courtney Conley 6:18 And it can be very painful. Remember we talked about when you go to push off when you're walking?

Steven Bartlett 6:23 Yeah.

Dr. Courtney Conley 6:24 The wider and the stronger the forefoot is, the more stable it is. So if I have a foot that doesn't have splay or that looks like this and you're trying to push off of it, you can irritate the nerves within the forefoot.

Steven Bartlett 6:40 Okay.

Dr. Courtney Conley 6:41 And you can develop these nerve symptoms at the forefoot. Very painful.

Steven Bartlett 6:45 What are the oth- the other types of sort of injuries or symptoms that people come to you with that you then route back to the feet?

Dr. Courtney Conley 6:53 Hammertoes.

Steven Bartlett 6:54 Hammertoes, which is?

Dr. Courtney Conley 6:56 The clawing of the toes.

Steven Bartlett 6:57 Oh, okay. Yeah.

Dr. Courtney Conley 6:58 Right. And this is what's cool about the foot because it's the only place in the body where you can see aberrant loads.

Steven Bartlett 7:05 What, what does that mean?

Dr. Courtney Conley 7:06 Abnormal load, dysfunction. Because you can't see it at the knee, you can't see it at the hip unless you were to take imaging, where you'd start to see structural change.

Steven Bartlett 7:17 Mm-hmm.

Dr. Courtney Conley 7:17 But you can see it at the foot. So you should be asking yourself, "Man, why am I developing hammertoes? And maybe I should pay attention to that." Because bunions and hammertoes also will increase your risk of falling and also decrease balance. That's a problem.

Steven Bartlett 7:36 I had, um, plantar fasciitis, which meant that I struggled to walk for a couple of weeks, uh, a few years ago when I was training for a football match. And that's really what s- started me on my journey of understanding the foot and trying to understand how to strengthen it-

Dr. Courtney Conley 7:51 Yeah.

Steven Bartlett 7:51 ... so that I could be more active, 'cause if you've never experienced plantar fasciitis, which I'm sure some of my listeners have, it really is an awful, awful thing. What are, what's the, the rest of the list of those kinds of injuries that people can get from having a weak foot? Is there anything else that we haven't covered?

Dr. Courtney Conley 8:07 Well, plantar fasciopathy is probably the most common. That's your heel pain.

Steven Bartlett 8:10 Okay.

Dr. Courtney Conley 8:11 And I do think that that is a diagnosis that we need to look at a little bit differently. Achilles tendinopathy, also very, very common. Um, other tendon diagnoses, posterior tibialis tendon. So that's...

Steven Bartlett 8:29 Okay.

Dr. Courtney Conley 8:29 ... the tendon that runs along the inside of the foot.

Steven Bartlett 8:31 Mm-hmm.

Dr. Courtney Conley 8:32 And it's one of the biggest stabilizers of the medial column of the foot. It's a powerhouse. That and the soleus, which is your calf, lower, the calf muscle, powerhouses of the lower leg. And all of these tissues can be strengthened and produce power. And we need to start looking at the foot just like we look at every other part of the body.

Steven Bartlett 8:53 So what do you do for a living, and who are you?

Dr. Courtney Conley 8:56 (laughs) Um, well, I'm a chiropractor by nature. Um, I went to chiropractic school. Um, you know, I knew that I wanted to get into some type of medicine that was proactive, you know, not reactive. I didn't quite have interest in surgeries or pharmaceuticals. Movement has always been a very big part of my life. And so I knew I needed to stay in that, in that arena.

Steven Bartlett 9:28 So what did you do?

Dr. Courtney Conley 9:30 When I was younger, I was a dancer. I was a ballet dancer, and then I shifted gears into being a runner and then a triathlete. And I didn't know at the time why movement was a necessity for me. You know, I certainly wasn't thinking, "Oh, you know, I need to do this because of longevity or because I'm gonna have better VO2 max." You know, and now in hindsight, when I think about it, it was a means of survival.

Steven Bartlett 9:59 Mm-hmm.

Dr. Courtney Conley 10:00 Uh, movement was survival for me. And in my teens and into my 20s, you know, I had some personal demons that I fought. And the one thing that was consistent that I felt I could control was making sure that I stayed moving. And the problem is, is when you have foot pain, you can't do that. And because movement was a, was a lifeline for me, it was a mode of survival, there were days where, you know, I was a dancer, I had all of the diagnoses we just talked about, bunions, neuromas, heel pain, and when you tag on day after day of not being able to walk and not being able to move, you can go to some pretty dark places.

Steven Bartlett 10:44 Mm-hmm.

Dr. Courtney Conley 10:45 And so I just, it was a mission of mine to figure this out and figure out how I can personally be able to continue to move, but then also be able to hopefully help other people.

Steven Bartlett 10:58 It got tough for you, didn't it? I can see it in your face.

Dr. Courtney Conley 11:02 (laughs) Yes.

Steven Bartlett 11:04 Because for this to matter this much to you, then it's, it's personal, to say the least.

Dr. Courtney Conley 11:10 It changed my life when your... You know, I think whenever we have a passion, there's always this quest personally behind it. And so I saw what it did for me, and then over the past 20 years, being able to see what it has done for my patients is why I'm even more hard-pressed to get this information out there.

Steven Bartlett 11:36 Walking.

Dr. Courtney Conley 11:37 Yes.

Steven Bartlett 11:39 We don't do much of that these days. It seems to have gone out of fashion with all the Ubers and the other ways to, to get around and all the sedentary, uh, behavior that we do living in of- uh, living and working in offices. What, what should we know about walking and how important it is? Because I'll be honest, I don't walk that much.

Dr. Courtney Conley 11:59 Yes, it's, um... I always say it's the most underrated, underutilized, easily accessible activity that most of us are not doing.If you think about, if you look at the research on average step count that most people globally are taking, it's about 45 to 4,900.

Steven Bartlett 12:20 Mm-hmm.

Dr. Courtney Conley 12:20 Okay?

Steven Bartlett 12:21 Mm-hmm.

Dr. Courtney Conley 12:21 Which means that there's a lot of us that are taking less than that. So when I'm working with my patients, we always look at baseline numbers. What's your baseline? So for example, if you had a person who was walking 2,500 steps a day, I mean some of us would be like, "Wow, that's not a lot."

Steven Bartlett 12:40 Mm-hmm.

Dr. Courtney Conley 12:41 But for a lot of us, it is. If you were to walk an additional 500 steps in a day, your baseline's 2,500, you can reduce your risk of cardiovascular mortality by 7%.

Steven Bartlett 12:57 Wow.

Dr. Courtney Conley 12:59 Here's a bigger wow. If you have a thousand step increase, you can reduce your risk of all cause mortality by 15%.

Steven Bartlett 13:09 Dying of anything?

Dr. Courtney Conley 13:11 All cause mortality. 15%, that's, that's a big number for a thousand steps.

Steven Bartlett 13:17 Mm-hmm.

Dr. Courtney Conley 13:18 So I, I have a story for you. This is a patient of mine and it just, you know, w- warms my heart to talk about him because when I saw him, he was two years into a diagnosis of heel pain, 27 years old. So he had, um, gone to see a bunch of people and the last doctor that he had seen told him to limit his step count to 2,500 steps a day.

Steven Bartlett 13:48 Why?

Dr. Courtney Conley 13:49 (laughs) To rest. To rest the foot. Now, this is chronic pain now. We're not talking acute heel pain. We are two years into this song and dance and he's being told at 27 years old to take 2,500 steps a day. So he comes into my office, we're talking about all of this, and he's also a quadruplet. So it was one of the first quadruplets I think I've ever treated. So he has, um, you know, which why I think pain is so difficult, it's so complicated because now you have this 27-year-old who's seeing his siblings who are at 27, like enjoy their life and doing all of these things, and he's being told he can take 2,500 steps a day. So he's now living in his father's basement and he's afraid to go above 2,500 steps and he used to tell me, he's like, "I cry a lot. I'm depressed." And wouldn't you be if...

Steven Bartlett 14:51 Yeah.

Dr. Courtney Conley 14:53 So there wasn't any magic exercise that I was going to give him two years into this. There wasn't any magic orthotic or magic shoe. He had done all of that. Shame on me if I would have done the same thing.

Steven Bartlett 15:06 Mm-hmm.

Dr. Courtney Conley 15:07 So we had a conversation and I knew I needed to get him outside and I needed to get him walking. That was my goal. Forget about the heel pain. We didn't even focus, we didn't even talk about the heel pain. I knew I needed to get him outside and start loading his foot. Two years, this foot by the way, when you're walking four to six times your body weight, it can handle four to six times your body weight when you're walking, but you don't load it appropriately and muscles atrophy. So I told him, we had a long, long conversation and I said, "We're going to slowly start to introduce steps." And if you think about this, if we were to say add 1,000 steps a day, to some people that might not sound like a lot, but to someone who's taking 2,500 steps, that's almost 50% of what they're doing.

Steven Bartlett 16:03 Mm-hmm.

Dr. Courtney Conley 16:05 So we introduced the concept of a micro walk, which is a five minute walk. So a five minute walk is about 500 steps.

Steven Bartlett 16:17 Okay.

Dr. Courtney Conley 16:18 A 10 minute walk is about 1,000, about 1,000 steps.

Steven Bartlett 16:24 Okay.

Dr. Courtney Conley 16:24 Right? So that makes it, like, a little more digestible, right? So you're talking to him, you're like, "Listen, all I need is five minutes." And so we started five minute walks and for the first couple weeks it was, you know, there were good days, there were bad days, and there still are, but we were starting to build his confidence and movement. We were starting to get him comfortable on his foot again. And it was, you know, it was one of those cases where I just, like, I, I really enjoyed working with him and watching what had happened because if you look at step counts, I knew what number I was trying to get to because if you look at, um, depression for example, 5,000 steps a day can reduce the risk of having symptoms of depression.

Steven Bartlett 17:16 Mm-hmm.

Dr. Courtney Conley 17:18 If you get to 7,500 steps per day, it can reduce the prevalence of the diagnosis of depression. So that was in the back of my head. I'm like, "We just got to keep working towards these numbers."

Steven Bartlett 17:32 Mm-hmm.

Dr. Courtney Conley 17:33 So while we were doing that, we were strengthening his foot. I had him in different footwear and at the end of each week we were also talking about three good things. Tell me three good things that happened to you this week. And in the beginning of treatment it was, it was a struggle, Steven. It was a struggle for him to think about good things happening in his life. And, um, I, I spoke with him probably about a month ago and his email is like my why. He was like, um, on average he's walking between 5 and 6,000 steps a day.He still has good days, or still has bad days, more good days than bad days. But he said to me, he's like, "Haven't cried, I can't tell you the last time I cried." He's going to church. He's spending time with his dad, you know? And it's not, it's not the step count, it's the person behind the step count. And that's why I think this stuff is so powerful. I saw it change my life. I saw what it does to my patients. I mean, it has the capacity to improve not just your physical health, but how you interact with the world.

