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

17:35Dr. Rangan Chatterjee:Thus, I can create a shoe. And that's not the case. The other thing, when you also look at not only fashionable footwear, like dress footwear, but when you look at the industry of what's happening with trainers and running shoes, for example, shoe companies respond to what people need and what they want. So a lot of the things that I will hear in my clinic, it's hard for me to walk. It's hard for me to push off. My father just had this conversation with me. He said, you know, Courtney, I was walking around the mall and it was really difficult. I feel like I couldn't push through my foot. He's going to be 80 this year.

18:20Dr. Rangan Chatterjee:Now, instead of having the conversation of, hey, dad, if you can't push through your foot, these are the exercises we're going to do. We're going to work on your calf strength. We're going to work on your foot strength so that you can start to regain your power when you walk. The shoe company says, Hmm. Well, he's having difficulty pushing through his foot. So let's just create a shoe that rockers him forward.

18:50Dr Courtney Conley:So we make it easier for him.

18:52Dr. Rangan Chatterjee:Correct. So now this shoe looks like a boat. So he puts this shoe on and he says, Courtney, this is great. I can now roll through my foot. Why would my father, who doesn't have this type of knowledge, think anything other than this must be a great idea. And where I challenge him is that if you don't use it, you're going to lose it. So the rocker shoe, it does help in the short term.

19:24Dr Courtney Conley:Is that fair to say? It's at least his perception of this problem where he can't push off is initially getting better. The problem is there's an unintended consequence which is his feet are going to get even weaker because they're not being used.

19:41Dr. Rangan Chatterjee:Doing more of the work for him.

19:43Dr Courtney Conley:The shoe's doing the work.

19:44Dr. Rangan Chatterjee:Yes. And that shoe can be beneficial for someone who has, for example, a fusion of their big toe. Yeah. Or some type of, you know, surgical intervention. But outside of that, your foot is very capable of being retrained. Your strength is very capable of improving. and those are the conversations we need to be having because I don't want my dad walking around not having the strength and power to be able to propel him forward.

20:18Dr Courtney Conley:Courtney, make the case to someone who's listening to this who doesn't have any foot pain. You know, pain is a, it can be a very powerful motivator to do things, right? Because if you've got pain, you want to be out of pain. But if someone is listening to this and they're not in any pain, and they've been wearing thick cushioned shoes their entire life. And let's say, I don't know, they're in their 40s and they're functional. Let's say it's a woman and they wear high heels when they go out. Maybe they wear high heels for work and they're not experiencing pain. How do you convince or inspire people who are not in foot pain to focus on their foot health?

20:59Dr. Rangan Chatterjee:This is where I really get excited about this conversation because I think this is where healthcare is going. And hopefully people are being more aware that we should be proactive instead of reactive with our health. Instead of waiting until there's a problem, because oftentimes by the time there's a problem and you're experiencing pain at the foot, this has been there, it's been building, there's been problems for a long period of time and now movement is deterred. So I always like to have the conversation of being proactive with these things. I think the other beautiful thing about the foot is it's the only place in the human body where you can start to see aberrant loads or changes.

21:48Dr. Rangan Chatterjee:So what I mean by that is if you were wanting to, I had knee pain. You have to take an x-ray or an MRI. Is there arthritis? Is there some type of tear? But at the foot, if you see a bunion, regardless if it's painful or not, if you see hammer toes, if your toes are more narrow, so the widest part of the foot should be the toes. Yep, everybody starts looking at their feet. I'm looking at my feet now.

22:18Dr Courtney Conley:I think I'm okay, but you can tell me later.

22:21Dr. Rangan Chatterjee:So if you see these things, we know that changes in the foot, bunions, hammer toes, increase our risks of falls. It changes the stability of the forefoot. It changes the strength of the foot. So that's what I encourage people to do. Take a look at your foot. Are there things that shouldn't be there? Can you do exercises like lifting your big toe, having toe dexterity? These are all things that can be very good indicators of good foot health, which will also have implications up the kinetic chain.

22:57Dr Courtney Conley:Yeah, there's a whole section in the second half of your book where you go through these exercises, these self-assessments that we can all do. And, you know, it's interesting. I've been paying attention to my foot health, I would say, for a good 12 years now.

23:15Dr Courtney Conley:and this morning as I was finishing reading off the book there was an exercise I think it was calf raise single leg calf raises but in essence it was great because you put some songs in there which have a 60 beats per minute cadence and the one I chose because I love the song was landslide by Fleetwood Mac put it on put my stopwatch on and try to see how many I could do on the beat basically. And I was, you know, as I said to you before, I had just come back literally from four days skiing and it was, you know, difficult, steep off-piste terrain and my legs are crushed, but still I thought I'd be okay.

23:55Dr Courtney Conley:But I think I only managed 24 in a minute. And I was like, that's less than the average that you would expect at my age. I thought, what the hell? Like, I was really shocked to see that. Now, yes, could fatigue from the last few days we're playing a role? Maybe. But I think that's going to be so useful for people to just assess where they are.

24:15Dr. Rangan Chatterjee:I love that chart. It's a research that looked at how many single leg calf raises one should be able to do per decade.

24:22Dr Courtney Conley:Yeah.

24:23Dr. Rangan Chatterjee:And it is one of the assessments I do with all of my patients. And I get very picky, not only about can they do it, but can they do it on the beat? What does the height of the calf raise look like? Are they able to push through their big toe? Or they kind of look like they're going to sprain their ankle? There's a lot of information that you can get from watching someone do a calf raise. And unfortunately, the majority of my patients, when I pull out that chart, sit well below which they should be able to do.

24:55Dr Courtney Conley:You say majority of patients, as well as Joe Public, you deal with a lot of elite athletes. Do you also see elite athletes fail or not do so well on these tests?

25:07Dr. Rangan Chatterjee:This is what the elite athlete conversation, I think, is so fascinating to me. And as a good friend of mine, Jay Dachery, he always says this, we are building jet engines of bodies. So we're getting stronger, we're getting faster, we're lifting more weights, we're training power on paper airplanes of feet. Yeah. And that I think is so very important because our feet take on the loads of our body. So we want to get faster. We want to get stronger. You have to pay attention to that strength below the knee. And so when I have worked with players in the NFL and all over these professional sports, I always look at these assessments and I'm sitting here going, these are the elite, the top of the top.

25:52Dr. Rangan Chatterjee:and they're using their bodies very well without using the third that's producing the most power and speed and agility.

26:02Dr Courtney Conley:So you're probably thinking you're doing this well and you're not looking after your feet. If we could just do 20 minutes a day on your feet, you could unlock all kinds of potential. And I guess we're in a generation now because one of my favorite bits in the book is when you talk about how footwear changed maybe a hundred years ago. Was it Phil Hoffman? Yes, Dr. Hoffman, yes. Dr. Hoffman, yeah. And how he was sort of raising the flag back then saying, hey, listen, this is gonna cause a problem. But a lot of the top athletes now have grown up, of course, with, you know, poor footwear. Yeah. You know, overly cushioned, you know, maybe pronation supports, heel lifts, all this kind of stuff.

26:47Dr Courtney Conley:And what's also really interesting is that I've had the privilege of talking to Elliot Kipchoge twice on this show. You know, the guy who's regarded as one of the fastest marathon runners of all time. And I know he wears the, you know, the modern super shoe for running. But actually, when he was growing up and training, you know, it was a lot of barefoot. It was minimal footwear. So probably at the formative years of his life, he probably was living a lifestyle that grew strong, functional, wide feet. Do you know what I mean? Yes.

27:25Dr. Rangan Chatterjee:And I think when you look at his running gait, he is an elite, elite runner. It's a beautiful, beautiful running gait. And I think we need to pay attention to that. The shoe in that case is icing on the cake because he has these beautiful mechanics. When you take most runners and, you know, recreational runners who don't have his speed or there's his grace, if you will, that's an entirely different conversation when they're wearing a shoe like that. And I do think that when growing up and you have your foot on the ground and you're running and you barefoot, you start to adopt a different running gait.

28:07Dr. Rangan Chatterjee:And I think that's important to consider.

28:09Dr Courtney Conley:Yeah, it's a bit like away from sort of physical health and foot health, we know for our emotional well-being later on in life, our early childhood years are really important. Yes. right what are the messages we get when we're young kids you know what are our attachment bonds like with our adult caregivers maybe your parents if you're you know or whoever is in your life we know that that can have implications when you're 30 40 50 and I'm kind of seeing a similar pattern with you know our feet and this kind of foundation upon which we interact with the ground I wonder if you know Kipchoge was the example I just used now but perhaps if we as a society really focus on the first 15 years of life and said right for our children we want to make sure that we teach them about good foot health we put them in the right shoes maybe not overly cushion them or whatever maybe they'll build such a strong foundation that I'm not saying they can get away with poor shoes later but it probably insulates them somewhat later would you agree with that?

29:21Dr. Rangan Chatterjee:I think that's our biggest opportunity. Really? Is with the children.

29:24Dr Courtney Conley:So what would you ideally do for a child in terms of footwear?

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33:18Dr. Rangan Chatterjee:If you think of the foot as a sensory organ, if you will, because there are thousands and thousands of receptors on the bottoms of our feet. the same amount of real estate as the hands and the lips in the brain. So these are sensory powerhouses, if you will, that are gathering information from our environment and telling us how to improve, how to improve our motor outputs, how to move. So with kids, their little nervous systems are developing. So when their foot is on the ground and they're gathering all of the sensory information, whether they're walking on grass or sand or all different types of materials, their brains are developing.

34:04Dr. Rangan Chatterjee:Their foot is developing. And so when we interfere with that, if you watch a baby crawl that has a very stiff shoe on, for example, their foot's range of motion is restricted. If I had a very rigid shoe on and I'm crawling, I can't go into plantar flexion, you see?

34:26Dr Courtney Conley:So it's so obvious for people listening, Courtney's got up at the moment a model of the human foot. And you just see how much complexity is there and how much potential movement is there. You think, yeah, of course, if a baby is crawling with a stiff shoe on, it's going to lock down a lot of those joints. So there will be a compensation.

34:46Dr. Rangan Chatterjee:Yes. And if you look at any baby on the planet, the first thing they do is take their shoes off. They take their shoes off. They take their socks off. They want their foot to gather information. And I think that's so important as that foot is developing, six, seven, eight, nine years old, the foot needs to feel.

35:04Dr Courtney Conley:So for a parent listening to this, right? Because we need to, and we will address at some point for people who have maybe got foot problems or have been in inappropriate footwear for a number of years, you know, of course, they're going to be listening going, well, you know, is it too late? Can I do something about it? And of course, it's not too late. And there's many things you can do to retrain your feet. But let's start with this blank canvas. If there are some new parents listening, when I say new parents, parents of maybe babies or young kids, what are some common things that you would recommend that they do or don't do with their children to protect the health of their feet?

35:45Dr. Rangan Chatterjee:We get a lot of calls into the office about flat feet. And so parents are very concerned with their child's flat feet. That is common in young children. They have flat feet. Their bodies are still developing. And that can be associated with knock knees or the knees are coming together. And so they'll say to me, do we need some type of foot orthosis or does my child need a brace? They need sensory stimulation. So we will let children go barefoot as long as they can so they can gather information to improve motor outputs. And the shoes that we do put on our children's feet should respect the anatomy of the foot, meaning a thin and flexible sole so the baby's foot can move, so the toes can extend, so the ankle can dorsiflex or bend, the wide toe box so the toes can splay.

36:45Dr. Rangan Chatterjee:It's really interesting when you see even young children's feet who have been in restrictive footwear, you will start to see that change I was talking about. The formation of little bumps on the inside of the foot, that should not be there.

36:59Dr Courtney Conley:Because what's interesting when I hear this, Courtney, is problems in the foot go up the entire chain in the body, right? so how many cases of injuries later on in life even as teenagers you know back pain hip pain knee pain neck stuff how many of are actually downstream consequences of that our feet don't move properly so you lock something up there because of the footwear you wear and then it

37:31Dr. Rangan Chatterjee:just goes up the chain yes i my patients i when i see them i always say i wish it was just a foot problem because it would make things easier, but it never is. It is never just a foot problem. What do you mean?

37:43Dr Courtney Conley:You mean if it's something further up?

37:45Dr. Rangan Chatterjee:Yes. Neck pain, low back pain, hip pain. I'm always assessing their entire bodies. There's a person behind this diagnosis of heel pain. So you can't just look at the heel because there's so many other factors that are driving how that foot is hitting the ground. So there is certainly is a correlation between what that foot is doing and how those loads and ground reaction forces are going up the rest of the body.

38:12Dr Courtney Conley:Yeah, it's like, I'm no builder, right? As this will make very clear, but let's say you're building a house and we're talking about the foundation, the feet are the foundation of the entire body, right? It's like building a house on sand. Yeah, or you're building a house, let's say it's uneven at the bottom. And therefore, let's say it's a two-story house. You're like in the bedroom going, hey, the ceiling is, it's not flat, right? We need to do something. We need to get someone to fix the ceiling. It's like, yeah, but of course the ceiling isn't flat because your foundations aren't right, right?

38:42Dr Courtney Conley:So it's like, why don't we fix the foundations first and maybe this will naturally correct itself.

38:47Dr. Rangan Chatterjee:Yes, or you're going to have to keep fixing the ceiling.

38:49Dr Courtney Conley:Yeah, exactly.

38:51Dr. Rangan Chatterjee:And you're not going to ever get the result you're looking for.

38:53Dr Courtney Conley:So in practical terms, I think what you're saying for a child is in the house, keep them barefoot as much as you can. Does that mean without socks as well?

39:07Dr. Rangan Chatterjee:Anytime there's an interference between the sole of the foot and the ground, you change the sensitivity of the receptors or the amount of pressure that simulates these receptors. Sock obviously is going to be better than, say, a very thick sole. But when the foot can feel barefoot, that would be ideal.

39:25Dr Courtney Conley:Okay. So keep them barefoot as much as they can. Obviously, if it's super cold, you might want to put some socks on. but if so, as thin as possible, I guess you would say. What about when that child is going to leave the house? What are the key things? I know you've sort of touched on this, but I just want to make sure the point has landed. Like, should they be wearing shoes? And if so, what shoes?

39:48Dr. Rangan Chatterjee:Yeah, I think it's, you know, that's such a, there's so many kind of layers there. I think the environment is important. In certain parts of the world where children are used to being barefoot more often, the transition into minimal footwear or barefoot footwear tends to be easier. But in other cultures where, you know, shoes are still worn inside or, you know, they're not used to barefoot, there's a different conversation there. When we look at footwear for children overall, thin and flexible sole. So again, you want the sole to be able to move like the foot moves.

40:23Dr Courtney Conley:And just, you know, for people who feel that they're not necessarily trained and you know because of course sometimes the store staff will tell them something different to what you're saying Courtney but is it as simple as them just feeling the soul roll it up in a ball roll it up in a ball because that's what the vivos I wear yep you can just roll it up roll it up twist it which basically means that your feet can do what your feet want to do without the soul negatively influencing it. Yes. Okay, so thin and flexible sole.

40:56Dr. Rangan Chatterjee:Wide toe box. That's kind of my non-negotiable. The wide toe box is really my number one because when you start to taper the toes, you change what the foot was designed to look like.

41:11Dr Courtney Conley:So, you know, I know this is obvious to you and to a degree to me, but you just think about whether it's guys or women, like women with high heels and these really narrow soles, men's dress shoes with these pointed soles. I mean, we're quite literally deforming our feet.

41:34Dr. Rangan Chatterjee:It's exactly what we're doing. That's exactly what we're doing.

41:36Dr Courtney Conley:It's almost, you can't, you know, I say that I almost have to catch myself because that can be seen as quite an inflammatory comment to people, but that's what we're doing. Yes. We're wrecking our feet by trying to shove it into these things. It's like, what other body part would you do that with? You wouldn't. And be okay with that. Yes. It really - Marketing's powerful.

41:54Dr. Rangan Chatterjee:It is. And it really, I love when I hear my patients say, well, that really makes sense. And you've given me hope. Like, this is not a hard conversation. If you really think about this.

42:08Dr Courtney Conley:Yeah.

42:08Dr. Rangan Chatterjee:This is not, wow, that's, you know, that sounds odd. It makes sense. It makes sense. And that wide toe box is very important for not only the development of a child's foot, but also an adult foot. And then this heel, the other factor with the footwear is having the heel and the toe sit on the same plane.

42:29Dr Courtney Conley:So you don't want the heel above the toes. Correct.

42:33Dr. Rangan Chatterjee:When you have the heel above the toes, you're changing how the foot is feeling the ground. So you're shortening the Achilles and the calf complex. You're putting more pressure through the ball of the foot. and now you're putting more pressure through the ball of the foot when it looks like a point.

42:53Dr Courtney Conley:I mean, if you guys are watching, you know, if you're listening to this, maybe just have a quick look at the YouTube version of this video because just put that up again, Courtney, because it's crazy. You've got this gorgeous, you know, who do you quote? You quote Leonardo da Vinci in your book, the human foot is a masterpiece of engineering and a work of art. Yes, it is. Right? It looks gorgeous there. Yes. And you're just scrunching it up and squeezing these beautiful joints, which is the high heel shape, right? Yes.

43:24Dr. Rangan Chatterjee:And this is really, I think is really fascinating. When people say to me the foot needs arch support, if my foot looks like a foot, so for example, when the toes are wide and splayed and strong and I go to push off when I'm walking, this foot was designed to get stiff and to be strong to propel us forward. Now, if I take this big toe and I squeeze it together, when I go to push off, I lose the integrity of the foot. So you're changing the dynamics and the forces going through the foot. To me, that is, it doesn't make any sense.

44:08Dr Courtney Conley:Which is why, of course, when I was in, you know, wedding season with my mates, as it were, it's not uncommon for you know my wife or her mates or my mates at the end of the night to say you know want to take those high heels off oh yeah as soon as possible after the wedding yes yeah okay so two big non-negotiables for you you say number one and this goes beyond children this is now adults as well when we're choosing our footwear you want a wide toe box and you don't want this draw. No, sorry. Was it a thin and flexible sole?

44:42Dr. Rangan Chatterjee:So if I had to put these in order, and there's a reason for this. The wide toe box, the sole, the heel and the toe sitting on the same plane, and then the thin and flexible sole. This is where I was going with the adaptation piece. The thin and flexible sole component is difficult for people to get used to. if they have not been walking around barefoot, if they don't have a lot of experience with their foot on the ground, because thin and flexible can also be a little uncomfortable for someone who's not used to it.

45:18Dr Courtney Conley:Okay, so I like this. So you're saying there's a way to progress.

45:21Dr. Rangan Chatterjee:Yes, and that's very important because a lot of my patients live in cities, for example, and they've been walking around in poor footwear.

45:31Dr Courtney Conley:For decades.

45:32Dr. Rangan Chatterjee:For decades. And so if I said to them, if we have this conversation and it will make sense to them, so they'll want to go all in. They'll say, give me a minimal shoe. And I said, well, hold on. Yes, I want you in a wide toe box. But you've been walking around in a trainer that has a 10 millimeter drop. That's a high heel in my world. So to drop you down to zero and put you in something thin and flexible, that'd be like me telling someone to squat 100 pounds this week and 200 pounds next week.

46:07Dr Courtney Conley:It's too much load. Which is, of course, where some of the critique comes at, you know, any of those comes barefoot shoes or minimal shoes, whatever you want to call them, because we're looking at people who've spent decades in poor footwear suddenly they try and go and run a half marathon in a barefoot shoe and go, oh, you know, I got injured. Barefoot shoes are a load of rubbish. It's like, well, wait a minute. Wait a minute. You need to transition perhaps. Okay, Courtney, just to make sure this is landing with everyone, right? So if in my head, there's almost, well, two or three categories of people we need to be thinking about.

46:49Dr Courtney Conley:Okay. One is children. So assuming your child is born and there's no issues, what we're trying to do is not create issues for them in the future. So as much as possible, do the things that we mentioned so far. Yes.

47:06Dr. Rangan Chatterjee:And I think also for parents, it's also understanding that your child might play football. They might be on ice skates. It's okay. Yeah, exactly. It's okay. They're going to be in certain footwear at times because that's what the task requires. It's when they're out of that footwear, that's when we want to make sure that they're in minimal footwear, functional footwear.

47:34Dr Courtney Conley:But yeah, that's really reassuring, okay, for people. So yeah, wear the football boot with studs when you're playing football. Yes. No problem. But just don't wear them all the time. That's right. Which of course they wouldn't do with that. But I'd say what you do see a lot these days is you see a lot of these premium running brands, which are, I won't necessarily mention the name of one of them, but they're very, very thick, cushioned running shoes. And you could just about, well, I'd love your perspective on what you think about these, in a verse, commas, running shoes. But I think one of the problems is that people are not just wearing them for running.

48:15Dr Courtney Conley:they're wearing these floaty heavily cushioned shoes for work, for walking around the airport for going to the supermarket maybe there's a case for wearing it when you run although you may have a different perspective on that but don't spend the rest of your life in it as well

48:32Dr. Rangan Chatterjee:there's a different tool for the task at hand your running shoe your trainer is not your strength training shoe if we go let's talk about strength training for a second. When I'm in a gym and I'm carrying heavy things, your foot has to feel the ground. It has to be strong and stable. If I was going to deadlift, for example, or heavy squat, I don't want to be squatting or deadlifting with a lot of weight in my hand standing on a pillow. That would change the pressures going through my knee and through my hip, it would basically, your body's sitting there going, wait a second,

49:17Dr Courtney Conley:I need to feel something. Connie, that's such a provocative analogy, standing on a pillow. Everyone kind of gets that, right? You wouldn't do that in the gym. You wouldn't stand on a pillow and try and do this stuff. You'd want to feel the ground, give you traction and get that feedback. Why is it okay then to run on pillows?

49:41Dr. Rangan Chatterjee:It depends on what type of runner you are, I guess.

49:44Dr Courtney Conley:I want to say pillow. I'm talking about these thick, cushioned soles where, frankly, you can't feel the ground.

49:51Dr. Rangan Chatterjee:There's always a trade-off with footwear. So if we look at cushioned footwear, for example, when someone puts that on initially, they say, wow, this is comfortable. I have a lot of protection. You are getting protection. There's a lot of material between the sole of your foot and the ground. But here's the trade-off. You compromise sensory acuity. What does that mean? You compromise sensory information because there's an interference between all those beautiful receptors on the soles of the feet and what they are trying to feel when you put a lot of sole between your foot and the ground. So if my goal is I want to help someone's balance, my dad, I want to make sure he doesn't fall.

50:44Dr. Rangan Chatterjee:Does it make a lot of sense for me to make that harder on him by putting a lot of material between what he's supposed to be feeling in the ground? So we need to think about those things. Is your goal to walk 10 miles on a trail? and does your foot not have the capacity or strength? Do you need more cushion in that scenario? Possibly. But keep this in mind. You will compromise what you're getting, what you're feeling from the ground. So you have to ask yourself that question. What are my goals?

51:24Dr Courtney Conley:It's the cost of comfort, right? That's right. We can see the cost of comfort in other areas in life. If we drive everywhere, comfortable in our heated car with our favorite music playing, wonderful. But if we keep doing that and don't move our bodies, there comes a cost. Yes. We get that. If we use our phones for everything and get all our shopping delivered and our food delivered to us, very convenient. Yes. But there's a cost. Yes. And I love the way that that also applies to our footwear. a nice cushioned shoe, beautifully, you know, you bounce and go, oh God, this is nice. But you're switching off your nerves, your proprioceptive kind of inputs to the body, your balance.

52:07Dr Courtney Conley:So are you aware of the trade that you're making when you purchase your footwear?