Steven Bartlett 18:53 Y- it has a completely different meaning when you understand the real sort of human consequences it can have on someone's life, for better or for worse. Um, and it's, and it's not often until we have some kind of injury or issue

Steven Bartlett 19:08 that we-

Dr. Courtney Conley 19:09 Yes.

Steven Bartlett 19:09 ... realize that our feet and ankles were, were there (laughs) .

Dr. Courtney Conley 19:12 Yes.

Steven Bartlett 19:12 And that's certainly been the case in my life. It wasn't until I got plantar fasciitis that I was like, "Oh, my God, I should've been doing something about this sooner." And then as I told you before we started recording, I've currently got a high ankle sprain-

Dr. Courtney Conley 19:21 Mm-hmm.

Steven Bartlett 19:21 ... so I pulled some ligaments in my, the top of my ankle training for this game called Soccer Aid. So I'm now going through the whole process once again of, like, figuring out what I did wrong and what, where, what I should've been doing as a preventative measure-

Dr. Courtney Conley 19:33 Yeah.

Steven Bartlett 19:33 ... to try and strengthen my feet. One of the things that I think most of us get wrong is our footwear choices.

Dr. Courtney Conley 19:39 Yes.

Steven Bartlett 19:40 And I've got a range of footwear on this table in front of me here. These are the types of shoes that most people wear. Um, from a very young age, I think we all wear shoes like this.

Dr. Courtney Conley 19:51 Yes.

Steven Bartlett 19:52 So, sort of narrow shoes with a big heel, if anyone can't see our conversation at the moment. So, like, the, the typical trainer.

Dr. Courtney Conley 19:57 Mm-hmm.

Steven Bartlett 19:58 What is, what is the issue with wearing these from an early age?

Dr. Courtney Conley 20:05 When I was doing research to have this discussion with you, it was fascinating to me when you look at the statistics of, especially with, um, children, with girls, s- around 70% are wearing shoes that are too narrow.

Steven Bartlett 20:21 Too narrow, the end part?

Dr. Courtney Conley 20:22 Yes.

Steven Bartlett 20:22 Yeah.

Dr. Courtney Conley 20:23 Remember we talked about the widest part of the foot should be the toes.

Steven Bartlett 20:26 Mm-hmm.

Dr. Courtney Conley 20:27 So when you look at a shoe like that, that is not the widest part. It's tapered. See how the toe box looks like it's tapered?

Steven Bartlett 20:35 Yeah, it's point, like, pointed.

Dr. Courtney Conley 20:36 Correct.

Steven Bartlett 20:36 Yeah.

Dr. Courtney Conley 20:37 So when you put your foot in there, it's doing this.

Steven Bartlett 20:42 Mm-hmm.

Dr. Courtney Conley 20:42 It changes the structure of the foot. It's like the lowest hanging fruit for me, is just wear a shoe that fits your foot, because when it's in that position, it changes the structure. If I walked around with a, my arm in a sling for 10 years, would my bicep get weak?

Steven Bartlett 21:04 Yeah. Your mo- you'd lose your mobility as well, right?

Dr. Courtney Conley 21:06 Correct. If you don't use it, you're gonna lose it. And so that's why I think footwear has such a big implication on our function. Men's dress shoes.

Steven Bartlett 21:19 Men's dress shoes?

Dr. Courtney Conley 21:19 Yeah (laughs) .

Steven Bartlett 21:20 I mean, that is crazy, the point on that.

Dr. Courtney Conley 21:23 Yes. It's funny, my, um, brother lives in New York City, and we have this conversation all the time, and he's like, "Look at this one, it's wide." I'm like, "Nope, that's not wide."

Steven Bartlett 21:32 (laughs)

Dr. Courtney Conley 21:33 "Okay?" And they're stiff, and they're, you know, again, changing the structure of the foot. A lot of those shoes also have a little bit of a heel to toe drop.

Steven Bartlett 21:44 Yeah.

Dr. Courtney Conley 21:44 Yes.

Steven Bartlett 21:45 Yeah.

Dr. Courtney Conley 21:45 So that is when the heel to toe drops, so the heel and the toes sit in one plane. But when you have a higher heel to toe drop, it's like you have a mini high heel on.

Steven Bartlett 21:55 Yeah. And what, what's the problem with that?

Dr. Courtney Conley 21:58 Well, if my foot is supposed to sit flat, I have tissues in the back of my leg that are in a good length tension relationship. I have even pressures across my foot.

Steven Bartlett 22:13 Yeah.

Dr. Courtney Conley 22:14 The second I go and change those things, where I go into a heel, you put additional pressure on the front of the foot. You shorten the muscles in the back of the leg. So you start changing the, the function and the structure of not only the foot, but everything that sits above it.

Steven Bartlett 22:31 Your, your calf, your-

Dr. Courtney Conley 22:33 Yes.

Steven Bartlett 22:33 ... hamstring, your back. Do you see a lot of back injuries that are relating to things like heels and this?

Dr. Courtney Conley 22:40 Yes.

Steven Bartlett 22:40 You do?

Dr. Courtney Conley 22:41 Mm-hmm. It's all, you know... I see mostly people come in for foot pain. And I always say to my patients, "I wish it was just about the foot." I wish I could just look at your foot and say, "This is what it is. It's all right here," but it's not, 'cause there's a body that sits on top of the foot.

Steven Bartlett 23:02 Mm-hmm.

Dr. Courtney Conley 23:03 The strength of the hip, for example, controls the foot. It controls how the foot unlocks. So you have to take that into account when you're looking at patients with foot pain.

Steven Bartlett 23:16 But this, this is the shape because it's fashionable, right?

Dr. Courtney Conley 23:19 Yes. It's my biggest... You know, I always tell, even my daughter, 'cause my daughter, you know, she's like, "You make me wear these platypus shoes." And I'm like, "Listen, it's function over fashion, but I get it." That is my biggest challenge is making, you know, is looking for shoes, but they've come a long way. They're, they've come a very, very long way, and I think that, uh, we're getting there.

Steven Bartlett 23:43 Is there an issue with the thickness of the heel on these shoes, this big... When I say the thickness of the heel, I really mean the thickness of the sole.

Dr. Courtney Conley 23:53 So the cushion and the-

Steven Bartlett 23:54 The cushion. It's, I mean, it's really, really soft, soft and cushiony, and there's about, you know, uh, an inch at the back here of sole.

Dr. Courtney Conley 24:02 Yeah. Um, the cushion conversation is always very interesting. Um... There's always a trade-off. So there's a lot of popular shoes right now that have a lot of cushion on them.

Steven Bartlett 24:16 Yeah.

Dr. Courtney Conley 24:17 And...It's hard to argue when someone goes into a store and they're given this shoe that has this pillow on it, and they're standing on it for three seconds, and they're like, "Man, this feels really good." The problem with cushion is that the more stuff that's between your foot and the ground, the less you feel. So there's a loss of sensory acuity. There's a loss of sensory perception. Remember, the foot is... Imagine the foot's a sensory organ, and it is, because there's thousands of receptors that are, you know, screaming for information to help keep us upright in a biped. So when we start interfering with how that foot feels, you can expect there to be problems. Now, if you have someone that's standing in place all day long, right, on concrete, on man-made surfaces, there's a time and a place. But my non-negotiable is at least keep the foot in its functional position, which means a wide toe box. So, you want to stand on concrete all day long, fine. Put a... put some cushion underneath your foot. Help yourself out. That's okay. But at least allow those toes to splay so that you can have balance, you can have your foot in a position that can propel you forward.

Steven Bartlett 25:42 I was just thinking about my foot as you're talking, and I'm pretty sure, like my... I'm pretty sure that my pinky toe looks...

Dr. Courtney Conley 25:51 (laughs)

Steven Bartlett 25:52 I'm not going to be able to sell pictures on OnlyFans of my feet-

Dr. Courtney Conley 25:54 (laughs)

Steven Bartlett 25:54 ... because, um, my pinky toe is kind of like crumpled in.

Dr. Courtney Conley 25:57 It like curls under, right?

Steven Bartlett 25:58 Yeah, it's like curled under.

Dr. Courtney Conley 25:59 Yeah. Right. It kind of looks like a shoe, like you had a shoe there, like...

Steven Bartlett 26:02 Excuse me.

Dr. Courtney Conley 26:03 (laughs)

Steven Bartlett 26:03 Um, no. No, but you're right. It is. It is like that. Um, it's kind of like been pushed, pushed in and underneath, and I guess that's not natural.

Dr. Courtney Conley 26:12 No, it is not.

Steven Bartlett 26:14 How does a natural foot look? Like have you been to see a tribe who, who don't wear these cushioned shoes? Have you seen what like a uncushioned foot looks like?

Dr. Courtney Conley 26:24 I'm obsessed. I watch people's feet all the time. I was just in Belize with my mother and daughter for spring break.

Steven Bartlett 26:30 Slightly creepy.

Dr. Courtney Conley 26:31 (laughs)

Steven Bartlett 26:31 Sorry.

Dr. Courtney Conley 26:31 It is, isn't it? (laughs)

Steven Bartlett 26:35 (laughs) And you're looking at people's feet on holiday?

Dr. Courtney Conley 26:37 Oh, I'm always looking at people's feet, um, because it tells a story. It's like someone's gait. You know, watching someone walk tells a story. You can tell if they just got fired or if they just got promoted, you know? But when you look at someone's foot... I was in Belize and, with my mom and daughter, and, um, there were these two guys building a house, you know, a little bit off the beach, barefoot. And I'm looking at their foot and I'm going, "Wow." It was wide. It looked thick. It looked flat. And, you know, I think in our society, if you will, when we think of a flat foot, we think, "Oh, this is bad news. We better go get an orthotic."

Steven Bartlett 27:19 An orthotic is a?

Dr. Courtney Conley 27:20 Um, a device that you put underneath the foot to help, um, modify loads.

Steven Bartlett 27:26 Ah. What do they call those in the UK? Um, insoles.

Dr. Courtney Conley 27:29 Like an insole.

Steven Bartlett 27:30 Okay.

Dr. Courtney Conley 27:31 Yes. And so I'm watching these guys build this house and they're like coming up on their toes and they have all this, you know, toe range of motion and all this strength and power to their foot. And I'm like, "That's, that's what our foot was designed to do, is to be strong, to support..." It's like building a house on sand.

Steven Bartlett 27:49 Yeah.

Dr. Courtney Conley 27:50 You have to have a foundation that you can build upon. And it was really cool to see. It

Dr. Courtney Conley 27:56 really was.

Steven Bartlett 27:56 When I had that pain in my foot, which they told me was plantar fasciitis, they recommended that I go to some foot doctor person, and this foot doctor person measured me up for insoles.

Dr. Courtney Conley 28:08 Yes.

Steven Bartlett 28:09 And I put the insoles in, and then I took the insoles out, and instead of that, I just wore different shoes.

Dr. Courtney Conley 28:17 Yeah.