52:14Dr. Rangan Chatterjee:I just, that is my goal. My mission in life is to just get people to start thinking about the foot like we do everything else. All those examples you just gave, if we took those examples and applied them to the foot, we would all be asking ourselves that question.

52:30Dr Courtney Conley:Yeah. Let's go back to these three groups of people I had in my mind. Children who have got healthy feet, let's try and not do stuff that messes their feet up. Correct. Then the second category of people for me was people, I guess, who were well, maybe they don't have you know a and so in a verse comes a problem like a bunion or plantar fasciitis or you know foot pain whatever it is but they realize that you know what i'm not wearing the best footwear for me and as i get older i better start paying attention to my feet and then i guess the third category is people who do have established problems yes um from the modern world, maybe from inappropriate footwear.

53:17Dr Courtney Conley:So I want to make sure I keep those three groups of people in mind throughout this conversation. You've mentioned how to choose footwear for children. If you're in that second category, you know, like I imagine many people listen to this podcast, they're sort of, they're pretty well, they try and look after themselves, they're interested in health and they're realizing, I've not really thought about my foot health, but I don't want to have a fall when I'm older. I don't want to have other problems. So let me start paying attention. And let's say they're used to wearing modern, cushioned, supported footwear.

53:57Dr Courtney Conley:Help that person understand what to do. And I think what might be useful is this distinction you make in the book of minimal footwear versus functional footwear.

54:08Dr. Rangan Chatterjee:If someone, it's been really interesting to see my practice change too, because years ago it was, people would come in with foot pain and say, hey, can you help me with my foot pain? But now I think because this education is becoming more widespread, I'm seeing people in the second category. They're like, I know I haven't been wearing the right footwear. I don't necessarily have problems in my feet, but this makes sense to me. So what do I do? So we will run them through the assessments of their foot. How does it move? Do they have dexterity? Do they have good strength? And then based on that, we will talk to them about footwear.

54:50Dr. Rangan Chatterjee:If I put them into a minimal shoe, which those requirements, again, are wide toe box, zero drop, so heel and toast on the same plane, and thin and flexible sole.

55:00Dr Courtney Conley:So those are the three criteria for a minimal shoe. Yes. And could you just, top of your head, mention some brands which qualify as a minimal shoe? Vivo Barefoot. Yeah.

55:12Dr. Rangan Chatterjee:Bilenka.

55:13Dr Courtney Conley:Yeah.

55:14Dr. Rangan Chatterjee:Zero.

55:14Dr Courtney Conley:These are minimal shoes. Okay.

55:18Dr. Rangan Chatterjee:We will have the conversation of duration. So I always say you have to earn your right to wear minimal footwear. Okay. Because there are more loads going through all of your tissues, your bone, your tendons, your ligaments, your muscles. This is a good thing. This is when we get stronger. But again, taking everything we know about the human body and how we would train the human body, we have to apply that to the foot. So it is slow. You're going to wear this shoe for five to ten minutes a day. You're going to see how you feel that night. You're going to see how you feel the next morning. If things are good, you slowly add time.

56:02Dr. Rangan Chatterjee:But if you wake up the next morning and you're like, hmm, my heel's a little sore.

56:07Dr Courtney Conley:You wait.

56:08Dr. Rangan Chatterjee:You wait. And it's not the shoe's fault. That was one of the, you know, with the pandemic, I saw all these articles come out. You know, people don't walk around barefoot at home because you're going to damage your foot. And I'm going, we have the message wrong.

56:24Dr Courtney Conley:It's not. It's not just wrong. That's the most ridiculous thing. I mean, if you just look at our history as humans, we have walked around barefoot for the vast majority of it. It is ridiculous to think that walking around barefoot home for most of us is damaging our feet. It's kind of messed up. It is. I don't get it.

56:44Dr. Rangan Chatterjee:I think the biggest argument that people will say is, well, we weren't designed to walk on man-made surfaces. Okay.

56:51Dr Courtney Conley:And what do you say to that?

56:53Dr. Rangan Chatterjee:Okay. Okay, so if that is the argument, you can still put your foot into its functional position here. Enter functional footwear.

57:02Dr Courtney Conley:Okay, so minimal footwear is maybe what, is that the ultimate goal, would you say, for people? But is functional footwear a bridge?

57:09Dr. Rangan Chatterjee:Yes.

57:10Dr Courtney Conley:Okay. I think more people will live in the functional footwear kind of area.

57:20Dr. Rangan Chatterjee:ideally as their foot strengthens and they can transition you can move into a shoe that is going to require more out of you but the functional footwear is where i take everybody is that like a transition yes it's wide toe box but that's the same as minimal isn't it yes okay so you still got

57:36Dr Courtney Conley:wide toe box that's my non-negotiable okay so that's in both minimal and functional you have a wide toe box that's right so okay put another way don't buy a shoe that's going to deform the front of your foot. Yes. Okay.

57:50Dr. Rangan Chatterjee:Yes. I mean, that should... It's a kind of basic...

57:53Dr Courtney Conley:When you say it like that, it's like, why on earth would you compress the front of your feet? Correct. Okay, so wide toe box. Yes. Then what's next in this functional footwork? So when we talk about

58:02Dr. Rangan Chatterjee:the heel to toe drop, functional is low to zero drop. So six millimeters are below. And that's with research saying... We've done the studies and low to zero drop is six millimeters to zero.

58:17Dr Courtney Conley:So minimal footwear is zero drop, where the heel and the toe are on the same level. And you're saying when you're transitioning, perhaps go to a functional shoe where there is a drop, but it's just not very much. Correct. Okay.

58:32Dr. Rangan Chatterjee:Especially if someone has had plantar fasciopathy or heel pain, or they have a history of Achilles tendinopathies, where they have some type of issue where we know we have to work on strength and mobility. You don't want to take them down too quickly. So it's, hey, let's try this. Let's try this zone. And then the functional footwear is where you can play with variations of stack height. So that's how much cushion is under the sole of the foot.

59:00Dr Courtney Conley:So in functional footwear, you still will have some cushioning, maybe just not as much as you're used to. Yes.

59:08Dr. Rangan Chatterjee:So a lot of the footwear, there's companies now where you'll see stack heights of 55 millimeters. I mean, it is gigantic. That is a significant cushion under your foot. So these brands that are aware of the anatomy of the foot, so respecting the toe box, dropping the heel a little bit, but still giving people some of that cushion that they often seek because their foot hasn't felt the ground in decades, that's a nice lane to sit in as they start to transition.

59:46Dr Courtney Conley:What are some of the brands that sit in the more functional footwear category as opposed to minimalist?

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1:02:01Dr Courtney Conley:What are some of the brands that sit in the more functional footwear category as opposed to minimalist?

1:02:07Dr. Rangan Chatterjee:There's not many. Ultra Running.

1:02:09Dr Courtney Conley:Is that ALTRA?

1:02:10Dr. Rangan Chatterjee:ALTRA. Yeah. Topo Athletic.

1:02:13Dr Courtney Conley:Yeah.

1:02:14Dr. Rangan Chatterjee:Notice is a newer brand. But that's what I think happened here when this conversation of minimal footwear is not new. All right. In 2007, the Vibram five fingers, we were having these conversations and people got real excited about it. And they went from zero, they went from over here into minimal. and people were saying, well, I have, you know, my foot isn't ready for this. And they were saying my calf hurts or my foot hurts. And again, not the shoes fault, the fact that we didn't build capacity, but this lane of functional footwear didn't really exist. So people either said, you're going to be in this real aggressive shoe or you have minimal.

1:03:01Dr. Rangan Chatterjee:And so that's where I think this education and these brands are saying, hey, people do need, this might be a lane for some people to start in.

1:03:13Dr Courtney Conley:Could we make the case, Courtney, or would you agree with this? Let's say we turned the clock back 150 years or even 200 years. We wouldn't need any of this stuff because our feet would just be stronger. But because we've been in inappropriate footwear as a society for so long. Now, for some of us, if we want to do the work of restoring our foot health, we need to gradually transition.

1:03:38Dr. Rangan Chatterjee:I mean, some people can clearly go

1:03:39Dr Courtney Conley:to minimal footwear straight away. If they're careful, they have no problems. But for some people, you're saying you might be better off going to this halfway house first.

1:03:49Dr. Rangan Chatterjee:And we're talking decades, decades of people's feet getting weak. This doesn't happen overnight. So that second category that you mentioned, with people that don't have any symptoms or pain. I have plenty of patients that can walk around in cities in minimal footwear with no problem. But that third category, and I sit in that third category because that's how I got into all of this. I have bunions. I've had neuromas. I've had all the things because my foot structure has changed due to me not paying attention.

1:04:24Dr Courtney Conley:Can you tell us a little bit about your story? One of the things I found really interesting in the book is that you seem to understand the benefits of walking for you quite early on. And from what I remember, you used to walk regularly because you knew it helped you until you started to get problems in your 20s, I think.

1:04:44Dr. Rangan Chatterjee:Yes. Movement has always been my therapy. I didn't realize it at the time when I was growing up, but it was my, you know, through some pretty dark times. I didn't quite know what I was doing, why it was so beneficial for me. But anytime that something was going on, I'd just walk and I'd keep walking until I felt better. And I grew up as a ballet dancer in pointe shoes. And then I transitioned into the triathlon world and my feet were just perpetually shoved into footwear that was restricting its motion. And I developed bunions and neuromas. I've had stress fractures. I've pretty much had all the diagnoses that my patients come to see me with.

1:05:30Dr Courtney Conley:Which is of course why you do what you do today, right?

1:05:35Dr. Rangan Chatterjee:And walking became very difficult. And that was very hard for me because I didn't have any other coping strategies at the time. I was young. I'm like, I can't walk. And you start to see this cycle of what happens and you see how depression and anxiety can set in very quickly when you can't move your body. And so as a personal quest, I just became, I was like, I have to get a hold of this. And so that's what started all of this. So to get back to that footwear conversation, I, because I have structural change in my foot, Now, albeit it is much better. There are no symptoms there. 80 % of the time I'm in minimal footwear, but I know I have that bunion.

1:06:33Dr. Rangan Chatterjee:If I'm going to be standing on concrete, if I go to a concert and I'm not walking per se, I'm just standing still. I know I still want my foot in that wide toe box, non-negotiable. I'm okay with my heel and toe being in the same plane. But if I'm standing in one place, I want a little stack height. And that's where I live in the functional category. So I have this shoe spectrum. And I think that's important for people. We are not saying 100 % of the time you need to be doing this. We're not going to, you know, that's not how we should be educating.

1:07:11Dr Courtney Conley:No.

1:07:12Dr. Rangan Chatterjee:It's live along the spectrum. Dance over here for a little bit. This is where you're going to get stronger. But it's okay. You can live here. Keep your foot in its functional position. But where you can't live is in footwear 100 % of the time that is restricting your function and interfering with your sensory acuity that's going to affect your longevity.

1:07:38Dr Courtney Conley:Could we take that principle, let's say, for a woman? if a woman let's say lived 90 % of their lives in good footwear but on a Saturday night to go out they wore high heels because they like to yeah right they like the way they're looking at you know I'm not sort of criticizing that at all I'm saying a good strong functional foot I'm guessing can tolerate being in different kinds of footwear now and again if the vast majority of the time you're in the correct footwear?

1:08:13Dr. Rangan Chatterjee:Yes. I tell women, go for it. If you want to, if that's what makes you feel good, that's powerful. Yeah, exactly. Just when you get home, in the book, we have a high heel rehab. If you're going to wear high heels, do these things. You know, I used to still have my occasional high heels in my wardrobe, but about six years ago, I also was going to a wedding and my fiance, I put on my heels and I sat there for a second and the look on my face, he looked at me, he goes, please take them off because you're going to complain all night long. And from that moment on, I have not worn a pair of heels because the second I put my foot in there, I'm just like, oh no.

1:08:55Dr Courtney Conley:So. What did you wear?

1:08:58Dr. Rangan Chatterjee:I wear sandals.

1:09:01Dr Courtney Conley:is that hard like if you're going somewhere where you have to dress up like do you find it difficult to go yeah but that because there is a sort of I won't say an expectation but there is a sort of thing you wear at certain events right yes you know it's such a

1:09:18Dr. Rangan Chatterjee:good question um first when I first started doing this there were maybe a handful of companies that made minimal footwear or appropriate footwear. Now there's many. So the options are much greater. But I think about this, when we get dressed, we want to feel confident, right? That's the goal. We want to feel confident and comfortable on our skin. For me, being able to walk with confidence and feel strong and feel stable, a lot of that comes from how I'm interacting with the ground. So I feel like I'm walking more confidently and I look more confidently when I have my foot on the ground. Yeah.

1:10:05Dr Courtney Conley:Could someone make the case that if you have well-functioning feet, let's say you had the time, knowledge, and discipline to spend 30 minutes on your feet each day. I expect very few people listening to this have done that or will do that. But let's just do a thought experiment for a minute. if all the tests that you write about in the book you know the lean to wall test the credit card toe strength single leg calf raise single leg balance test right let's say you worked on all these things and your feet your toes your calf muscles were functional and strong if that was the case could you argue that you can you can kind of wear whatever footwear you want because it's really your feet function that determine the vast majority of the outcome.

1:11:01Dr Courtney Conley:And, you know, because I guess what I'm trying to get at, you could, for example, someone could listen to this. I go, all right, you know what? I've heard wrong and bang on about this for a number of years, but, you know, I wasn't sure, but Courtney's persuading me, right? I'm going to get into this. And they may go to a functional shoe or a minimalist shoe. but if their feet are not working well it's not necessarily going to correct that by going into a different shoe is it? They could still have issues with the way their feet interact with the ground unless they do some of the rehab work. Do you see what I'm saying?

1:11:38Dr. Rangan Chatterjee:Yes. The priority is the foot itself. It's what you put into the shoe.

1:11:44Dr Courtney Conley:Exactly.

1:11:45Dr. Rangan Chatterjee:You have to pay attention to that. The shoe is, it's icing on the cake, like I say to my patients. It's icing on the cake. Pay attention to what you're putting in the shoe.

1:11:56Dr Courtney Conley:So Kipchoge with excellent foot function and strong feet from childhood, well, he'll probably be all right in anything.

1:12:04Dr. Rangan Chatterjee:I was just going to actually use that example because in my runners, if they want to run on race day in their super shoes where they get their running economy, fine. I'm not gonna win all those battles. But when they're training and they're practicing and they're trying to become the most efficient runner and the strongest runner, you're not gonna be training in your super shoes. I want your foot to get strong. I want your ankle to get strong. So again, having this shoe spectrum, work in an environment that's a little more challenging. So that when you go and put your foot into your super shoe, now you have this strong, resilient system.

1:12:54Dr. Rangan Chatterjee:Maybe your running gate mechanics are better. So those are all the things I like to think about. You can't cheat the system forever without thinking that there will not be a consequence.

1:13:05Dr Courtney Conley:What about these cultural ideas that we pick up, right? So take me, for example. so you know you don't know much about my history but i used to have really really bad back pain in my 20s i had time off work couldn't lift my baby boy when he was born you know really affected my quality of life in a massive way now i've subsequently realized there were multiple contributing factors to my back pain including emotional things about you know having to carry the weight of my father was very sick. And, you know, I was the person in the family is that I guess the medical son who was kind of semi in charge of all that care.

1:13:52Dr Courtney Conley:But there was also a physical component, right? Because I think with chronic pain, you know, this stuff's multifactorial. It ain't just one thing. But on my journey to being completely pain free, which I've been for many years now. There was this amazing guy, Gary Ward, who's a really good friend of mine. I found, do you know Gary? Yes. Yeah. I basically, I found this guy and he was like, I think he's going to be able to help me. And I went down and I studied, I took his anatomy and motion courses. I think it was the first doctor to do his courses. And it's a great course. It's brilliant. And Gary said to me, this is back probably in 2011, 2012.

1:14:33Dr Courtney Conley:He's like, your right foot is not working properly. Or, you know, he didn't exactly say that, but that's my colloquial way of trying to describe it. And he gave me some foot exercise. I said, oh, Gary, I've got a flat foot. He said, no, no, wrong. Listen, your foot is stuck in pronation. Pronation is not a problem, but we need to help it get out of pronation. That's right. And so he gave me a couple of exercises for my right foot. I remember doing them. I was walking, I was like, where's my back pain gone? It was the first time that I was like, wait a minute. How my right foot is functioning is contributing to my back.

1:15:13Dr Courtney Conley:Yes. So that was kind of, it was really interesting for me. And that in many ways started off my journey with, oh, my feet is really important. And as I said to you, when you came to my house this morning, I said to you 12 years, I've been wearing Vivas, but I think it's longer because my first time I bought them was in, I think it was October, 2012, when I made my first Viva Barefoot purchase. So what we're looking at, maybe 13 and a half years now. People will say, yeah, okay for walking, maybe okay for running if you've trained, but for lateral movements, you need supportive footwear. Well, here's the thing.

1:15:52Dr Courtney Conley:I took up paddle about six months ago with my son. Do you know paddle? So quite a lot of lateral movement. I wear my vivos playing paddle. I have no problems at all. So we have these, and again, I'm used to wearing minimal shoes. I was going to say barefoot, but I like your definition of functional and minimal. So I will say minimal shoes. What's your take on that? Maybe I can manage it. Maybe some people who are not used to it will need some lateral support. But what's your take on that? Because the belief system is, yeah, but these modern sports, you need lateral support.

1:16:27Dr. Rangan Chatterjee:What would you say? Again, going back to if we just think about the foot like we think about the rest of the body. If I was going to train my shoulder and strengthen my shoulder, Would I only train it in flexion or extension? Wouldn't I want to train it in internal rotation and external rotation and abduction and adduction? So when we talk about the foot, one of the foot's most incredible capabilities is its ability to invert and evert, which is this motion. So the foot going in and then it going out. The foot moves in all these different planes of motion. So rather than avoid these movements, we train into them.

1:17:16Dr. Rangan Chatterjee:We don't say, hey, your foot's flat. We need to avoid pronation. We want to find pronation. We want to get you to control pronation. You've sprained your ankle. That doesn't mean go get a brace and never allow your ankle to go into inversion again. That's life. That's environment. You have to train the brain to see inversion again. So I'm a very big proponent of training the foot, especially into inversion and eversion or lateral motions. I think that's very important. So you're saying that obviously I've chosen to,

1:17:56Dr Courtney Conley:so I think it's the Vivo barefoot motus that I use when I play paddle. but could we argue that well listen when i'm doing my foot work away from the paddle courts i'm training all these movements but if i if i wanted to play in a traditional tennis shoe or i don't know i haven't seen paddle shoes but i'm guessing they're similar to tennis shoes with lateral support that's fine as well isn't it it's you know there's so much research coming out that

1:18:27Dr. Rangan Chatterjee:The, you know, shoes don't cause the injuries. And there's so many layers. Yeah. There's so many layers. You can't blame footwear for injuries. That would be, there's other factors. It could be sleep. It could be lack of strength. It could be, you just want to give your body the best chance you can. And that means creating resiliency, which means training your foot like you would train the rest of your body. And then when you put it into a shoe where you say you're going to play tennis, you're going to do that, just play. Have a good time. Yeah.

1:19:02Dr Courtney Conley:Put what you need to put on to go and have fun.

1:19:04Dr. Rangan Chatterjee:That's right. Some people like playing in minimal footwear on a tennis court. Great.

1:19:08Dr Courtney Conley:And some people don't.

1:19:09Dr. Rangan Chatterjee:And some people don't. Also great. Yeah. But just pay attention to your foot. Make sure your foot is strong and mobile. Yeah.

1:19:17Dr Courtney Conley:I remember this as a kid. I used to go to India every other summer for six weeks to see my grandparents and my family. and I remember at my maternal grandparents house they used to live in a block of flats on the second floor and because it's hot in the day every day at about 4 p.m there was like three or four um sort of blocks of flats around that all the kids would kind of congregate downstairs at about 4 p.m and do all sorts of stuff and yeah I'm on holiday playing with my cousins and my young cousins say we're gonna play football so I'd go down with my shoes on and they're all playing football like full on barefoot.

1:19:58Dr Courtney Conley:So obviously I take my shoes off and it's a little sore for me because I'm not used to it. But then by the end of the summer, you're like, yeah, there's no problem. You see them properly tackling, sliding, whatever, completely barefoot. And we would think in the West, we think you can't play football like that. I'm not at all suggesting anyone does that, but it does show you how resilient and adaptable our feet are when we start to use them. That's right.

1:20:25Dr. Rangan Chatterjee:Give them what they need.

1:20:26Dr Courtney Conley:Okay. So if it's the foot function, that's the most important thing.

1:20:31Dr. Rangan Chatterjee:That is the most important.

1:20:32Dr Courtney Conley:Which is what Gary would definitely say. Yes. I think Gary's viewpoint would be if your feet function well, you can probably get away with anything. But I think a lot of us, in fact, how...

1:20:44Dr. Rangan Chatterjee:Think about it like stacking behaviors.

1:20:47Dr Courtney Conley:Yeah.

1:20:49Dr. Rangan Chatterjee:If you don't pay attention to your feet, and you don't strength train your foot, and you don't mobilize your foot, and you're wearing foot orthoses forever, and you're wearing restrictive footwear, you're putting a lot of things not in your favor.

1:21:03Dr Courtney Conley:Yeah.

1:21:04Dr. Rangan Chatterjee:Do you see? It's this stacking concept. So we have to do something. Some people choose to just wear minimal footwear. There's studies saying if you just wore minimal footwear, you will improve the strength of your foot.

1:21:19Dr Courtney Conley:Yeah, 62 % increase in just four months. And that study, I think University of Liverpool was remarkable. Because it's like, if you're someone who goes to the gym, right? If someone could tell you, you could get a 62 % increase in your biceps or your quads.

1:21:40Dr. Rangan Chatterjee:Everybody's in.

1:21:41Dr Courtney Conley:Yeah. But the crazy thing is that you're not actually doing anything. You're just wearing minimal shoes. so your feet are naturally getting a workout. And you know, it's crazy. It's like, it's kind of free money sitting there for some people.

1:21:55Dr. Rangan Chatterjee:You know, when I was doing the research for this book, I was looking at so many studies and a lot of them were delineated in what happens when you wear this type of footwear versus what happens when you do these exercises. And I would love to see more research where those conversations are combined. The and conversation. What happens when you wear functional or minimal footwear and you exercise your foot? You know, I think that would be, but for those who are saying, hey, I would just prefer to wear minimal footwear. You will get benefit. There's others say, hey, I'm just going to, I'm going to work on strengthening and mobilizing my feet.

1:22:35Dr. Rangan Chatterjee:Great. Do something.

1:22:38Dr Courtney Conley:Okay. on that topic then of doing something, there are so many tools in this book for people to think about doing, right? But let's start to stratify it. Let's say someone's listening to this, Courtney, and they're like, yeah, I'm not sure about changing my footwear, but I'm interested in improving the health of my feet. What are your sort of top daily, you know, three, four times a weak? Like what are some of these top drill stroke exercises you would recommend people start doing?

1:23:15Dr. Rangan Chatterjee:I think the first thing is, do you have good foot awareness? Most of the time, people have not paid attention to how their foot feels. And so that's where we'll start. So we'll have people keep their four toes down. And can you just lift your big toe? Okay, hold on.

1:23:33Dr Courtney Conley:So they'll keep the four toes down and just lift that big toe. Now, I know, because I've done this before with Helen, that it's different on my left and right. So on my left foot, for example, I can keep my toes down, I lift up my toe. On my right one, my second toe starts to come up. I know you haven't examined my feet, but is that common? And if so, why does that sort of happen?

1:24:00Dr. Rangan Chatterjee:It is common. And what's I think very interesting is a lot of the times when I see that, the foot that has poor dexterity or poor awareness will often be the side where you'll start to see symptoms.