Steven Bartlett 28:18 A lot of people's first sort of diagnosis and the, the thing that they're told to do whenever they have foot pain or back pain or whatever is go get some insoles. Is this what you think we should be doing? Because it's really, really common.

Dr. Courtney Conley 28:31 It is.

Steven Bartlett 28:31 It's like... It seems to be the, the... Like in medicine, they throw pills at you if you have certain symptoms. It seems to be the first thing that we do when someone has a foot problem or an ankle problem.

Dr. Courtney Conley 28:40 First line of intervention is... That's why I, I... you want to change how we're viewing the foot. It's either, "If your foot hurts, here's an orthosis."

Steven Bartlett 28:49 Which is a?

Dr. Courtney Conley 28:49 A foot orthotic, an insert.

Steven Bartlett 28:51 Yeah.

Dr. Courtney Conley 28:52 Or, "If it hurts worse, get surgery." If you look at the research on plantar fasciitis, okay, so "itis" being acute, it will tell you that putting an orthosis or something to modify the load underneath the foot can be beneficial initially because you want to offload something that hurts.

Steven Bartlett 29:16 Yeah.

Dr. Courtney Conley 29:17 But if you don't use it, you're gonna lose it. So what they're not... The part of the conversation that's being missed is the "and" conversation. It's, "Wear this insert and strengthen your foot," because the goal should be to have an exit strategy for the insert and get your foot back on the ground. Because I have patients, Steven, they will come in with 20 pairs of orthotics, 20 pairs of inserts. They've tried this one. They've tried that one. They've tried different shoes, higher heel to toe drops, more cushion. And I'm sitting there going, "We're missing the boat here. Let's have the and conversation." One of the muscles that is a good predictor of having heel pain, okay, is it runs parallel to the plantar fascia. So it's flexor digitorum brevis. It basically takes the four toes and presses them down.

Steven Bartlett 30:18 Mm-hmm.

Dr. Courtney Conley 30:19 There's ways you can assess for this.So we'll look at their toe strength, and then it almost always correlates with the side that has the heel pain on because it, it shouldn't be one of those conversations where you're like, "Man, I wonder where this came from?" No. Your foot is weak. Your foot is weak, there's a lot of load going through it, and the structures are, you know, getting beat up.

Steven Bartlett 30:45 There's something Daniel Lieberman said to me which I've never forgotten. He said, "If you took a child and you put them in two-inch thick gloves from the day that they were born-"

Dr. Courtney Conley 30:54 Yeah.

Steven Bartlett 30:55 "... and then you took those gloves off at 30 years old, can you imagine how deformed their hands would be?"

Dr. Courtney Conley 31:01 Right.

Steven Bartlett 31:01 And that's like very much the way that we live our lives.

Dr. Courtney Conley 31:03 Yes.

Steven Bartlett 31:03 We spend pretty much all day wearing these big cushioned shoes that sometimes have these heels on, so it's no wonder that so many people are getting foot problems, ankle problems, back pain.

Dr. Courtney Conley 31:13 Yeah.

Steven Bartlett 31:14 So-

Dr. Courtney Conley 31:14 One in three people.

Steven Bartlett 31:15 One in three people.

Dr. Courtney Conley 31:16 Foot pain. I mean, it is, it really is a statistic that we need to be paying attention to.

Steven Bartlett 31:24 We use this word plantar fasciitis, but we didn't explain what it is and what the symptoms of it are. Is it essentially a pain in the, the heel of your foot?

Dr. Courtney Conley 31:32 Pain in the heel, yes. And they've played around with, you know, the terminology, it being plantar fasciitis, so more of an acute issue, versus plantar fasciopathy, because oftentimes these cases will turn into, you know, having heel pain for very long periods of time.

Steven Bartlett 31:50 Yeah.

Dr. Courtney Conley 31:50 So then you have to treat it differently. You don't treat something that's acute the same as you would treat something that's chronic. And so you have to look at, "How can I build the resiliency to the foot?"

Steven Bartlett 32:02 How did it happen?

Dr. Courtney Conley 32:05 How did all of this happen?

Steven Bartlett 32:06 How did plantar fasciitis happen? Like, how did I get it?

Dr. Courtney Conley 32:09 (laughs)

Steven Bartlett 32:10 So w- I'll tell you what I was doing. I was living my life as normal.

Dr. Courtney Conley 32:14 Yeah.

Steven Bartlett 32:14 And then I started training to play for this-

Dr. Courtney Conley 32:16 Yes.

Steven Bartlett 32:16 ... soccer game, and I started training several, may- maybe twice a week. And then maybe by week four or five or six, I get this horrific ongoing pain which lasted throughout the entire day-

Dr. Courtney Conley 32:31 Yeah.

Steven Bartlett 32:32 ... where I couldn't walk easily. It was especially bad in the mornings, and, uh, yeah, I thought I'd like broken something or ripped something in my foot. And when they told me that it was plantar fasciitis, I'd never had that term before, but understanding what I did there, how did I get it?

Dr. Courtney Conley 32:48 When... I see, I hear very similar stories with that diagnosis. There's alwa- there always seems to be some impetus of, "I s- I added load too fast too soon."

Steven Bartlett 32:59 Mm-hmm.

Dr. Courtney Conley 33:00 "I went on a longer hike. I..." This is one of my favorites. Um, "I went barefoot during COVID around my house," and everybody wanted to blame the fact that (laughs) , you know, don't ever go barefoot, and I was like, "Mm, maybe it's just 'cause your foot was weak and you weren't ready to handle these loads." You add loads too fast too soon, and the foot just says, "You know what? You weren't ready to give me this amount of load this quickly."

Steven Bartlett 33:29 Okay.

Dr. Courtney Conley 33:30 And that's, you know, when you asked me earlier about, um, why we need to pay attention to our foot strength, is it just because, you know, we're gonna, we want to prevent falls when we're 70? This is the why. 'Cause we want to have healthy feet, strong feet so you can say, "Hey, I want to go play a soccer game and I don't want to worry about having plantar fasciitis

Dr. Courtney Conley 33:51 in my 30s."

Steven Bartlett 33:52 Mm-hmm. Or, I mean, now with this, this ankle sprain that I have-

Dr. Courtney Conley 33:56 Yes.

Steven Bartlett 33:56 ... pulling my ligaments, which takes you out of activity for so long, which is-

Dr. Courtney Conley 33:59 Yes.

Steven Bartlett 33:59 ... horrific. That's like a big part of this, which is if you get an injury-

Dr. Courtney Conley 34:03 Yeah.

Steven Bartlett 34:03 ... if you get a bad injury, if you get like an Achilles tendon issue or the, you tear a ligament like I have, or even plantar fasciitis, w- the inactivity that stems from that causes a bunch of downstream-

Dr. Courtney Conley 34:15 Yes.

Steven Bartlett 34:15 ... issues. So I'm, my muscles are gonna atrophy. I'm gonna lose muscle over th- this next couple of weeks in my lower half. I'm gonna get probably a little bit lopsided because the injury's on my right side, so now my left side's having more of the burden. Uh, my, my lower legs, my upper legs, my lower back is probably susceptible now to some kind of injury as well. And it feels like, you know, this down, downward spiral-

Dr. Courtney Conley 34:39 Yeah.

Steven Bartlett 34:39 ... of injury just because I didn't strengthen my foot. What do you think of these shoes? These are women's heels, but listen, anyone can wear them. It's 2025.

Dr. Courtney Conley 34:49 (laughs)

Steven Bartlett 34:49 Um, what do you think of these shoes?

Dr. Courtney Conley 34:51 Well, it doesn't look like a foot. Your foot in that position is not the position it, it's supposed to be in. Now, with that being said, there is a time and a place. You know, I don't think I'm going to win the battle of, you know, you need to wear, you know, functional footwear 24 hours a day, seven days a week. Time in those shoes should be limited. Just like with, you know, other things, it's

Dr. Courtney Conley 35:21 moderation.

Steven Bartlett 35:22 Do you see a lot of women getting injuries because they spend too long wearing heels?

Dr. Courtney Conley 35:28 I don't know if acute injury, but cr- but a weakening of tissue, yes. Because, you know, I live in Colorado now, so I don't have that, uh, there's not too many women in Colorado that are wearing heels. However, when I go to New York City, it's a different conversation, different environment.

Steven Bartlett 35:47 Mm-hmm.

Dr. Courtney Conley 35:47 So, you know, I have to say, I have to use the... That is not the position that you want to keep your foot in. It's changing the structure of your tissues, changing the pressures in the foot. Not to mention, that, those are... I don't, I don't care what anybody says, that's not comfortable to walk around in. People will be like, "Oh, I'm really comfortable in heels." I'm like, "Are you really though?"

Steven Bartlett 36:09 The lengths we go to to look good though, right?

Dr. Courtney Conley 36:11 That's right.

Steven Bartlett 36:12 Okay, so let's talk about some good shoes then.

Dr. Courtney Conley 36:14 Okay.

Steven Bartlett 36:15 I've got two pairs of shoes here.

Dr. Courtney Conley 36:17 Okay.

Steven Bartlett 36:18 One of them is Vivobarefoot-

Dr. Courtney Conley 36:20 Yes.

Steven Bartlett 36:20 ... who are actually a sponsor of mine.Ever since I saw it started talking about feet. Um, and then I don't know this brand. What is this brand?

Dr. Courtney Conley 36:28 That is Ultra Running. So let's talk about, um, the things you want to look for in a functional shoe. My non-negotiable is the wide toe box. The toes have to be able to splay. When you think of all the diagnoses that we talked about, bunions, neuromas, hammertoes, when the forefoot can splay, the foot's going to function better. So that's number one. Number two is having the heel and the toe in the same plane. And number three is having a shoe that is thin and flexible. When you wear this type of footwear, I call this a workhorse shoe, because there is more loads going through all of your tissues, through your bones, through your ligaments, through your tendons, through your muscles. So your foot gets stronger when you wear this type of footwear. There's research on that.

Steven Bartlett 37:29 Hmm.

Dr. Courtney Conley 37:30 Now, you have to earn your right. This is the plantar fasciopathy conversation. You can't go from wearing a, um, aggressive, k- high-cushion

Dr. Courtney Conley 37:42 shoe-

Steven Bartlett 37:43 Like this one here.

Dr. Courtney Conley 37:44 ... with an, yes, with an insert, for example, and say, "Oh, this stuff makes sense. I'm going to go take that off and I'm going to go wear this 24 hours a day." You won't like me.

Steven Bartlett 37:54 Why?

Dr. Courtney Conley 37:55 Because you'll say, "Hey, my heel's hurting." Because you haven't done the work. It's, "Hey, let's do these foot exercises. Let's wear this for 10 minutes a day." And then people are like, "Wow, that does feel better." And then it's a transition into wearing this more often. Now, when you have patients that have had a, a very weak foot, or clients that have had a very weak foot with different diagnoses, this is a hard, you know, shoe to walk around in for extended periods of time. So that's when we'll talk about footwear that still puts the foot in a wide position, wide toe box. I love this shoe. And I also like the mesh upper, because you can, the toes can expand in here. I still have zero drop, right? Where the heel and the toe sit in the same plane. But you'll notice the difference between the two shoes is the amount of stack height or the amount of cushion. There's more stuff.