1:24:13Dr Courtney Conley:That's true with me for sure.

1:24:16Dr. Rangan Chatterjee:So pay attention to that. Also, when you're lifting the big toe, I also look at how you're lifting the big toe. When you lift the big toe, does it deviate away from the middle of your body? so think of a bunion if i was going to lift my big toe it's my toe should go straight in the air if you lift your big toe and it goes towards your second toe

1:24:41Dr. Rangan Chatterjee:muscle muscle weakness because there's a muscle that straightens the big toe

1:24:46Dr Courtney Conley:can we just pause that on bunions a minute because bunions are so common as you've said you you experienced them i think in your 20s i have a couple of questions around bunions which relate to this exercise. Number one is, are bunions a modern problem? Okay, so do we get them in traditional societies to the best of your knowledge? And then if so, once you have a bunion, is there anything you can do about it?

1:25:20Dr. Rangan Chatterjee:Yes. So let's attack the first one. the first one. One of the studies that I found so interesting in regards to Hallux valgus or bunions when I was researching the book was there were scientists who looked at centuries and they said in the 12th and 13th century versus the 14th and 15th century. And they dug up the skeletal remains, and they noticed that in the feet of the men in the 14th and 15th centuries, there is more of a prevalence of hallux valgus.

1:25:58Dr Courtney Conley:And what is hallux valgus? Bunyan. Yeah.

1:26:02Dr. Rangan Chatterjee:There was also happened to be more fractures in that population as well. Now, we can't make the correlation that a bunyan is directly a cause of fracture, but I thought that was interesting.

1:26:13Dr Courtney Conley:Okay. So when you look at those two areas, what changed in the 14th and 15th centuries?

1:26:23Dr. Rangan Chatterjee:Why, when they looked at these skeletal remains, was there an increased prevalence of Hallux Valgus in that century versus 12th and 13th? The medieval times. And it was the introduction of the Krakow and the Poulain boot, you know, the very pointy medieval boot. Right. that was worn mostly by men. Because we think of bunions today.

1:26:48Dr Courtney Conley:For women. For women. That is so interesting. It is. I never heard that before.

1:26:53Dr. Rangan Chatterjee:I would argue, is it really a female problem? Now it could be because the female footwear is very different. These are all just things to think about.

1:27:04Dr Courtney Conley:Well, there was a very powerful story in the book about, was a female air hostess who came to see you. And, you know, she's just required as her job, you know, they have to have a minimum heel height as parts of her job.

1:27:21Dr. Rangan Chatterjee:Yes, it's so upsetting to me.

1:27:22Dr Courtney Conley:Yeah.

1:27:23Dr. Rangan Chatterjee:I've written so many letters to airlines.

1:27:26Dr Courtney Conley:Have they ever written back to you? No, not yet. Not yet. Well, but your book, the podcast you appear on, the more, all it takes, I realized, all it takes is for someone in a position of power at one of these companies to have experienced the problems themselves yes ultimately that's what changes things right humans when it when it affects you suddenly you're motivated to do something about it right if you were the female ceo of pick your international airline company yes and you experienced this and ended up at your clinic you might go hey this is crazy right we're going to change our policy but until that happens it gets tricky, doesn't it?

1:28:08Dr. Rangan Chatterjee:Yeah. She said to me, she goes, you know, I wish we took care of our feet as much as we're supposed to take care of our passengers. I said, that's very fair.

1:28:17Dr Courtney Conley:But just on that, if there is an air hostess listening to this, Courtney, who for her job has to wear heels, you're still, I guess, going to argue that, well, not argue, you're going to perhaps make the case that when you're not at work, you need to be really paying attention and maybe when you're walking, I don't know, maybe when you're on your break on a long flight, get the heel. Do you know what I mean? There are things that you would recommend they do to mitigate the downside.

1:28:47Dr. Rangan Chatterjee:They have changed. There are several airlines now where they used to require that there is a small heel worn both in the airport and on the flight. Some of these airlines have changed. Now they only have to wear the heel on the flight so they can wear different footwear when they're walking through the airport.

1:29:07Dr Courtney Conley:It's kind of interesting, isn't it? Yes, very. Because I guess, what is the thinking? I guess the thinking is whenever you see one of our, I guess we're talking about women at the moment, female air hosts, they're going to have a certain look, right?

1:29:21Dr. Rangan Chatterjee:The goal with any company of an airline, I would think, is customer service. You want your flight attendant to, you know, be interacting with your passengers and be happy and be, you know, confident and comfortable. If they're not comfortable and anybody who's had foot pain, you're not walking around with a smile on your face.

1:29:41Dr Courtney Conley:Yeah. You're going to be more reactive. Less forgiving when you get asked for something for the 500th time on the flight or whatever.

1:29:49Dr. Rangan Chatterjee:Okay.

1:29:50Dr Courtney Conley:So basically, I think where we're up to at the moment is we're saying traditional societies, we don't think had bunions. We think, well, I don't know if that's the case you're making, but certainly in the 14th, 15th century,

1:30:04Dr. Rangan Chatterjee:it looks as though there's this increased prevalence because because of footwear yeah okay and then there always is the argument with bunions about are they genetic so my mom had a bunion my grandma had a bunion so that's why i have a bunion and there are certain you know factors we can say connective tissue laxity, hypermobility. There are factors that are inherited that would make a foot more likely to have a bunion. But this is always my argument with that. If you went to the doctor and they ask you for your family history, do you have a history of cancer? Do you have a history of heart disease?

1:30:49Dr. Rangan Chatterjee:And you say, yes, my mother had heart disease. What do they tell you to do?

1:30:55Dr Courtney Conley:Change your lifestyle.

1:30:57Dr. Rangan Chatterjee:Change your lifestyle. So when someone says, my mom has a bunion or my grandma has a bunion, what I'm going to tell them to do, change your lifestyle, change your footwear, start strengthening your foot. It's not a just because now you are going to have bunions. Have the conversation of education. What can you do? Empower the person to make that change for themselves.

1:31:22Dr Courtney Conley:Yeah, a couple of things go through my mind there. First of all, number one, we're talking about earlier on in this conversation. how do you motivate people to start caring about their feet if they don't have a problem? And it could be if your mom or your grandma or your dad even had bunions. So maybe you have a genetic predisposition, right? It's not your destiny. It's just a predisposition. Correct. Maybe that's even more of a reason to go, wow, I saw how much pain or discomfort my mom was in. I don't want that to be me. Let me get onto it. So number one, it could be a motivating factor. The other thing that has come up several times to me according to this conversation is the similarity between the way you look at the feet and the way that let's say I might look at physical health.

1:32:08So let's take type 2 diabetes, right?

1:32:13Dr Courtney Conley:We know that by the time you get a diagnosis of type 2 diabetes, the process and the physiological changes that led to it probably started five to 10 years prior to that. So you've got this long period of time where you're living your life, your sugar hasn't quite gotten to the diabetic range yet, but it doesn't mean things are good. And you made that case earlier on with the feet, right? Just because you're not in pain at the moment, by the time they come and see you with their problem in their foot, that didn't start the week before. That has been building up because of your lifestyle and your footwear and how you treat your feet for maybe a decade, right?

1:32:54Dr Courtney Conley:So there's this latent period where you could intervene. There's also a similarity in terms of what you just said, which is people will say sometimes, oh, you know, doc, yeah, but my dad had diabetes, type 2 diabetes, so of course I'm going to get it. It's like, well, hold on a minute. Your dad may have had a genetic predisposition, but I can guarantee you if you eat in this way and you keep your weight here and you do this sort of exercise, whatever it might be, you're not going to get it.

1:33:26Dr. Rangan Chatterjee:Yes. Do you know what I mean? It's the same thing. Yes, it's an exciting conversation. It's one of empowerment. Yeah. And I think people get excited about that, that there's something that you can do. It's part of the journey, if you will. And that's why I love when people say, oh, you've given me hope, because that is what it's about.

1:33:45Dr Courtney Conley:Your whole book is a message of hope, actually. I think it deals with everyone. I love the way with footwear, You take this very nuanced approach saying, well, it kind of depends. Depends where you currently are. Right? You take this approach with walking, which we haven't gone into in depth, your build program, which, you know, maybe we'll get to today. Maybe we'll have to leave it for a part two. But this idea that actually, look, sure, our ancestors may have been 15 ,000 plus steps a day. But let's not make the aim for 15 ,000 or 10 ,000 put you off. Even if you can increase from 2 ,000 to 4 ,000 steps a day, you're getting benefits.

1:34:27Dr Courtney Conley:So this message of hope, I think, comes through in all of your work, which I'm sure comes from your own experience personally with yourself and with dealing with patients for so many years.

1:34:39Dr. Rangan Chatterjee:I think that's where it comes full circle with the foot strength, footwear conversation and walking. Because I think that's such a great question. How do you convince somebody to pay attention to this stuff when they don't have foot problems? And that's where I think the integration of the conversation of walking. because if you were to ask someone if something would deter you from walking in the future, what do you want to do when you age in your 80th decade? What do you want that to look like? There's not one person that would say, I don't want to walk.

1:35:21Dr Courtney Conley:Yeah.

1:35:21Dr. Rangan Chatterjee:They might, you know, it might vary as far as strength training or this or that, but every single one of my patients has always said, I want to be able to walk, whether that's with their spouse or their friends or their children. And that's where the foot is the biggest player in that conversation. Yeah. It's pretty, it still gives me chills. I like, it's such an important conversation.

1:35:46Dr Courtney Conley:It really is. And of course, it's your foot that interacts with the ground. It doesn't matter how strong your biceps are when you're 80. Got to be able to walk. And you're going to want to walk. Okay. Going back to these practical exercises. So I sort of took you off on a bit of a tangent on bunions.

1:36:05Dr. Rangan Chatterjee:It's okay.

1:36:06Dr Courtney Conley:So let's just finish your bunions for a minute then. So we're basically saying we think they are a modern condition. You, I think, got bunions in your 20s, right? So a couple of questions then. Do you still have bunions? And do you think that the work you're doing, what are you hoping? You're hoping for a reversal of the bunion? Or are you hoping that actually, even if it stays like this, I'm going to still have functional pain-free feet as I age?

1:36:39Dr. Rangan Chatterjee:I think that's a great question. When I look at my foot, what is the goal? I used to have a lot of pain that was affecting my walking and my movement. Yeah. If you were to say to me, what is more important for you? That aesthetically you would get rid of the bunion or that you don't have pain and you can be more functional? That's a very easy question. less pain, more function. When you have early intervention with bunions, mild to moderate, we can see the change in the foot. The bunion might decrease. In my case, I was more on that moderate to severe end of that. So I still have my bunion. If anyone looks at my foot, now it looks a lot different.

1:37:27Dr Courtney Conley:Is it better than it was?

1:37:29Dr. Rangan Chatterjee:It's better than it was. The biggest difference, I think, when you look at my foot now versus 15 years ago, is 15 years ago, it looked like skin and bones. It looked like an atrophied foot. You could see the metatarsals. You could see just how thin the foot was. I still have the bunion, but my foot is beefier. It's bulkier, has more strength to it. And that, I think, is a very big difference. If you think about that, you know, the muscles in the feet are just like the muscles in your bicep, for example. If I did a thousand bicep curls, my bicep's going to get bigger. When I start to strengthen my foot, you will see changes in the foot.

1:38:16Dr. Rangan Chatterjee:And so a combination of strength and paying attention and the right footwear, my bunion no longer bothers me.

1:38:24Dr Courtney Conley:Do you wish you didn't have a bunion?

1:38:27Dr. Rangan Chatterjee:I think it's part of the story.

1:38:28Dr Courtney Conley:So do I.

1:38:29Dr. Rangan Chatterjee:You know?

1:38:30Dr Courtney Conley:That's kind of why I asked the question. It's like, because, yeah, I just, I just, I really wonder your perspective on that, because I guess in many ways, if you didn't have the bunion, you probably wouldn't be sitting here in the studio today.

1:38:45Dr. Rangan Chatterjee:And it also, all the other diagnoses, the neuromas that I've had, and it reminds me when a patient is sitting in front of me also, that, you know, I've been there and I understand. And I do know that it can cause a lot of problems, not only physically, but mentally and emotionally. So there's a connection there that I'm grateful for so that I can empathize and understand.

1:39:13Dr Courtney Conley:Do some people, when they come and see you need a manipulation in their foot because some, you know, maybe the joints are stuck or locked in certain places and the exercises are not enough? Or perhaps a manipulation can free up a joint, which makes it easier to do the exercise?

1:39:27Dr. Rangan Chatterjee:Yes. Well, often, for example, the calcaneus, the heel. When we walk, there's a reason we are designed to graze that heel. Because think of a pole vault. It hits the ground. It initiates pronation. So it starts to evert or open, and that's our beginnings of shock absorption. So oftentimes patients will have, the joints will be sticky, if you will. So we'll get in there and we'll mobilize the calcaneus. We'll get the foot to move. And then we say, just like you mentioned with Gary, go do these exercises, drive it home.

1:40:06Dr Courtney Conley:how much time do you think people could realistically spend on their feet per day or what let's let me phrase it another way what is the for the time pressured busy person who likes listening to health podcasts and every week has different things that they could be doing to improve their health and well-being and then they hear oh my god another now i need to look after my foot health as well as everything else, right? Yes. What is a reasonable minimum that they could spend a day on their feet and get benefits? Yes.

1:40:42Dr. Rangan Chatterjee:I've heard this often. I'll tell my patients, start with 10 minutes a day. And we have designed things that you can literally do when you're sitting at your desk. So that toe yoga, for example, you can do it sitting at your desk. you can lift all of your toes and spread them and reach them forward. You can walk around barefoot for five minutes. All of these little things count.

1:41:07Dr Courtney Conley:Do you know what's crazy to me? And I guess it's clearly it depends what your starting point is. But as someone who literally lives their life barefoot, certainly in my house, it's crazy to think that, yeah, spend five minutes barefoot, that counts. Of course it does count. Yes, it's an entry.

1:41:24Dr. Rangan Chatterjee:I've had many patients, when they get out of bed, their foot goes into a slipper. They will wear some type of sandal, even in the shower. So the foot never sees the ground.

1:41:36Dr Courtney Conley:Why is that for grip? Pain.

1:41:39Dr. Rangan Chatterjee:Because once, for example, someone with heel pain, if you were to Google heel pain, you will see a lot of cushion. Don't, you know, don't let the foot feel the ground. So for years, you'll have people deloading their foot. Deloading, taking load away. Tissues need load. We know that. We know tendons need load. We know muscles need load. So you can't deload something forever.

1:42:12Dr Courtney Conley:This is the problem, isn't it? It's a vicious cycle, right? You want people spending more time barefoot at home. At the same time, if you've spent decades not looking after your feet through no fault of your own, right? You may be in a situation now where like that patient, where you get up, you put something on, you go in the shower, you need something. These are downstream consequences. They're not the cause. It's like, let's go upstream and try and prevent that happening in the first place. And then on the other side of the spectrum, you'll have patients that have been walking barefoot

1:42:44Dr. Rangan Chatterjee:and we'll tell them, hey, when you're in the gym, grab a kettlebell that's half your body weight and do your calf raises. That's a lot of weight. Wow. The foot can handle it.

1:42:57Dr Courtney Conley:The foot's strong, isn't it?

1:42:59Dr. Rangan Chatterjee:Peter Maliaris, I love his research. And there was a study that he did looking at Achilles tendinopathies and the strength that the foot can actually produce. And in this study, he mentions doing six single leg standing calf raises holding half of your body weight. And if you were seated, one and a half times your body weight. Okay. That's a lot of weight.

1:43:32Dr Courtney Conley:And what happens if you do that?

1:43:35Dr. Rangan Chatterjee:That was a kind of a healthy runner can do, that's how much force that we can do.

1:43:43Dr Courtney Conley:I.e., basically our feet are not fragile, weak structures. they're very very strong they are we're not utilizing that strength we're not loading them up enough in fact we're doing the opposite we're trying to protect them and stop them doing any work by putting them on pillows every day and these cushioned overly cushioned shoes yes whereby they don't have to work yes the cost of comfort again load the foot like we would load everywhere

1:44:12Dr. Rangan Chatterjee:else. When we started talking about the beginning exercises, toe yoga, spreading the toes, things like that, then you can move into resisted exercises. Let's say you're doing banded work. Then you move into more loads, farmer's carries, holding heavier weights.

1:44:32Dr Courtney Conley:So it's like progressive overload for any other part of the body. Exactly. But you're also just now paying attention to your feet. Yes. Okay. Let me try and get back onto the practical things. I'm so fascinated by this topic. You know, I think we've got at least three podcasts in this. Well, I'm here for it. Because I'm so interested and I've experienced the benefits myself. So I want to spread this with the world and say, hey, listen, you know, it's funny, my wife, when I started wearing Vivos, I don't think for, I'm going to guess, three or four years, she wouldn't wear them. Yeah. She's like, I don't like the way they look, right?

1:45:07Dr Courtney Conley:But she has pretty much, I think, been exclusively in them now for maybe eight years. Yeah. You know, I think once you get, and again, listen, yes, Vivo Beth sponsored this podcast, but this is not about that. This is about, you know, you mentioned many brands so far, right? I just want people to start paying attention to their feet. And if they're interested, start experimenting with functional shoes, whatever brand you want, minimal shoes, whatever. I don't, yeah. For me personally, my journey has been with Vivo. So I've got that experience. And I'll tell you one thing on a sign I've always loved about Galahad, who's the founder of Vivo, is that he always used to say to me, like, I want to see the day where there are loads of barefoot companies, barefoot shoe companies.

1:45:55Dr Courtney Conley:Like he.

1:45:56Dr. Rangan Chatterjee:I love his mission. I love his. It's community. It's about, it's a bigger conversation.

1:46:03Dr Courtney Conley:Yeah. It's not about their company. He's like, we're not the enemy. Like the enemy is Big Shoe, right? He wants to see thousands of barefoot and minimalist footwear companies because that then, you know, it normalizes it. It becomes the new norm for people. And, you know, going back to the societal conditioning we're saying before, I know for a fact there are top world-famous athletes who will wear barefoot minimal shoes where they're not on camera because they know the benefits, but they have signed multi-million dollar deals with big brands. So when they're being shot, you know, And again, I'm not criticizing or judging anyone.

1:46:41Dr Courtney Conley:I'm just saying marketing is mega powerful. And a lot of these top end athletes, they know the benefits. And so when they're not being filmed, they wear this stuff.

1:46:50Dr. Rangan Chatterjee:You're seeing a lot more of it. Because at the end of the day also, that's their careers.

1:46:55Dr Courtney Conley:Exactly.

1:46:56Dr. Rangan Chatterjee:They want longevity in their careers. And so the more this information gets out, they're saying, hey, this does make sense.

1:47:03Dr Courtney Conley:Yeah.

1:47:04Dr. Rangan Chatterjee:They're going to do what's necessary. What they need to do.

1:47:07Dr Courtney Conley:Yes. So in terms of practical exercises, okay, we were getting somewhere where, and I pushed us off into bunions, but you said you can look at your big toe and how much it's able to come up off the ground. Okay. Let's say someone does that. What are they looking for? If they can lift their toe, can they lift it straight?

1:47:29Dr. Rangan Chatterjee:And can they repeat it?

1:47:32Dr Courtney Conley:and what if you know and I'm guessing you want symmetry in both feet ideally if one foot can do it better than the other what do they do about that? Practice. Okay, you just practice.

1:47:48Dr. Rangan Chatterjee:Just practice. And a lot of the times it's very frustrating for people to not be able to lift their toe. You'll see their brains going they're lifting their hands or they're trying to rock back onto their heels.

1:48:01Dr Courtney Conley:basically compensating in whatever way possible.

1:48:04Dr. Rangan Chatterjee:You know, and it's eventually when they can start to do it, it's very exciting. You know, that's a big deal. It's driving information to your brain.

1:48:14Dr Courtney Conley:Okay, so everyone listening to this right now is able to do that at home and assess, can I do that? And if not, practice. Okay, so that's one exercise I can do. What's another one of your kind of favorites that people could start thinking about each day?

1:48:29Dr. Rangan Chatterjee:I think one of the, because I'm such a fan of toe splay and toe strength, I will always look at, can someone lift all of their toes? So keep the ball of your foot on the floor. So the ball of the big toe, the ball of the little toe and the heel. Lift up all of your toes. When you do that, you'll see the arch of the foot increase. Keep the arch of the foot and try to spread your toes. you should be able to see daylight in between each and every one of your toes.

1:49:05Dr Courtney Conley:Can you do that sitting down or has to be standing up?

1:49:07Dr. Rangan Chatterjee:Sitting, standing.

1:49:09Dr Courtney Conley:Do you want to have a quick look at mine now under the sable? I would love to. Right? Okay.

1:49:14Dr. Rangan Chatterjee:I'm always the girl at the parties that's on the floor looking at everybody's feet.

1:49:17Dr Courtney Conley:So I would say just, we'll make this relatively quick, but okay, left foot.

1:49:21Dr. Rangan Chatterjee:Yes.

1:49:22Dr Courtney Conley:I've lifted it up.

1:49:23Dr. Rangan Chatterjee:Yes.

1:49:23Dr Courtney Conley:And now I'm spreading. Yes. I can see, well, maybe not between my fourth and fifth. Well, I'll let you do the assessment. That's my left foot. My right foot, I don't think this is good. Lift it, splay it. Yes. Okay, talk to me.

1:49:40Dr. Rangan Chatterjee:Okay. Let's talk about the little guy who people think he's just there to get broken on furniture. The pinky toe, when you see the fourth and fifth toes, oftentimes they're curled under.

1:49:54Dr Courtney Conley:Yeah.

1:49:55Dr. Rangan Chatterjee:This is muscular imbalance. There is a muscle in the foot that extends the toes and there's also one that curls the toes. So when we become flexor dominant, footwear, foot weakness, we can't extend the toes. So that exercise is very good to start to get that splay. For people who've had neuromas, where there's an inflammation in one of the nerves in the feet, the toes will actually start to split if there's a you know it's a sign where the second and third toes for example those the toes will start to split because the body's making room for that neuroma these are all little things to pay attention to you have to be able to lift the

1:50:47Dr Courtney Conley:toes and spread them and splay them so these exercises that they're assessment exercises and their therapeutic exercises. I love that.

1:50:59Dr. Rangan Chatterjee:Yes, it's, can you do this?

1:51:01Dr Courtney Conley:Yeah.

1:51:02Dr. Rangan Chatterjee:And if you can't, practice.

1:51:04Dr Courtney Conley:Interesting enough, had you been here five years ago, you would have seen very different feet. So as you said before, it takes decades of, I guess, abuse to these feet to get them a certain way. It's probably not going to reverse in six months.

1:51:19Dr. Rangan Chatterjee:But it's well, well worth it on the other end.

1:51:21Dr Courtney Conley:Yeah, exactly.

1:51:22Dr. Rangan Chatterjee:I had a really cool experience since I've been here. I was at a workout class in London and I'm sitting there having coffee and someone said to me, Dr. Conley? And I turned around and I thought he was in the running class that I did the day before, but he wasn't. And he said, I just want to thank you. And I said, oh, I said, this is an honor. And he said, I had patellar tendonitis for a very long time. And I started doing your foot exercises that I saw on Instagram and YouTube. He's like, and paying attention to my foot has significantly helped my knee pain. He's like, I no longer have knee pain.

1:52:03Dr. Rangan Chatterjee:And I'm like, this is my heart. It was, those are the stories I live for because I hear them all the time, whether it's your foot or your knee or your hip or your back, paying attention to this part of our bodies has such a massive implication on everywhere else. Goes all the way up the chain.