Steven Bartlett 38:58 Yeah. So on this, on this shoe, the, it does look like the, you call it a plane, looks level.

Dr. Courtney Conley 39:06 Yes.

Steven Bartlett 39:07 Okay. And it's got a good toe box.

Dr. Courtney Conley 39:09 Yes.

Steven Bartlett 39:09 You can see from this side that the toe box is wide so you can splay. But it is elevated.

Dr. Courtney Conley 39:16 It's elevated off the ground.

Steven Bartlett 39:17 Yeah.

Dr. Courtney Conley 39:18 But the heel and toe are in the same plane.

Steven Bartlett 39:20 Okay, fine. But it can, it's, it's still elevated though.

Dr. Courtney Conley 39:23 Yes.

Steven Bartlett 39:23 They're still like quite thick.

Dr. Courtney Conley 39:24 Yes.

Steven Bartlett 39:25 That's not too much of a problem because it's still flat.

Dr. Courtney Conley 39:27 It depends on what your goals are.

Steven Bartlett 39:29 For running.

Dr. Courtney Conley 39:30 That is, that is a, I think a great shoe to run on, to run with, right?

Steven Bartlett 39:35 Mm-hmm.

Dr. Courtney Conley 39:35 If you're running on concrete, if you're running on asphalt, you want a little something underneath the foot.

Steven Bartlett 39:42 What about the-

Dr. Courtney Conley 39:45 (laughs)

Steven Bartlett 39:46 ... Nike Alphaflys, which is why-

Dr. Courtney Conley 39:48 You're gonna make me start sweating.

Steven Bartlett 39:50 Really?

Dr. Courtney Conley 39:50 Uh, um-

Steven Bartlett 39:51 This is my current running shoe, and I bought it because it looks great.

Dr. Courtney Conley 39:54 Yes. I mean, you know, it, it, it's, it-

Steven Bartlett 39:57 I have torn the (laughs) ligaments in my, in my ankle.

Dr. Courtney Conley 40:01 (laughs)

Steven Bartlett 40:01 But (laughs) , but I look good.

Dr. Courtney Conley 40:03 Here's the super shoe, right? So here's this shoe, right? And here's your super shoe over here.

Steven Bartlett 40:07 Yeah.

Dr. Courtney Conley 40:08 Okay? When you look at that shoe, there's certain characteristics to that shoe that you definitely do not see in this shoe, one of them being the toe spring. So see how it kind of lips on the front of the shoe?

Steven Bartlett 40:21 Yeah.

Dr. Courtney Conley 40:21 Okay?

Steven Bartlett 40:22 This part here, yeah.

Dr. Courtney Conley 40:22 Yes. So if I had that shoe on this table and I went like this to the front of the shoe, it would literally rocker for me.

Steven Bartlett 40:29 Mm-hmm.

Dr. Courtney Conley 40:29 So it facilitates the rocker of the foot. Sounds great. You put that on, you're like, "Man, this is great. I can fly." If you don't use it, you're gonna lose it. So there is research that shows when you put your foot in a position with toe spring, you will weaken the intrinsic muscles of the foot. So, I'm not saying don't have race day and wear that shoe, right? You get, the research will tell you 2% to 4% running economy. People run faster because the shoe has the technology to facilitate gait. But if you train in that all the time and you never let your foot get stronger, it's just a matter of time you're going to say, "My hamstring, my foot, my this, my that." And it's like we, that's why the conversation has to happen is, this is the shoe that you're going to get stronger in. Spend time in your training shoe. And then that's your speed day, that's your race day. So it's having this shoe spectrum, knowing when to dance along the spectrum.

Steven Bartlett 41:35 I feel like I can bounce in these.

Dr. Courtney Conley 41:36 (laughs) I mean, you probably can.

Steven Bartlett 41:40 I literally, when I put it on, I was like, "Wow, I can bounce." And that-

Dr. Courtney Conley 41:42 That's right.

Steven Bartlett 41:42 I think it has like a piece of metal going through the middle of it, which-

Dr. Courtney Conley 41:45 Yeah, there's carbon in there. You know what another fun fact is though? Certain plyometrics, so plyometric is training the spring of the body, so think like jumping. There's research that will show you that plyometrics also increase capacity in running by 2% to 4%. So my conversation I have with my patients is, "Listen, what if we stacked therapies, right?" What if you did plyometric work-

Steven Bartlett 42:12 Which is?

Dr. Courtney Conley 42:13 Uh, jumping.

Steven Bartlett 42:14 Yeah.

Dr. Courtney Conley 42:15 You know, once or twice a week. And we worked on your strength, and I had you in these shoes the majority of the time. And then, on race day, you want to throw that shoe on?... it's like you're, you're a running, you're like a running fairy. You're, like, running and things look beautiful and everything is, you know, because you have a strong body on top of the shoe. But if you put a weak body and a weak foot in that shoe, you gotta earn your right.

Steven Bartlett 42:45 Should we be standing more often? Because most of us work and live in offices now, and we sit at desks, and I, I, you know, I do this podcast sat down. Do you think much about standing desks or how often we should spend bipedal, or, or I think that's what you referred to as?

Dr. Courtney Conley 43:00 I think that it's more about movement.

Steven Bartlett 43:02 Okay.

Dr. Courtney Conley 43:03 I don't know if standing in one place is any better than sitting in one place, other than when you're standing, you can actually, like, you know, move around and, you know, make it more active standing. But it is a matter of taking movement breaks. Like, that's, uh, I call them, you know, movement snacks. All of us spend a lot of time either sitting all day long or, you know, standing at our desks. If we were to take micro walks, a five-minute walk a couple times a day, the system stays moving, you're staying active, and you're slowly, you know, inching up that step count that we know is so important for not only physical health, but emotional and mental health.

Steven Bartlett 43:44 Mm-hmm.

Dr. Courtney Conley 43:45 That's what I like about it.

Steven Bartlett 43:46 I think you mentioned there was this, an association with movement, walking and dementia-

Dr. Courtney Conley 43:52 Yes.

Steven Bartlett 43:52 ... Alzheimer's risk. What, what does the science say there?

Dr. Courtney Conley 43:56 You know, when you look at step counts, if that was going to be our baseline, 9,800 steps per day can reduce the risks of dementia. But what I think is the cool part with that is 3,800 steps, you get 50% of the maximal benefit. So if you were to, let's just call it 4,000, shoot for 4,000 steps, you're going to get a benefit.

Steven Bartlett 44:32 Mm-hmm.

Dr. Courtney Conley 44:32 A 50% benefit. And some of my favorite research on looking at that population with walking is relationship walking. There's really cool studies, um, looking at walking in groups for the elderly population and how that has a social connection, and it improves their emotional health, and it combats loneliness and feelings of isolation. And that is the beauty of a

Dr. Courtney Conley 45:03 walk.

Steven Bartlett 45:03 Run clubs are getting i- incredibly popular at the moment-

Dr. Courtney Conley 45:06 Yes.

Steven Bartlett 45:06 ... aren't they, all around the world? Are you seeing more and more people come to you as a result of that?

Dr. Courtney Conley 45:09 Yes. I think also, um, you know, it was interesting, I was working at the running event in Austin, Texas, and I was teaching there, and so a lot of the shoe stores were there. And one of the bigger shoe stores had said that the majority of their clients now are actually walkers and not runners, and I thought that was pretty interesting. And I'm thinking to myself, "I wonder why that is. Like, are more people reverting to walking because they're getting injured when they're running? Are they..." You know, I'm making all these conclusions in my head. I'm like, "Well, is it because we're going in the wrong direction with footwear? (laughs) Because we're creating this shoe that is basically doing the work for us and it feels so good and, you know, people aren't putting the work in anymore?" I don't know, but I'm certainly going to do my best to change that.

Steven Bartlett 46:04 You brought me a box, which I have-

Dr. Courtney Conley 46:08 Yes.

Steven Bartlett 46:08 ... here in front of me. Foot health kit.

Dr. Courtney Conley 46:12 Yes.

Steven Bartlett 46:12 That's what it says on the front of the box. Um, foot health kit, I mean, what is in this box?

Dr. Courtney Conley 46:19 It's like my little, like, bag of treats. You know, when I started doing this, it was funny, um...

Steven Bartlett 46:24 This is what you give people is a bag of treats-

Dr. Courtney Conley 46:26 That's right. (laughs)

Steven Bartlett 46:27 ... for their birthdays and stuff.

Dr. Courtney Conley 46:30 I want people to start thinking about their feet, because I, I think there's such, um, implications for their health, and I wanted to make it easy, because when we think about all the things we need to do to stay healthy, it's like, "I have to strength train. I have to, you know, eat this. I need to VO2 max. I need my cardiorespiratory fitness." There's a lot. So I wanted to make it easy. So I, um, first, what, one of the things that's, uh, that is in there are toe strengtheners.

Steven Bartlett 47:04 So I'll, I'll pull them out the box. So...

Dr. Courtney Conley 47:07 Those are toe spacers.

Steven Bartlett 47:09 Toe spacers?

Dr. Courtney Conley 47:10 Yes.

Steven Bartlett 47:11 So, uh, is this all the same thing, right?

Dr. Courtney Conley 47:12 Yes.

Steven Bartlett 47:13 So these are toe spacers?

Dr. Courtney Conley 47:14 Correct.

Steven Bartlett 47:15 And then there's this.

Dr. Courtney Conley 47:18 Yes.

Steven Bartlett 47:18 What's this?

Dr. Courtney Conley 47:19 Those are toe strengtheners.

Steven Bartlett 47:20 Toe strengtheners, okay.

Dr. Courtney Conley 47:21 Yes.

Steven Bartlett 47:21 So that's my toe workout.

Dr. Courtney Conley 47:23 Yes.

Steven Bartlett 47:23 There is this thing.

Dr. Courtney Conley 47:25 A band.

Steven Bartlett 47:26 And then there's this ball.

Dr. Courtney Conley 47:29 Yes.

Steven Bartlett 47:30 So this is like, this is my foot gym?

Dr. Courtney Conley 47:32 That's right.

Steven Bartlett 47:33 Can you show me how this stuff works?

Dr. Courtney Conley 47:35 Absolutely.

Steven Bartlett 47:36 Okay. So, um, these are my feet and these are my ankles. So I had plantar fasciitis in, I believe it was this foot actually, and then right now I've got a high ankle sprain, which is some kind of ligament here has been torn, and they told me that it's torn on all three sides. So I've been in a boot for the last couple of weeks, but I've taken it off over the last, uh, week or two, and I, I was on crutches as well. Um, what are you... The minute I took my socks off, you became fixated on my feet.

Dr. Courtney Conley 48:05 Yes.

Steven Bartlett 48:06 What, w- w- what do I need to be thinking about and what can you see just by looking at my feet?

Dr. Courtney Conley 48:10 You know, when you're looking at this foot here, you can start to see

Dr. Courtney Conley 48:13 this little, see this little bump here.

Steven Bartlett 48:15 Mm-hmm.

Dr. Courtney Conley 48:16 You can start to see bumps on the top of the big toe.

Steven Bartlett 48:21 Mm-hmm.

Dr. Courtney Conley 48:22 Okay? And, uh, it, the diagnosis is a hallux limitus or a hallux rigidus, and basically what that means is that you have formed, um, arthritis...... on the top of the toe. So, it prevents you from getting that full range of motion that we need when we walk and run.

Steven Bartlett 48:39 Okay.

Dr. Courtney Conley 48:40 Okay? If the bump goes out to the side, that's what we call hallux valgus. That's the bunion.

Steven Bartlett 48:49 The bunion, okay.

Dr. Courtney Conley 48:50 Okay? So, that's wh- why, uh, the foot is a, a window to mechanics, because you can see loads, aberrant loads, right? Why is this forming here? So, you know, one of the first things I'll wanna look at is how much range of motion. And the big toe, it's all about the big toe. When we're walking, we put a lot of loads and force that go through the big toe when we walk. You should have about 40 to 45 degrees to walk out of that big toe. So, here's Eddie, here's 45 degrees.

Steven Bartlett 49:28 It's up.

Dr. Courtney Conley 49:29 Up.

Steven Bartlett 49:29 Okay.

Dr. Courtney Conley 49:29 Okay?

Steven Bartlett 49:30 Mm-hmm.

Dr. Courtney Conley 49:30 So, yes. So, what I'll wanna see is how much range of motion. Can you see how he's off the ground though?

Steven Bartlett 49:36 Mm-hmm.

Dr. Courtney Conley 49:36 I want the ball of the big toe-

Steven Bartlett 49:38 Mm-hmm.

Dr. Courtney Conley 49:39 ... on the ground. That's a good amount of range.

Steven Bartlett 49:42 That's the first nice thing you've said about my feet.

Dr. Courtney Conley 49:43 (laughs) We're just getting started. I'll find something else. A- and then you wanna look at toe dexterity. So, in other words, can you isolate your toes? So, can you lift just your big toe on the right? Good.

Steven Bartlett 50:00 (grunts)

Dr. Courtney Conley 50:00 And then on the left. Good.

Steven Bartlett 50:03 Tha- that's actually quite hard. Like, I've never had to do that before.

Dr. Courtney Conley 50:07 It's funny, 'cause when you'll see people that have poor awareness to their feet, when they try to lift their toes, you'll see them, like-

Steven Bartlett 50:13 You're going back. (laughs)

Dr. Courtney Conley 50:13 ... with their hands (laughs) and like... Your back isn't going to extend your toe. Okay, and then put your big toe down, and then extend your four toes. Yes.

Steven Bartlett 50:24 No, that pinky is not ... That's not listening.

Dr. Courtney Conley 50:27 There you go. And here. Okay. And then what I want you to do is you're gonna lift up all of your toes-

Steven Bartlett 50:34 (grunts)

Dr. Courtney Conley 50:36 ... and spread them. And you can see in two, three, and four, right? They don't want to spread as much.

Steven Bartlett 50:44 Mm-hmm.

Dr. Courtney Conley 50:45 Earlier we talked about those neuromas. The neuromas live within the toes here, right? Within, right in between the toes.

Steven Bartlett 50:52 Mm-hmm.

Dr. Courtney Conley 50:53 So, if we have issues with nerve problems here, you gotta be able to splay.

Steven Bartlett 51:01 Mm-hmm.

Dr. Courtney Conley 51:02 So, you wear Vivos. You know, when you allow your foot to be in a shoe where the feet can actually splay, you'll start to see changes.

Steven Bartlett 51:12 Mm-hmm.

Dr. Courtney Conley 51:13 But imagine if you, you know, were in a shoe where your foot... I mean, I had a... I was at an expo working a couple of weeks ago, and this woman came up to me and she's like, "Man, I can't figure out why my foot hurts." And I took her shoe off, and I'm telling you, her foot looked like this. It looked like a shoe.

Steven Bartlett 51:30 (laughs)

Dr. Courtney Conley 51:30 And I took a picture and I showed it to her, and I was like, "Does your foot look like a foot, or does it look like a shoe?"

Steven Bartlett 51:36 We don't really know the difference these days, I think.

Dr. Courtney Conley 51:37 No. Because remember, the widest part of the foot should be the toes.

Steven Bartlett 51:42 Mm-hmm.

Dr. Courtney Conley 51:44 So, that's what we wanna look for in the front of the foot. We also talked about that muscle. What side did you have the heel pain on?

Steven Bartlett 51:54 I believe it was the right side.

Dr. Courtney Conley 51:56 So, one of the things we'll do, um, and you can actually do this at home. You could use, like, uh, a credit card. So, in my office, we can actually measure that. But if you were to do it at home, you just take a card and put it underneath the toe.

Steven Bartlett 52:09 Mm-hmm.

Dr. Courtney Conley 52:10 Okay? And make sure you're lined up here, yep. And some people will also do that. See how you're, like-

Steven Bartlett 52:16 Yeah.

Dr. Courtney Conley 52:16 ... holding your leg? Just the toe.

Steven Bartlett 52:18 Mm-hmm.

Dr. Courtney Conley 52:19 And then I'll try to pull the card out from under you-

Steven Bartlett 52:22 Mm-hmm.

Dr. Courtney Conley 52:23 ... and I shouldn't be able to do that. I should feel some tension.

Steven Bartlett 52:25 Mm-hmm.

Dr. Courtney Conley 52:27 And then I'll ask the patient, "Where do you feel this? What's working?" And if they say, "My hip, my quad," it's the wrong, wrong guy. We're talking about the foot. So, you should feel that in the arch of the foot, and maybe into the calf.

Steven Bartlett 52:43 Mm-hmm.

Dr. Courtney Conley 52:45 Okay? Big toe, flexor hallucis longus. This guy, by the way, this muscle, starts over here. It's very important to strengthen this muscle when you have a history of ankle sprains. Starts on the fibula, which is the outside of the leg. It comes down the foot, crosses under, and inserts into the big toe. Then I'm gonna take the card, and I'm gonna put it underneath the four toes. The muscle that we're looking for... Yes, that's beautiful. See how you got that little... See, that's the second com- compliment I gave you about your feet.

Steven Bartlett 53:20 Mm-hmm.

Dr. Courtney Conley 53:20 (laughs) I'm gonna put this underneath your toes.

Steven Bartlett 53:25 Yep.

Dr. Courtney Conley 53:26 Right? A little... Yep. And then, don't let me pull the card out. And you should feel that in the arch of your foot. Patients that have-

Steven Bartlett 53:37 I'm not really feeling it, to be honest.

Dr. Courtney Conley 53:39 (laughs)

Steven Bartlett 53:39 I'm not feeling it in the arch.

Dr. Courtney Conley 53:40 Okay. Oh, what?

Steven Bartlett 53:42 Okay.

Dr. Courtney Conley 53:42 There you go. Roll the, roll the bottom of the foot.

Steven Bartlett 53:44 Like this?

Dr. Courtney Conley 53:45 Yes. Just wake it up a little bit. There's a bunch of receptors on the bottoms of the foot. So, when we can't feel things, then it, it shouldn't surprise us. You know, if we've been walking around in footwear that compromises the function of a foot, or we've had injuries, it, you start to lack what we can feel.

Steven Bartlett 54:02 Mm-hmm.

Dr. Courtney Conley 54:02 So, just wake it up a little bit.

Steven Bartlett 54:04 And how long would you do that for in the morning?

Dr. Courtney Conley 54:06 60, 90 seconds.

Steven Bartlett 54:08 Do you do this every day?

Dr. Courtney Conley 54:09 Uh, I do (laughs) . I'll tell you when I... Like, if I'm standing at my desk, I'll keep the ball there.

Steven Bartlett 54:15 Okay.

Dr. Courtney Conley 54:16 When I come back from a run, I do this whole little setup. But I wear these all day.

Steven Bartlett 54:22 What is that that you're wearing there?

Dr. Courtney Conley 54:24 So, these are toe spacers. So, they do exactly that. They splay the foot.

Steven Bartlett 54:30 And, and why are you wearing that?

Dr. Courtney Conley 54:31 Okay? Remember when I was telling you about my years of being a ballet dancer?

Steven Bartlett 54:35 Mm-hmm.

Dr. Courtney Conley 54:35 Okay?Um, in point shoes. Uh, I wore Orthotics for a long period of time. I wore ill-fitting footwear and my foot was weak and things hurt. Okay? And we talked about why I needed to fix all of that. Um, you can see my bunion here.

Steven Bartlett 54:53 Mm-hmm.

Dr. Courtney Conley 54:53 Okay? So, I work on all of this stuff all the time, and toe splay is a big part of that. So when I have these toe spacers in, they splay the foot for me. Every pair of shoes that I wear, um, is compatible with a toe spacer.

Steven Bartlett 55:17 Okay, so you don't wear any narrow shoes?

Dr. Courtney Conley 55:20 No. Non-nego-... That's my non-negotiable.

Steven Bartlett 55:22 Okay.

Dr. Courtney Conley 55:23 And this is important. There is a difference between a wide toe box and a wide shoe. So people will say, "Well, I ordered the wide." The width will come here. That's where they change the width. But if the toes are still tapered-

Steven Bartlett 55:43 Mm-hmm.

Dr. Courtney Conley 55:43 ... the width has to extend into where the toes are.

Steven Bartlett 55:47 Mm-hmm.

Dr. Courtney Conley 55:48 So that's where you gotta be careful. It's, a wide shoe is not a wide toe box shoe. And if you try to wear these in just a wide shoe, you're not gonna be comfortable.

Steven Bartlett 55:57 So, if I wore this for one year, what promise could you make me? What could you s- tell me the benefit and the upside would be?

Dr. Courtney Conley 56:05 You would s- definitely see improvement of the splay of your foot.

Steven Bartlett 56:10 Yeah.

Dr. Courtney Conley 56:12 And when you have the tissues, the, the splay, you can start to improve the strength of the foot.

Steven Bartlett 56:20 And what's downstream from strong foot?

Dr. Courtney Conley 56:22 Go up the chain. You have better toe strength, you're gonna build a better platform. You're gonna have a jet engine on a jet engine. So your ankle mobility, then your knee extension, your hip extension, 'cause your foot is doing what it was designed to do, which is be mobile and be strong.

Steven Bartlett 56:41 Mm-hmm. Okay.