1:52:20Dr Courtney Conley:Yes. How beautiful is that, that they didn't even have to go and see you in your clinic? Yes. Of course, it's great if people can, but isn't it so wonderful that you can just pop a video out on Instagram or YouTube and someone 3 ,000 miles away from where you live

1:52:34Dr. Rangan Chatterjee:consumed it, did the exercises

1:52:37Dr Courtney Conley:and suddenly their knees better. That's awesome.

1:52:40Dr. Rangan Chatterjee:It was awesome. I mean, it was so great.

1:52:45Dr Courtney Conley:Okay, so we've got toe going up. Yes. Big toe, sorry, going up. And one thing I haven't mentioned yet, but I wrote this down because I thought it was, I've never heard it put like that before. In your book, you say the big toe is possibly the most important joint in your body. And you've got a bias, of course. Yes. But I thought that was great. And you say it's more than just a joint. It's a demonstration of how far we've come as humans in movement, resilience, and evolution. That is beautiful. Can you just sort of explain that for us?

1:53:23Dr. Rangan Chatterjee:If you look at how the big toe has evolved and how important it is in bipedal locomotion, it is the part of our bodies that stabilizes us as we move forward. It's the part of our bodies that we propel forward. When we have good range of motion at that joint, So I'm going to get a little technical here.

1:53:47Dr Courtney Conley:It's okay.

1:53:47Dr. Rangan Chatterjee:The range of motion of the big toe, if you look at how much range we should have, studies 60, 65, 70. So in the higher range of motion there.

1:54:01Dr Courtney Conley:65 to 70 degrees off?

1:54:03Dr. Rangan Chatterjee:Off the ground.

1:54:05Dr Courtney Conley:Off the ground. So that would be extension.

1:54:07Dr. Rangan Chatterjee:Yes. in a walking gait, we need about 40 to 45 degrees to have efficiency. So walking is considered a mid-range range of motion activity, meaning our joints go to a certain range of motion, but we don't take them to its end range.

1:54:29Dr Courtney Conley:Okay.

1:54:29Dr. Rangan Chatterjee:Okay. If someone has a restriction in that big toe. So let's say they only have 20 degrees. You will not only see symptoms at the foot, but you will see symptoms at the knee, at the hip, and at the low back.

1:54:49Dr Courtney Conley:And how common is it for people to have issues with their big toe?

1:54:53Dr. Rangan Chatterjee:It's probably second to heel pain, probably one of the most common diagnoses I see.

1:54:59Dr Courtney Conley:and of course you're seeing people who are struggling right so you're not necessarily seeing the general public healthy population you're you're you're it's slightly skewed because people are coming in with a problem that's why this assessment is so important what that first one you mentioned where you keep the four toes down and you see how far you can

1:55:18Dr. Rangan Chatterjee:lift the the big toe up if you do that and there's a pinching in the top of the joint So let's say I go to lift my big toe.

1:55:26Dr Courtney Conley:Yeah.

1:55:26Dr. Rangan Chatterjee:And you're like, wow, it's kind of pinching at the top of the big toe. You need to pay attention to that because something is going on that's saying, I don't like extending. It's not to be ignored.

1:55:39Dr Courtney Conley:That's the key thing, isn't it? It's not to be ignored. Because you do it, don't just switch off and go, oh, screw it. I'm not going to pay attention. It's like, no, no, you're storing, you're kicking the can down the road, as we'd say in this country. Yes.

1:55:49Dr. Rangan Chatterjee:And here's the next layer to that. Oh, my big toe hurts when I extend it. You go buy a shoe. And then you buy a shoe that doesn't have a lot of flexibility in the toe box. And you put the shoe on and you say, great. My toe doesn't hurt at all. It's not pinching. Yeah. And so they say, oh, great. I'm just going to wear this shoe all the time. So then they come home. They take that shoe off. They walk barefoot. Oh, there's the pinching again. I better go grab my shoe and now wear it in the house. and now that joint is not even getting to the range of motion that it had. And then we start to lose more and more range.

1:56:31Dr. Rangan Chatterjee:You see this cycle there?

1:56:33Dr Courtney Conley:Yeah, if you don't use it, you lose it. It's funny, this weekend I was just with my sort of best mates from uni. One of my friends was talking about his mum. Yeah. Who, you know, she lives by herself, and he was just saying, yeah, we might have to move us somewhere where there aren't stairs. And all I said to him is, you know, I said, I think about this a lot. Like, stairs are difficult for some people as I get older. But what I've seen so many times is, of course, you don't want anyone to fall and hurt themselves. But the problem is, there's a cost to security, isn't there? You remove the stairs, and suddenly they're not using those muscles at all anymore.

1:57:15Dr Courtney Conley:Like, I remember when my mum used to go up and down the stairs. It's like, she said, you know, it would be slow. It would take a while. but I'm like, this is good. She's like using a quad, not only going up, going down. Magic, you know, having to really control the descent. And I wasn't giving him advice. You know, I'm sure there'll be an OT, an occupational therapist, you know, fantastic profession who will be properly assessing what needs to be done. But you know what I'm saying? You don't want people to fall.

1:57:42Dr. Rangan Chatterjee:You have to get a little uncomfortable.

1:57:44Dr Courtney Conley:Yeah.

1:57:45Dr. Rangan Chatterjee:You do. And I have a story of that in the book where I had a patient who was told to sell her house and buy a ranch. Yeah. And I hear that a lot. And I would rather have the conversation, especially with movement variability. There's so many different ways we can move. So rather than have the conversation of, you can't do this, how can we get you to do that? I think the squat is a very good example.

1:58:13Dr Courtney Conley:Yeah.

1:58:15Dr. Rangan Chatterjee:You can't squat. don't squat for whatever reason sitting on a toilet sitting in a chair is a squat so we have to train instead of saying don't do that yeah so wouldn't it be nice and again i'm not saying

1:58:31Dr Courtney Conley:you know there's amazing healthcare professionals out there who are who are probably doing this already but just that mindset shift just be very careful before you make your life in inverted commas, more safe and easy. There is, as you said before, there's a consequence to everything. You know, you choose a certain foot where there's a consequence. Just be aware of that. That kind of relates to walking, doesn't it? Is this, I mean, I don't know if you, you know, what your take is on this, but to my understanding, or certainly to my knowledge, And the complexity in walking for a human being to walk still hasn't been able to be replicated by a robot.

1:59:14Dr Courtney Conley:To my understanding, I mean, maybe that's changed now, but it just speaks to what a phenomenal movement just walking is.

1:59:25Dr. Rangan Chatterjee:It's very complex. Very complex. We don't think about it because it's just something that we do, like breathing.

1:59:31Dr Courtney Conley:Yeah.

1:59:31Dr. Rangan Chatterjee:But it's a very complex movement. There's a lot happening between what we're visually seeing, what we're hearing, our vestibular inputs, what we're feeling. So we're gathering all this information and we're integrating it. And to see a walking gait, I think is, you know, I could study it forever.

1:59:55Dr Courtney Conley:Yeah.

1:59:56Dr. Rangan Chatterjee:Because there's a lot of information you can get.

1:59:59Dr Courtney Conley:it's just a practical exercises we can't clearly can't cover all of the ones that are in the book um we mentioned a few things so far there's there's a couple i just wanted to bring up yeah um one i've already mentioned that single leg calf raise yes that you have in the book a table that you know at different ages what should you be able to do and i think that's an exercise probably like the ones you've already mentioned that can be an assessment tool and a training right so you do it what are the cheats that people do without realizing it okay so because I think I was doing one without realizing it right so you're on one leg yeah you're lightly touching the wall yes why is it important that you lightly touch the wall it's not balance we're

2:00:44Dr. Rangan Chatterjee:not looking at balance we want to have a little bit of control okay so and how high should you come up when you look at the height of the calf raise you want to get to the ball of the foot And when you look at the ball of the foot, it should be flat on the ground. Okay. So oftentimes when I see someone do a calf raise, when they get to the ball of their foot, it's almost like it looks like they're going to sprain their ankle. Okay. So that's telling me, hmm, have they ever sprained their ankle? Do they have poor eversion strength? Can they not get to their big toe? do they have a pinching at the big toe that's preventing them from getting to the ball of the

2:01:28Dr Courtney Conley:foot you know what's funny Courtney is you're saying that you saw some uh I mean I'm aware of these issues already but I'm working on them on my right foot yes but that's where I've always had my symptoms I used to sprain my ankle my right ankle I used to play competitive squash as a teenager and every, you know, with not, you know, with, with alarm and regularity, I would spain my right ankle. So there's, you know, there's probably, you know, was it the foot problems that caused the sprains? Was it the sprain that has caused issues that I haven't properly rehabbed? Probably a bit of both, who knows, but, but it's interesting, isn't it?

2:02:04Dr Courtney Conley:Yeah.

2:02:04Dr. Rangan Chatterjee:You can always, whenever I'm assessing someone's gait, you can, you can tell the gait of someone with chronic sprains. It's their foot has, you know, the ligaments heal. The proprioception, how they feel the ground, that is what also needs to be retrained.

2:02:20Dr Courtney Conley:Yeah.

2:02:21Dr. Rangan Chatterjee:And so that's important. Getting them to feel where their big toe is again. You can see that in a calf raise if they don't have that good control or strength.

2:02:29Dr Courtney Conley:Yeah.

2:02:30Dr. Rangan Chatterjee:So height is one. You'll see people try to bend their knees. You'll see them try to leg.

2:02:36Dr Courtney Conley:You want a straight leg. You don't want any.

2:02:38Dr. Rangan Chatterjee:Straight leg, through the foot. we're not trying to gain momentum and lean into the wall

2:02:44Dr Courtney Conley:and you've got some of these videos on your Instagram have you? and we'll shoot some after as well and put them on mine when the podcast comes out so people can see that so you can assess that if you're not where you want to be or even if you are you can work on that and get better at it the one maybe that I wanted to finish off with is the single leg balance test and what I found really interesting is, well, in that section, you make the case that when you're walking, is it for 40 % of the cycle? You're on one leg. So you have to be able to balance just to walk, right? But you were saying in that section, which I found fascinating, the feet contain four types of receptors to help you, I guess, feel the ground and feel where you are.

2:03:34Dr Courtney Conley:And then you said this, and this got me probably because I'm 48, right? You said, however, in the fifth decade of life, I thought, fifth decade of life, okay, I'm not 50 yet. I think she's talking about me. I think I'm in the fifth decade of life. You need 20 % more pressure to stimulate those receptors. Okay, so talk to us about balance, why it's so important for walking, and what is the relevance of that stat that when you get into your 40s, you need much more pressure to stimulate those receptors?

2:04:08Dr. Rangan Chatterjee:Again, thinking about the foot like we think of the rest of the body. We know when we age, sarcopenia is a factor. We lose muscle mass.

2:04:18Dr Courtney Conley:Yeah.

2:04:19Dr. Rangan Chatterjee:So that also occurs at the foot. So we have a foot that's starting to decrease strength. When we turn 50, all of those sensory receptors on the bottoms of the feet, those also start to dull, if you will. so it takes 20 25 percent more pressure to stimulate those receptors it's the fifth decade your 40s or is that your 50 years old so 50 oh 50 oh i'm good i'm good i should ignore that but

2:04:49Dr Courtney Conley:i'm good i've got a few more years left hey i'm rocking at the moment yes this is the conversation

2:04:55Dr. Rangan Chatterjee:so we got to convince you that you need a bit of attention to this now um so in the fifth decade When you turn 50, you start to lose sensitivity to these receptors. This is how quickly things escalate. When you turn 80, that number is 75%. So the feet, they kind of dull.

2:05:16Dr Courtney Conley:They dull.

2:05:17Dr. Rangan Chatterjee:Here's the good news. Guess what increases sensory nerve fiber branching in the foot?

2:05:25Dr Courtney Conley:Movement and walking.