Dr. Courtney Conley 56:43 We need to pay attention. If you... If things go south from here, you can expect there (laughs) to be changes up the chain. I see it all the time. (page turns)

Steven Bartlett 56:56 This one change has transformed how my team and I move, train,

Steven Bartlett 57:00 and think about our bodies. When Dr. Daniel Lieberman came on The Diary of a CEO, he explained how modern shoes, with their cushioning and support, are making our feet weaker and less capable of doing what nature intended them to do. We've lost the natural strength and mobility in our feet, and this is leading to issues like back pain and knee pain. I'd already purchased a pair of Vivobarefoot shoes, so I showed them to Daniel Lieberman and he told me that they were exactly the type of shoe that would help me restore natural foot movement and rebuild my strength. But I think it was plantar fasciitis that I had, where suddenly my feet started hurting all the time. And after that, I decided to start strengthening my own foot by using the Vivobarefoots. And research from Liverpool University has backed this up. They've shown that wearing Vivobarefoot shoes for six months can increase foot strength by up to 60%. Visit vivobarefoot.com/doac and use code Diary20 from my sponsor for 20% off. A strong body starts with strong feet. (page turns) Is there anything else that we need to be aware of? What is, what is this other stuff here? You've got, like, toe strengtheners as well.

Dr. Courtney Conley 58:00 So before we get to those, with, you know, the big toe and the four toes?

Steven Bartlett 58:04 Yeah.

Dr. Courtney Conley 58:04 This is when you can use that band.

Steven Bartlett 58:05 Okay.

Dr. Courtney Conley 58:06 Right? So you just put your heel on there. Okay? You grab your four toes, right? It's like you're doing a bicep curl, but you're doing it with your toes. And you press into the band, and you lift up, and you press it into the band. There is research, four sets, 12 reps. I mean, these are some of the things that they work on to improve function of the foot that helps with plantar fasciitis.

Steven Bartlett 58:30 Mm-hmm. Okay.

Dr. Courtney Conley 58:32 And then you go around the house and you grab the big toe, keep that ball of the big toe on the floor, and then press.

Steven Bartlett 58:39 Ah.

Dr. Courtney Conley 58:40 Yes. Right? And it's, it's a good place to start. You're building strength in your foot.

Steven Bartlett 58:49 Mm-hmm.

Dr. Courtney Conley 58:51 And if you wanna... If you wanna really get after it, go for just the little guy.

Steven Bartlett 58:54 Oh my gosh.

Dr. Courtney Conley 58:56 (laughs)

Steven Bartlett 58:56 Little piggy. Let's have a look.

Dr. Courtney Conley 59:00 It's really wild because the abductor digiti

Dr. Courtney Conley 59:03 minimi, the muscle that abducts the little toe, is just as big as the big one. We like, just are like, "Oh, that toe's just there to, you know, hit furniture."

Steven Bartlett 59:10 Mm-hmm.

Dr. Courtney Conley 59:11 It stabilizes the outside of the foot.

Steven Bartlett 59:14 Mm-hmm. What is the difference between someone that does this and doesn't do this?

Dr. Courtney Conley 59:19 Well, let's start with pain.

Steven Bartlett 59:21 Yeah.

Dr. Courtney Conley 59:21 They... And I, I use the word prevent injury. Uh, that's tough for me. You wanna create an environment where you can have the best opportunity for function.

Steven Bartlett 59:32 Mm-hmm.

Dr. Courtney Conley 59:33 So when people strengthen their foot, they are going to have a foundation that's going to have resilience to the rest of their system. This is what we, we walk on. You cannot, um, build a jet engine on a paper airplane. I'm working with a lot of... You know, athletes right now are getting bigger, they're getting stronger, they're getting faster. And if you look at the rates of injuries at the foot, they're going up, because we know the amount of loads that go through the foot when we walk and when we run.

Steven Bartlett 1:00:08 Mm-hmm.

Dr. Courtney Conley 1:00:08 So if we wanna do a bunch of squats and do a bunch of deadlifts and do all the sexy stuff, but not pay attention to the foundation on which we're putting all of this on, you're going to run into problems. So from a function perspective, you're improving your function from the ground up. You're providing a better environment for your body to decrease pain. And when we get older, it's... You know, you don't wanna be chasing your tail with this stuff.

Steven Bartlett 1:00:32 How does this dovetail into mobility and flexibility? 'Cause that's something I'm thinking a lot about at the moment. Uh, I, I realized that as I do a lot of upper body workouts-

Dr. Courtney Conley 1:00:39 Yes.

Steven Bartlett 1:00:39 ... and stuff like that, when you watch me, like, pick up the weights and stuff-

Dr. Courtney Conley 1:00:43 Yeah.

Steven Bartlett 1:00:44 ... or put them back down, I look like I'm-I've got the mobility of someone that you would think was doubled by age.

Dr. Courtney Conley 1:00:49 Yeah.

Steven Bartlett 1:00:49 And I wondered if it, a lot of it starts with our feet.

Dr. Courtney Conley 1:00:52 So, we talked about the big toe. When you're walking, the big toe has to extend a certain amount. Okay? I'm gonna show you here. Okay? So when I'm walking, I have to have a certain range of motion out of my toe, and that gives me range of motion out of my knee and out of my hip.

Steven Bartlett 1:01:13 Mm-hmm.

Dr. Courtney Conley 1:01:13 If I cheat the system, so let's say this is the only amount of range I have. Let's say I have a big toe that's only gonna extend 20 degrees. You're gonna compensate. You might shorten your stride. You might take shorter steps. You might not get access to hip extension 'cause your toe isn't going into full extension. So you will see some type of compensation.

Steven Bartlett 1:01:38 Mm-hmm.

Dr. Courtney Conley 1:01:39 You know, the other one I think about is ankle mobility. You know, I was listening to one of your podcasts, and you were talking about, um, the story of you rafting in Bali, I think.

Steven Bartlett 1:01:50 Oh, yeah. Yeah.

Dr. Courtney Conley 1:01:51 And how you were, you know, walking down the stairs, and how it's something that you wanna be able to do. And I was thinking to myself, I'm like, if you were to ask someone, "If you wanted to continue to be able to do that as you age, what would you want?"

Steven Bartlett 1:02:09 Uh, probably a VO2 max.

Dr. Courtney Conley 1:02:11 Endurance.

Steven Bartlett 1:02:12 Yeah.

Dr. Courtney Conley 1:02:13 Your hip strength maybe.

Steven Bartlett 1:02:16 Yeah.

Dr. Courtney Conley 1:02:16 Right? Your core strength. Your hip mobility. I think very few people would say, "Ankle mobility and toe strength." But here's the deal. If you don't have good toe strength, where are you going? You could be falling. If you don't have good ankle mobility, same thing. So, ankle mobility is a big one. Also, it gives us access when we squat, when we go up and down a stair, even walking.

Steven Bartlett 1:02:46 So what do you mean by ankle mobility? Do you mean my ability to go like this?

Dr. Courtney Conley 1:02:49 This. Dorsiflexion. The ankle also plantarflexes, and it inverts and everts, but the, the one I'm talking about when you're... You know, this ankle dorsiflexion-

Steven Bartlett 1:03:02 Mm-hmm.

Dr. Courtney Conley 1:03:03 ... is something I look at with all of my patients.

Steven Bartlett 1:03:06 And I... It's not stood up, is it? Uh, sorry. It's not sat down, is it stood up? Like, oh, he would...

Dr. Courtney Conley 1:03:11 If you, you can do it, you look at it seated, yes, but you wanna keep that heel on the ground.

Steven Bartlett 1:03:18 Okay.

Dr. Courtney Conley 1:03:18 Okay?

Steven Bartlett 1:03:18 I mean, that's, that's all we've got there.

Dr. Courtney Conley 1:03:20 Okay. And we're looking for about, you know, between 20, 30 degrees, but this range of motion is very restricted. Remember the high heel conversation?

Steven Bartlett 1:03:33 Yeah.

Dr. Courtney Conley 1:03:34 You walk around in a high heel for a long time, ankle dorsiflexion is affected.

Steven Bartlett 1:03:38 And what can I do to improve my ankle mobility to prevent myself getting injured or getting pains or issues with my lower leg, upper leg, back?

Dr. Courtney Conley 1:03:49 Um, you know, I think joints, you have to look at joints from two perspectives, both mobility and stability. How well does it move? And how well can you control that motion?

Steven Bartlett 1:04:01 Yeah.

Dr. Courtney Conley 1:04:02 Right? So, you can work on static stretching, dynamic stretching. The other thing I would be looking at here, though, is the strength of one of my favorite muscles, which is the soleus, this big calf muscle back here. Okay? Because it's the soleus, right, that helps control this motion.

Steven Bartlett 1:04:25 Mm-hmm.

Dr. Courtney Conley 1:04:26 And, you know, if you had a seated calf raise machine here-

Steven Bartlett 1:04:31 Mm-hmm.

Dr. Courtney Conley 1:04:32 ... and we wanted to look at baseline, like what can you do with your single s- single-leg seated calf raise?

Steven Bartlett 1:04:38 Which is this one, right?

Dr. Courtney Conley 1:04:40 Yes.

Steven Bartlett 1:04:41 Mm-hmm.

Dr. Courtney Conley 1:04:42 The capacity that the soleus can produce is it... You, you... It can put eight times your body weight going through your forefoot. That's a lot. So, there was a study that looked at return to run. So, um, they were looking at how much strength, if you will, can we produce out of a seated single-leg calf raise.

Steven Bartlett 1:05:07 Yeah.

Dr. Courtney Conley 1:05:08 One and a half times your body weight, six times.

Steven Bartlett 1:05:12 What? Six reps?

Dr. Courtney Conley 1:05:12 Yes.

Steven Bartlett 1:05:13 Okay.

Dr. Courtney Conley 1:05:13 Single leg.

Steven Bartlett 1:05:14 Okay.

Dr. Courtney Conley 1:05:16 So you would put one and a half pl- times your body weight plates six times. That's a lot.

Steven Bartlett 1:05:23 Hmm.

Dr. Courtney Conley 1:05:24 If you were to do it standing, holding half your body weight, six reps. But we don't train the lower leg like we do everywhere else.

Steven Bartlett 1:05:34 No. Especially men.

Dr. Courtney Conley 1:05:36 Yes.

Steven Bartlett 1:05:36 Men don't care about legs.

Dr. Courtney Conley 1:05:38 Yeah. It's-

Steven Bartlett 1:05:38 No.

Dr. Courtney Conley 1:05:39 I always say it's, you know, the, the machine at the gym that should have the longest wait line is the seated calf raise machine, and it's always open.

Steven Bartlett 1:05:48 What, what do you see the biggest mistakes that runners make, outside of the Alphafly issue, wearing those big cushioned shoes? Is there a certain way that we run that is causing us problems? And also, c- are we running too much? 'Cause some people, they really get hooked on running.

Dr. Courtney Conley 1:06:05 I mean, I love it. I think running is one of the best forms of activity. I think if we wanted to keep it very simple, overstriding is the enemy.

Steven Bartlett 1:06:16 Overstriding?

Dr. Courtney Conley 1:06:16 Yes.

Steven Bartlett 1:06:17 What's an overstride?

Dr. Courtney Conley 1:06:17 So, if I'm running, right? Here's my foot.

Steven Bartlett 1:06:21 Yeah.

Dr. Courtney Conley 1:06:22 I want my foot to strike as close to my center of mass as possible.

Steven Bartlett 1:06:26 As in cl- as close to your body as possible?

Dr. Courtney Conley 1:06:27 Yes.

Steven Bartlett 1:06:27 Okay.

Dr. Courtney Conley 1:06:29 So, overstride would be as if I landed with my foot all the way out here.

Steven Bartlett 1:06:33 Okay. Okay.

Dr. Courtney Conley 1:06:34 Yes.

Steven Bartlett 1:06:35 Got you.

Dr. Courtney Conley 1:06:36 So, our calcaneus, this heel bone, was beautifully designed to absorb shock.

Steven Bartlett 1:06:44 Mm-hmm.

Dr. Courtney Conley 1:06:44 Okay? When I overstride, and I can feel it, what am I gonna do? That's gonna hurt.So you're not gonna do it anymore. You're gonna overstride, and you're gonna be like, "Ah, that hurts." So I'm gonna adopt my gait pattern, and I might not overstride and bring that foot closer to me. So you strike differently.

Steven Bartlett 1:07:05 You want the foot to hit in line with your body?

Dr. Courtney Conley 1:07:07 A little bit in front of the body.

Steven Bartlett 1:07:08 Okay.

Dr. Courtney Conley 1:07:09 It's the heavy overstride you wanna avoid.

Steven Bartlett 1:07:11 Okay.

Dr. Courtney Conley 1:07:11 'Kay? But if I can't feel anything, you don't know. That's the... The more stuff on the shoe, you can overstride hot and heavy, and because you have all this cushion there, you're gonna be like, "Well..."

Steven Bartlett 1:07:25 Yeah.

Dr. Courtney Conley 1:07:26 So that's, you know, the argument of allowing your foot to be able to feel things.

Steven Bartlett 1:07:31 What about this whole thing with gaits and stuff? 'Cause sometimes when, when... I was videoed from the back, and someone in the comment section was like, "Your, like, gait is wrong," or something, "when you ran, Steve." So I didn't know what he meant. I didn't... Couldn't see his qualifications, so I kept it moving, but...

Dr. Courtney Conley 1:07:48 Everybody has a, a certain gait.

Steven Bartlett 1:07:51 What is a gait?

Dr. Courtney Conley 1:07:52 You have a running gait or walking gait. It's just your, what happens when your foot strikes the ground to the time it hits the ground again. So you have certain, um, stride lengths and step lengths.

Steven Bartlett 1:08:03 Mm-hmm.

Dr. Courtney Conley 1:08:03 Okay? So when I'm... If you were... If we had a treadmill here-

Steven Bartlett 1:08:06 Yeah.

Dr. Courtney Conley 1:08:07 ... and I would have you start running, that would be your running gait. I'd be looking at you from the back-

Steven Bartlett 1:08:13 Mm-hmm.

Dr. Courtney Conley 1:08:13 ... from the side, from the front, and seeing what happens when your foot hits the ground, when it comes back up into swing phase, what's happening above the foot. So what are your hips doing? What is your pelvis doing? So you're really looking at the person, and then you're also looking at, you know, what am I seeing that I think could be, um, you know, a factor in either pain or poor performance?

Steven Bartlett 1:08:40 Mm-hmm.

Dr. Courtney Conley 1:08:41 And then you see those things, and you're like, "Okay, let's start working on this." But this is the interesting thing with gait, right? Someone will see something, and they'll say, "Okay, you need to start doing calf raises." If they also don't cue gait, right? Or let's work on your cadence, let's work on some type of skill. Strength and skill light up different parts of your brain. So you can get really good at calf raises and great, but if you wanna be a good runner, you have to look at different things.

Steven Bartlett 1:09:16 Mm-hmm. So what, what's the most common issue with someone's gait?

Dr. Courtney Conley 1:09:20 The overstride.

Steven Bartlett 1:09:21 Overstride?

Dr. Courtney Conley 1:09:22 And then also kind of the crossover.

Steven Bartlett 1:09:25 Why is that a bad thing?

Dr. Courtney Conley 1:09:26 Uh... (sighs) It takes away some of that efficiency. So oftentimes you can see, you know, if someone's crossing over when they land, they'll have more of this kind of collapse through the extremity, if you will.

Steven Bartlett 1:09:40 Okay.

Dr. Courtney Conley 1:09:40 'Kay? We wanna control the foot when it hits the ground. That's why the hip conversation, right? The hip controls what happens at the

Dr. Courtney Conley 1:09:49 foot.

Steven Bartlett 1:09:50 Are we supposed to be barefoot?

Dr. Courtney Conley 1:09:53 We are supposed to let our foot function how it was designed, and that is letting the foot feel the ground. Now we live on man-made surfaces, and we walk around on concrete. So for me to say, yes, we should all be walking around barefoot. That's a conversation that's difficult to have.

Steven Bartlett 1:10:10 Mm-hmm.

Dr. Courtney Conley 1:10:11 But the stronger that your foot becomes and the more resilient that it becomes, you can handle these things a lot better, and it makes interacting with your environment so much more fun and easy.

Steven Bartlett 1:10:24 Mm-hmm. What are these?

Dr. Courtney Conley 1:10:25 Okay. (laughs) My daughter was a rock climber, and she was up in her room one day, and she had the bands around her fingers, and she was, like, strengthening her hands. And I was looking at it and I was like, "Man," I'm like, "I want one of those for the foot." And I'm looking for them, and I couldn't find them, so I said, "Well, here we go." So I designed these, and they're different resistances.

Steven Bartlett 1:10:48 Mm-hmm.

Dr. Courtney Conley 1:10:48 So it's the same concept as you would with your hands. You just put them around your toes.

Steven Bartlett 1:10:55 Okay.

Dr. Courtney Conley 1:10:55 'Kay?

Steven Bartlett 1:10:55 Give me the easy one. Which one's easier?

Dr. Courtney Conley 1:10:57 That's the easy one.

Steven Bartlett 1:10:57 Okay. Here we go. Are they-

Dr. Courtney Conley 1:10:59 So-

Steven Bartlett 1:11:00 ... all the same si- size? Would you need different sizes for different size feet?

Dr. Courtney Conley 1:11:03 Nope. So when your toes splay, you can slide those on a little easier.

Steven Bartlett 1:11:08 My (laughs) little piggy is completely redundant. It's doing nothing, it feels like. It feels like it's disabled.

Dr. Courtney Conley 1:11:14 Well, we're gonna change that. 'Kay?

Steven Bartlett 1:11:17 Yeah.

Dr. Courtney Conley 1:11:18 So when you lift up all your toes, try to get your big toe to touch my finger. Yes. That's abductor hallucis. That's this muscle right here. So people that have, like, bunions, it's like, just strengthen that muscle, right? So you... That guy goes in, and you hold right there. So now you're strengthening inside of the foot.

Steven Bartlett 1:11:40 Mm-hmm.

Dr. Courtney Conley 1:11:40 You're strengthening the muscles inside the arch of the foot. If you can get that little guy to go out, you're gonna strengthen this guy. So you're just gonna lift all your toes. Good, and then spread, reaching forward. Try to keep the tripod of the foot though.

Steven Bartlett 1:11:57 Okay, so I'm trying to-

Dr. Courtney Conley 1:11:58 Lift all your toes, but keep that tripod. One, two, center of the heel.

Steven Bartlett 1:12:03 So lift-

Dr. Courtney Conley 1:12:05 Yes. Yes, yes.

Steven Bartlett 1:12:08 And s-

Dr. Courtney Conley 1:12:08 And split. Yes. Now, press those toes to the ground as you spread them. Lift, spread, reach.

Steven Bartlett 1:12:17 Yeah.

Dr. Courtney Conley 1:12:17 Oh, that's pretty.

Steven Bartlett 1:12:19 Thank you.

Dr. Courtney Conley 1:12:21 (laughs)

Steven Bartlett 1:12:21 Okay. So, and that gets... You've got ones that get incrementally harder.

Dr. Courtney Conley 1:12:24 Yes. So this would be harder. This would be hardest.

Steven Bartlett 1:12:27 Okay. All right.

Dr. Courtney Conley 1:12:28 So we're doing like 30, 40 reps a day. That's how you'll know someone needs to work on this, because they can't keep those points. So they're kinda like... It looks like their foot's on an ice skate.

Steven Bartlett 1:12:38 Yeah.

Dr. Courtney Conley 1:12:40 So that's the front of the foot.

Steven Bartlett 1:12:41 Yeah.

Dr. Courtney Conley 1:12:43 When you get into this part of the foot, the rear foot, there's certain things you wanna pay attention to. We already talked about mobility at the ankle.But you also want to look at what happens when that heel comes off the ground, 'cause this is when all the magic happens, 'cause the foot engages, the intrinsic muscles engage. It's basically like, "I'm getting ready to, to propel forward." So there's certain muscles that you want to have some good capacity to be able to get your foot in this ready position. So two we can talk about is one that runs along the inside-

Steven Bartlett 1:13:25 Mm-hmm.

Dr. Courtney Conley 1:13:27 ... and then this is posterior tibialis, one of the very big stabilizers of the arch of the foot, and his best friend, which is the soleus. Those guys help do this to the foot, help invert the foot.

Steven Bartlett 1:13:43 Mm-hmm.

Dr. Courtney Conley 1:13:44 Okay? So go ahead and stand up for me. Put your foot in here. I'm gonna put this around your ankles.

Steven Bartlett 1:13:53 Oh.

Dr. Courtney Conley 1:13:55 There you go. Okay. Spread your feet a little bit. Toes pointing straight ahead. Which, by the way, we wanna talk about gaits. When I'm moving from point A to point B, my feet should also look like they're moving in this direction. If someone's walking like this...

Steven Bartlett 1:14:18 With their feet pointed out?

Dr. Courtney Conley 1:14:19 Correct.

Steven Bartlett 1:14:19 Yeah.

Dr. Courtney Conley 1:14:20 I wanna know why.

Steven Bartlett 1:14:22 Mm-hmm.

Dr. Courtney Conley 1:14:22 Do they have a, a bone in their lower leg that's rotated out? Which could happen. But if not, you don't get to li- you don't get to walk like that. So, we want the toes pointing straight ahead, as long as there's no compromise structurally.

Steven Bartlett 1:14:43 Okay.

Dr. Courtney Conley 1:14:43 Okay? So, what I want you to do here is you're gonna keep the ball of the foot on the floor.

Steven Bartlett 1:14:51 Mm-hmm.

Dr. Courtney Conley 1:14:52 And I want you to drive your ankles almost like you were gonna sprain your ankle, right? So you're gonna push into that range, out. So you're gonna take your ankles and drive them into the band.

Steven Bartlett 1:15:03 Into the band?

Dr. Courtney Conley 1:15:04 Yep. Watch me here. Okay, so here, this way. Yes, now keep that big toe on the ground. Yes. Yeah. See, there's your other compliment.