2:05:26Dr. Rangan Chatterjee:There you go. Yeah. exercise increases circulation increases nerve fiber branching increases sensation so the here's the hope conversation we are all going to age but when you strengthen your foot and you can improve the sensations at your feet you're going to be able to walk well you're going to be able to walk long and you're going to decrease your risks of falls that to me sign me up for that yeah have you had cases

2:06:05Dr Courtney Conley:in your clinic of people with neuropathy already so they've maybe they've had high blood sugars maybe you know type 2 maybe they've been diagnosed type 2 maybe not or they've got peripheral neuropathy from some sort of illness where effectively the nerves aren't working as well as you would want them to. Have you had patients who've come in like that and the exercises you've recommended have helped improve things?

2:06:35Dr. Rangan Chatterjee:There are so many treatments. Neuropathy is a difficult diagnosis, as you know. There are a lot of treatments that help, or so they say, help neuropathies. And they very well might. My patients that I have seen, they really struggle. But the one thing that has helped these people consistently is exercising their foot, increasing circulation to their foot. And then they can add all the other things, the red light and their supplements and everything else that they're doing. But if you don't have that component of exercise in conjunction with, I think you're missing a very big factor there.

2:07:15Dr Courtney Conley:Goes back to the start of this conversation. Walking is a physiological necessity. Yes. that your body requires for survival. And arguably, it becomes more important as you get older. Yes.

2:07:29Dr. Rangan Chatterjee:When you look at as we age too, there is a dramatic decrease in the step counts that you will start to see as people age. And that's what I want to encourage people do. You don't have to get to that 10 ,000 marker. Even at 3 ,800 steps, 7 ,000 steps, you start to see these reduced risks of dementia and depression and cancer. It's like this sweet spot. And we don't want to lose that capacity.

2:07:55Dr Courtney Conley:Yeah, the stuff that maybe we won't get time to talk about today, but I found fascinating in the book, this idea that, you know, it's not just walking. It's, you know, you have all these kind of things like roll the earth away, walk faster. When we walk taller, it lowers cortisol, improves memory. There was this thing about walking softly. And I stopped and laughed when you said we've all got that family member who you can hear coming a mile away, mile away, you know, stomping around upstairs. I'm not going to mention any names, but you were sort of saying how they might have a heavy heel strike and how you can correct that.

2:08:30Dr Courtney Conley:But also, I think you were talking about how there's research showing that as you get older, your walking speed goes down and it can predict dementia by seven years.

2:08:41Dr. Rangan Chatterjee:I was just going to say, we got to talk about walking speed. Yeah, let's do it. there were a couple researchers in 2009 that proposed that walking speed should be the sixth vital sign. So when we go to the doctor, we get our blood pressure, our heart rate, our respiration rate, our oxygen saturation. These are all vital signs that are taken at the very beginning of your appointment to see, hey, are there any red flags here? Is there anything going on with these vital signs that we need to be aware of because they will be predictors of a problem down the road? Walking speed should be in that category because that slower cadence, when you see someone walking slower, you need to start saying, why are they doing that?

2:09:38Dr. Rangan Chatterjee:you can predict dementias by this slow cadence up to seven years the research will say

2:09:45Dr Courtney Conley:does that mean a good annual practice or regular practice for all of us is to keep an eye on our walking speed absolutely to go around my block when i was 40 took me i don't know you know i'm just make it up 30 minutes, right? Let's say if when you're 45, that is taking you 36 minutes, for example, I mean, that's probably quite a big decline, even 32 minutes, right? What does that mean? I mean, because there's so many inputs to walking speed, aren't there? It's not just one thing. It could be muscles, nerves, maybe, you know, your visual, maybe your eyes, you know, there could be all kinds of factors.

2:10:24Dr. Rangan Chatterjee:That's why it's such a good, that's why it should be in that category of vital. Because why am I walking slowly? Is it because I'm starting to lose strength and power? That's a problem. We can address it. Am I afraid? Am I starting to lose balance? That's something that we can address when we identify it. Is it slow cognitive decline? Are we seeing cognitive decline? Because we know walking helps with cognitive decline. So just by looking at the speed of someone's gait can open up a lot of doors for opportunities for us to be better treating that patient. So if you were to walk, we want to see that number of around 120 to 130 steps per minute.

2:11:13Dr. Rangan Chatterjee:And it's not just, can I do this for a minute? the research when you look at cancer risk reduction for example yeah it's 30 minutes of brisk walking you're moving and so it might be great if you can walk around your block at that pace but we need sustained speed and i think that in itself is such a good thing for people to focus on. I'll have patients get a metronome. They can get it on their phone, listen to that beat and have every footstep match that beat. And I think you will find it's not as easy as some people think it is.

2:11:58Dr Courtney Conley:It's absolutely mind blowing. The other thing that I just wanted to add there is that maybe links this to your foot exercises. One thing I've experience when I go and see Helen is that because she measures me every time I'm there. So you will walk on the treadmill at a certain pace. What often happens is that when we identify the exercises for me to do, sometimes it's just literally five minutes a day, right? I'll do them five minutes day for four weeks. And then, you know, I might go back. Because my whole body efficiency has improved, I'm not trying to walk faster, but I'll go on and go, Helen, this feels really slow.

2:12:45Dr Courtney Conley:So I'm at the same speed as I was maybe six weeks ago, when it felt, yeah, that feels really good. i.e. my walking gait is improving, not because I'm trying to improve it, but because I'm working on my feet and my other movements. I mean, do you know what I mean?

2:13:05Dr. Rangan Chatterjee:Power. That is something also that I think we forget is walking at a brisk pace is power training. That is, we lose power faster as we age than we lose strength. And that I think we need to pay attention to.

2:13:19Dr Courtney Conley:What's the difference between power and strength?

2:13:20Dr. Rangan Chatterjee:So if I was going to be training strength in the gym, for example, slow, heavy loads, power is how fast can I move that weight with a speed component? So for example, if I was going to do a lunge, if I was power training, I would go down for three counts. One, two, three, and then try to shoot up as fast as I can. We need that power. Yeah. and that is one way to do it is by walking with a fast clip that's exciting to me

2:13:55Dr Courtney Conley:I feel like we're just warming up Courtney like I've literally got so much to talk to you about I feel we're only 10 % of the way there but I need to be respectful of your time what have we covered so far? we've covered so much we've made the case of why walking is not optional it is essential as essential as sleeping and breathing Yes. Right. So you've made that case. We've spoken about walking speed. We've spoken about the need to look after your feet, choose the right footwear. And in terms of practical exercises, we've talked about, you know, assessment exercises that can also be therapeutic.

2:14:31Dr Courtney Conley:So how far does your big toe go up? How many calf raises can you do on the second in a minute? single leg balance tests. We've mentioned single leg calf raises. Yes. I've already mentioned calf raises. Okay. We mentioned a lot so far, which hopefully has got people interested. You've also helped people understand how they might want to choose better footwear for their lives. So I think that was really interesting. Right at the end of this conversation, what I hope is the first of many conversations for that person, Courtney, who has listened to us so far and has had the realization they've never ever paid attention to their foot health.

2:15:21Dr Courtney Conley:They basically neglected it for the vast majority of their life. And they're perhaps wondering, is it too late for me to do anything about it? What would you say to them?

2:15:31Dr. Rangan Chatterjee:It's never too late. It's the beautiful thing about neuroplasticity. Our brains love novel stimulus. They love to learn new things. And I think that's such an encouraging, you know, point is that it is never too late to drive new information to our brains. If you have never put your foot on the ground, if that's where your journey starts, start there. If you're more into this journey, you can always add more loads, walk faster. So there's somewhere, this conversation is very inclusive. Because you really can find anywhere along the pathway to start here. And I think walking should be viewed. It is the most easily accessible, underutilized treatment that we have at our hands.

2:16:26Dr. Rangan Chatterjee:It should be on every physician's treatment protocol. It should be on every physical therapist's, you know, do these exercises because it's something that our body is craving to do. As a human, it is what we were designed to do was to walk. We were born to walk.

2:16:45Dr Courtney Conley:Yeah. Courtney, honestly, I think you're doing incredible work. The book Walk Your Life Depends On It is absolutely fantastic. Honestly, I'm such a fan of your work and what you're putting out in the book. We didn't get into your beautiful foot health kit today. Maybe we'll do that next time. But can we just quickly go through what is in this? Well, there's It's a book, of course, but then your company or your clinic is called Gates Happens. Yes. Where's that based?

2:17:10Dr. Rangan Chatterjee:Colorado. We're pretty much online though. It's more of a -

2:17:13Dr Courtney Conley:So you're online? Yes. And this foot health kit that you have, that you've very kindly gifted me and I can't wait to look at it. What is in it and how does it help people?

2:17:22Dr. Rangan Chatterjee:You know, we had the conversation of, gosh, you know, now I need to strengthen my foot. It becomes this thing. So what I wanted to do was make things very easy for people. I have been wearing toe spacers for probably seven years consistently throughout the day. The only time you will not see them on my foot is when I'm sleeping.

2:17:40Dr Courtney Conley:Why not when you're sleeping?

2:17:42Dr. Rangan Chatterjee:I'm always, my sleep is my priority. And so I'm like, nothing's on my feet. I'm focusing on sleeping. When you're wearing the toe spacers and you're actively on your foot, the tissues in the foot are moving. so they have um certain devices that you can wear when you're sleeping that will work passively right so they'll work on stretching the foot um these are designed to be worn actively

2:18:11Dr Courtney Conley:so you wear them and then you get on with your life correct fascinating um on my weaker foot

2:18:18Dr. Rangan Chatterjee:when i first started wearing these after about 10 minutes i wanted to throw them across the room because then my toes were rubbing and it was so uncomfortable because I didn't have toe splay. So it takes time. But now I run in them. I wear them all the time.

2:18:33Dr Courtney Conley:Well, I saw you when you came into my house, you took your shoes off. You had the, what are they called? The toe spacers. You had them in. Yeah. But you've got this little ball. Is that, what is that? To roll the sole of the foot?

2:18:43Dr. Rangan Chatterjee:The sole of the foot. But the reason I wanted that size was because we will also work on range of motion at the big toe. so that's another one of those drills that we'll do on how to improve range of motion at the toe

2:18:58Dr Courtney Conley:oh maybe we'll shoot a little video on that now and see but okay so for anyone who wants to get one of these very exciting kits which i'm actually very excited to see oh my god how am i going to incorporate these into my life these are just on the websites yes on the website gate happens gate happens okay so and on social media people want to sort of stay in touch with you and and keep up to date with your content. Where is everything?

2:19:22Dr. Rangan Chatterjee:Everything's gate happens.

2:19:23Dr Courtney Conley:G-A-I-T. G-A-I-T. Not G-A-T-E. Yes. Okay. Well, listen, Courtney, honestly, I love what you're doing. I love what you're putting out in the world. I really appreciate you making the journey out to the studio. And I hope to have you back here very, very soon.

2:19:37Dr. Rangan Chatterjee:Thank you so much. I'm so grateful to be able to share this message. It really is so important. So I can't thank you enough.

2:19:47Dr Courtney Conley:really hope you enjoyed that conversation do think about one thing that you can take away and apply into your own life and also have a think about one thing from this conversation that you can teach to somebody else remember when you teach someone it not only helps them it also helps you learn and retain the information now before you go just wanted to let you know about Friday 5. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming, and quotes that have caused me to stop and reflect.

2:20:33Dr Courtney Conley:And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free at drchatterjee.com forward slash Friday Five. Now, if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world, covering all kinds of different topics, happiness, food, stress, sleep, behavior change, and movement, weight loss and so much more so please do take a moment to check them out they are all available as paperbacks ebooks and as audiobooks which I am narrating if you enjoyed today's episode it is always appreciated if you can take a moment to share the podcast with your friends and family or leave a review on apple podcasts thank you so much for listening have a wonderful week and please note that if you want to listen to this show without any adverts at all that option is now available for a small monthly fee on Apple and on Android.

2:21:43Dr Courtney Conley:All you have to do is click the link in the episode notes in your podcast app. And always remember, you are the architect of your own health. Making lifestyle change is always worth it. Because when you feel better, you live more.

2:22:08Thank you.