Steven Bartlett 1:15:19 That didn't sound like a compliment.

Dr. Courtney Conley 1:15:22 (laughs) But what you should feel here is that when you increase the arch of the foot, you should feel it also in the hips.

Steven Bartlett 1:15:29 I feel like I just don't have an arch in my foot. I don't know, it's weird. It's, I don't feel like I can...

Dr. Courtney Conley 1:15:33 How about this? Put your hands on your chest. Rotate to your left as far as you can. Keep your feet on the ground. See, that's pretty.

Steven Bartlett 1:15:40 Hmm.

Dr. Courtney Conley 1:15:41 See that arch? Yes. Now go this way. So that's another way to work on how the foot feels, 'cause the foot should change shape. It should lower, and it should increase the arch.

Steven Bartlett 1:15:58 So do you recommend people do these types of exercise frequently?

Dr. Courtney Conley 1:16:00 Oh, yeah. I mean-

Steven Bartlett 1:16:01 How often do you do them?

Dr. Courtney Conley 1:16:02 You're standing at your desk. You know, here's your movement break. You rotate 20 times. Let your foot change shape. Do your toe yoga, big toe, four toes. Lift all your toes, spread 'em and reach 'em forward.

Steven Bartlett 1:16:20 Uh ... My physio gave me a towel and he put it on the floor and he said I have to like grab it and pull it up, and grab it and pull it up as part of my recovery for my injury. Have you... Do you, do you ever tell people to do that? You know that towel thing where you grab-

Dr. Courtney Conley 1:16:33 Yeah. I don't.

Steven Bartlett 1:16:34 You don't?

Dr. Courtney Conley 1:16:34 No.

Steven Bartlett 1:16:34 What?

Dr. Courtney Conley 1:16:36 (laughs) I don't wanna get anybody in trouble here.

Steven Bartlett 1:16:39 No, call him out.

Dr. Courtney Conley 1:16:40 Okay. When do you ever do this?

Steven Bartlett 1:16:43 N- never.

Dr. Courtney Conley 1:16:43 Correct. So, unless you were, you know, and maybe in your initial phases of rehab-

Steven Bartlett 1:16:50 Mm-hmm.

Dr. Courtney Conley 1:16:51 ... where you are just trying to wake up the foot-

Steven Bartlett 1:16:53 Mm-hmm.

Dr. Courtney Conley 1:16:54 ... you wanna, you know, towel scrunch, pick up marbles like the, you know, that's a very common foot exercise.

Steven Bartlett 1:17:01 Mm-hmm.

Dr. Courtney Conley 1:17:02 But from a functional perspective-

Steven Bartlett 1:17:04 Mm-hmm.

Dr. Courtney Conley 1:17:05 ... that never happens in the gait cycle. When you're walking and you're running, your toes never do this, or they shouldn't. Most people, when their foot is weak, that's one of the biggest compensate- compensations that you will see. They toe grip. You'll see them walking and it's like, you know, they start gripping the ground, 'cause they-

Steven Bartlett 1:17:26 I think their feet are weak.

Dr. Courtney Conley 1:17:27 Feet are weak.

Steven Bartlett 1:17:28 They compensate by standing up.

Dr. Courtney Conley 1:17:28 Yes.

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Steven Bartlett 1:19:30 you wear socks?

Dr. Courtney Conley 1:19:31 Uh, I do not wear socks.

Steven Bartlett 1:19:33 Why?

Dr. Courtney Conley 1:19:34 I just haven't found any that I, you know, love. My second and third toes, this is personal information here-

Steven Bartlett 1:19:43 Mm-hmm.

Dr. Courtney Conley 1:19:43 ... are webbed. So basically, there's skin that comes up in between two and three.

Steven Bartlett 1:19:50 Mm-hmm.

Dr. Courtney Conley 1:19:51 So as far as socks are concerned, most of the socks out there, like if you look at a compression sock, when someone puts it on their foot, it literally, like with my bunion, you'll see my foot look like this 'cause it's just suctioning my foot together, and it's so uncomfortable.

Steven Bartlett 1:20:09 Mm-hmm.

Dr. Courtney Conley 1:20:10 So my option would be a toe sock.

Steven Bartlett 1:20:13 Mm-hmm.

Dr. Courtney Conley 1:20:14 So a sock that, you know, just fits over your toes. But because my toes are webbed, I can't wear them.

Steven Bartlett 1:20:19 Well, what do you think is the most important thing that we haven't talked about yet that we should've talked about as it relates to foot health and everything downstream from foot health?

Dr. Courtney Conley 1:20:29 I mean, I think, you know, big picture, like what I hope to do, like my passion is to bring awareness to the foot. Because when we start doing that and we pay attention from getting stronger from the ground up, things, life gets easier. (laughs) And I mean that not just physically, but just like we talked about wellness, because you're able to move and get out there and walk and run and move like you want to. So that's kind of the big, the big picture here. I think we talked about the importance of foot strength and foot mobility and driving home the importance of footwear. I think the biggest, you know, or maybe the lowest hanging fruit for people is if this kind of work seems overwhelming, like, "I have to strengthen my toe and do all this stuff," just wear a shoe where your foot can feel the ground and your foot can be in its functional position. Start there. Because the research will tell you just doing that, you will start to improve the strength of your foot.

Dr. Courtney Conley 1:21:34 And I think that's, that's key. And start small, transition.

Steven Bartlett 1:21:40 It's so interesting listening to so many of these, um, the comments from some of your previous work. Uh, people of all ages, but, uh, often, people that are slightly older, talking about how transformative finding out more information about their feet has been and changing their footwear in particular. Reading this one comment here from this guy. It says, he's 65 years old, and when he discovered the zero drop wide box toe shoes, he lost all the pain in his feet, ankles, knees, and hips within a couple of months.

Dr. Courtney Conley 1:22:14 I hear it all the time. I hear it all the time, and it's, it seems so counterintuitive to us because I think we've been, you know, trained to think that our foot needs stuff, it needs support, it needs cushion, it needs spring. And that changes the dynamics of how your foot interfaces with the ground.

Steven Bartlett 1:22:37 Mm-hmm.

Dr. Courtney Conley 1:22:38 So when you bring it back to what it was designed to do, those comments you'll hear, well, you will hear all the time. And it's, it's a wonderful thing. It's literally why I do this.

Steven Bartlett 1:22:50 Is there anything else we should've talked about that we didn't, that you think is pertinent to anyone that's trying to get control of, um, their foot health?

Dr. Courtney Conley 1:22:58 I mean, I think, you know, I just wanna make sure that we highlight the conversation of transition, because I think that's where we lose people is this... When people listen to this, there's bells going off in their brains going, "Man, this makes sense. This makes sense." They want to go home, burn all their shoes, and like go buy a pair of barefoot shoes and call it a day. Uh, you got to earn your right, so there has to be that transition. There has to be that, "I'm going to step. I'm going to build. I'm going to have a shoe spectrum." And that, that conversation of a

Dr. Courtney Conley 1:23:34 s- shoe spectrum, there's a time and a place. You have your workhorse shoe. You have your cheat shoe, and you know when to wear what.

Steven Bartlett 1:23:43 Hmm. Where am I now? I'm, I think I'm in the workhorse shoe. I'm trying not to wear any cushioned shoes as much as I possibly can, um-

Dr. Courtney Conley 1:23:51 Well, when you think about it with ankle sprains, this is what I find fascinating, right? When that thing heals, when your ankle heals, and you say, "Well, I'm gonna go into a cushioned shoe," some of these shoes are get- getting high.

Steven Bartlett 1:24:08 Mm-hmm.

Dr. Courtney Conley 1:24:09 So you put the sole of your foot on a shoe that has a high cushion, you see the distance you have from your foot to the ground?

Steven Bartlett 1:24:17 Yeah.

Dr. Courtney Conley 1:24:17 So let's say you step on a rock and you have poor proprioception 'cause your foot can't feel real well 'cause you have a history of ankle sprains, and you step on a rock and you have this far to go, where do you think that ankle's going?

Steven Bartlett 1:24:29 Hmm.

Dr. Courtney Conley 1:24:30 So my ankle sprain patients, I want them close to the ground. I want them to feel, right? So it's, it's pretty wild when people are like, "I wanna wear, you know, all this stuff." You know, hiking boots, another conversation.

Steven Bartlett 1:24:47 W- what's wrong with hiking boots?

Dr. Courtney Conley 1:24:49 Well, people will say, "I need a hiking boot 'cause I n- I want my ankles to feel stable," and that's not what they do. It might be a... And there will be research coming out on this. Uh, when you wear a hiking boot, it's like a neurological hug. It kind of feels like, you know, that I'm gonna have this thing around my ankle.

Steven Bartlett 1:25:10 And it's gonna protect me.

Dr. Courtney Conley 1:25:11 It's gonna protect me. Uh, it doesn't. And when you walk down a mountain, this foot has to do... Remember we talked about this, ankle dorsiflexion. If you have something that's going to restrict ankle dorsiflexion, you have transfer loads. So you end up transferring load to the knee.

Steven Bartlett 1:25:32 Mm-hmm.

Dr. Courtney Conley 1:25:34 So, you know, when my patients say to me, "I need a hiking boot," I say to them, "Listen. Why don't we just work on getting your ankle more stable? Improving your mobility? So then you won't need to feel like you need this thing around your ankle." And that takes time. But in the long run ...

Steven Bartlett 1:25:56 Is there an issue if I'm wearing the barefoot shoes at the moment and then I start wearing, like, football boots again or, I think you guys call them cleats-

Dr. Courtney Conley 1:26:02 Yeah.

Steven Bartlett 1:26:03 ... is there a chance of me getting injured 'cause I spent so long in the barefoot shoes, now I'm performing in-

Dr. Courtney Conley 1:26:09 No, it's, your... Sometimes you can't do anything about the environment of the shoe. So think of a cleat, um, an ice skate, a ski boot. There's certain, um, you know, sports-

Steven Bartlett 1:26:21 Mm-hmm.

Dr. Courtney Conley 1:26:21 ... that require this stiffness. And so when you pay attention to your foot health, and then you put that foot in the cleat, you just make sure that when you get your foot out of the cleat, you do all the stuff. You take that kit, you roll the bottom of the foot. When I get out of my cycling shoes, even though they are wider now, they have wide toe box cycling shoes, I'm

Dr. Courtney Conley 1:26:45 always doing stuff for my foot. Because it's a, the cleat is an environment for the sport. So, you know, you pay attention before and you pay attention after.

Steven Bartlett 1:26:56 Courtney, we have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're going to be leaving it for.

Dr. Courtney Conley 1:27:02 (laughs)

Steven Bartlett 1:27:02 And the question that has been left for you ...

Dr. Courtney Conley 1:27:04 Oh, this is gonna be good, huh?

Steven Bartlett 1:27:06 It is a good one. What do you fear you will most likely regret 10 years from now?

Dr. Courtney Conley 1:27:13 This