The Secret to Healthy Feet and Pain Free Adventure with Courtney Conley

0:00A couple of years ago, my doctor told me that I had very little cartilage left in my knees and that I shouldn't run anymore. I've mentioned this moment a few times on this podcast, but that news was really hard on me. As someone who has a lot of energy, there's nothing that helps me clear my mind like going for a run. In fact, I try to do it before every interview for this show. When I was struggling with this news from my doctor, I reached out to a movement specialist named Courtney Conley. Courtney is the author of the national bestseller, Walk. Walk is about how strengthening our feet and ankles can help us stay active long-term.

0:38Courtney ended up giving me some physical therapy exercises, and they worked really well. Recently, I was even able to run a half marathon. So when I found out she'd be in Denver for outside days, I jumped at the chance to meet up with her in person for an interview and some training. Here's a clip from our session.

0:57Courtney Conley:So when you do a calf raise, you want to come up through the big toe. Okay. All right. Good. And then come back down. Okay. And then I also look at height. All right. So like, are you getting up onto the ball of the foot? Okay. See the toe gripping here? That is not what we want. That means you're gripping. I need a toe that's relaxed. Use your foot in calf. It already hurts. Yes. This episode is all about feet. So if you're into foot stuff, this one is for you. Just kidding. But seriously, in order to go after wild ideas like hiking, running, biking, and climbing, we need strong feet. The problem is, we don't usually think about our tiny toe tendons and muscles when we're training.

1:42Courtney is here to help us bring awareness to these parts of our body so that we can stay healthy for longer. I'm Shelby Stanger, and this is Wild Ideas Worth Living, an REI Co-op Studios production presented by Capital One and the REI Co-op MasterCard.

2:01Courtney Conley, welcome to Wild Ideas Worth Living in person.

2:05Courtney Conley:It's so good to see you. Thanks for having me. Courtney helped me be able to run when doctors said you should never run again. I don't really know how you made it work, but you just gave me some exercises, and I was like, oh my God, I can run. It's good for you. Okay, let's talk about walking, running, feet, all the things. First of all, you just wrote a book called Walk and how good it is at helping people maintain health and longevity. I'm curious where this idea came from and just a little bit about your background. Yeah, I have, I like to say I've had a healthy obsession with feet for a long time.

2:40Courtney Conley:It's kind of my passion. I've had my own history of foot problems. So I've always been kind of wanting to figure things out because movement has been such a huge part of my life. I have a practice here in Colorado, and I've been seeing patients with foot pain for probably the last 20 years. And it's really been very eye-opening for me as a clinician to see what happens when people's feet hurt. I don't think there's any musculoskeletal diagnosis that stops someone in their tracks faster than their foot bothering them. Because you can't do anything and you certainly can't walk. So that's what got me thinking about writing the book was there is this very big connection that I don't think people realize.

3:27Courtney Conley:That in order to be able to walk and to walk long distances like we should be able to do, your feet have to be healthy. So if you want to hike the Pacific Crest Trail or the Appalachian Trail or just a hike in your backyard, you have to have healthy feet. You sure do. It's like so wild to me. Like, you know, it's the first interface we have with the ground. It literally is what keeps us upright and balanced as a human being. And we hear of people like strength training their bodies and doing all these things for their bodies. And we don't really ever hear about that from below the knee. all right this is gonna be a fun interview let's talk about your background really quickly like were you outdoorsy as a kid did you play sport were you a dancer yeah I was a dancer um ballet modern the whole bit I was in pointe shoes my feet started bothering me um then and then I switched gears to triathlons so then I did um some 70.3s that was kind of my distance and very small distance so you went straight to Ironman basically distance it was uh it calmed my brain I I've realized that movement is a necessity for me to um keep sane so you went to PT school Cairo Cairo school yeah okay so I started looking at um what I wanted to do and I really wanted to learn about the foot and ankle so I was like okay like I think I can go to chiropractic school and we'll learn about all this stuff.

4:55Courtney Conley:And we did learn a lot, but unfortunately, what I was hoping for at the foot and ankle just wasn't quite there. The education was really, if the foot hurts, get them in some type of foot orthotic. And if it hurts more, refer them to surgery. There was very little conversation about how to strengthen the foot, how to mobilize the foot. So when I got out of school, I worked in a couple orthotic labs and And that's what we did. And, you know, I realized that we needed to switch it up.

5:29Instead of giving people equipment that created more structure and support for their feet, Courtney wanted to learn how to actually solve the problems her patients were having. It was clear that orthotics weren't really helping people prevent further issues. In fact, people's feet would often become worse over time. There's extensive literature that explores how the more support we give our feet with shoes, the less strength our foot is gaining on its own. Newer research has developed certain tools that actually can help improve painful foot issues like bunions, neuromas, and more. Courtney personally wears toe spacers, which are small pieces of silicone that go between her toes and help them spread out.

6:08Another strategy is to wear minimalist shoes or shoes that feature a wider toe box. it's kind of embarrassing to admit but you know my mom has these things but i had a bunionectomy in 2009 and it ruined me i was told that my knee problems were a result of having this thing on my foot and then i had the surgery and i like couldn't walk or run for a few years after and it was it was painful yeah and um i'm a runner it really crushed my soul

6:36Courtney Conley:Yeah, on both of my feet, I've kind of had every diagnosis in your foot, bunions, neuromas, stress fractures, like the whole bit. And clearly, I just wasn't addressing it correctly, because it was, I'm going to go get this foot orthotic, I'm going to go get this more aggressive shoe, and then we would like start to tweak it. And I'm like, Oh, I think I feel better. And then my knee would hurt. And it was like, what are we doing? Like, why am I not strength training my feet like I am the rest of my body? Like it just didn't make sense to me. And so the first thing I did was get into a shoe where my toe could actually sit straight, you know, which sounds so like it's like low hanging fruit.

7:18Courtney Conley:So for people who have any type of forefoot problem, bunion, hammer toe, things like that, you have to get into a shoe where the toes can like move around. and a lot of my patients will be like wow this once you start by the way going down that road of shoes that respect the anatomy of your foot you will realize very quickly when you put your foot back into a shoe that's too narrow for example that you don't like it yeah i hate no shoes i can't do it anymore even like cyclists like the cycling shoes are a whole nother conversation but um there are companies now that make anatomically shaped cycling shoes and I mean a lot of my cyclists with neuromas and like nerve pain um you know once they get into a different shoe and then they put their foot back in their narrow cycling shoe their toes are going numb and they're you know I mean you hear that stuff all the time but it just makes sense to allow the toes to be able to splay um so that's the first thing I did and then I started strengthening my foot.

8:21Courtney Conley:Like there's a muscle in your foot that straightens your big toe. What's the name of that muscle? Abductor halicis. It's like one of my obsessions. The other cool thing about that muscle is it's a postural stabilizer. So it's slow twitch muscle fibers. So basically what that means is it's kind of on all the time because it's helping your posture. It's helping you stay upright and balanced. It's helping straighten your toe. So for people who have heel pain or bunions, this is a big deal. Like you want to strengthen this guy. So how do you do it? You all, you start with toe spacers, right? This is passive, but then you can do drills where you're strengthening that muscle.

9:03Courtney Conley:Um, and it's quite hard. Like one of my favorites to do is if you were a single leg balance and you were to take a band and put it underneath the ball, of the big toe. So the band would be like attached to a table. You're balancing on your right leg and the band is under the ball of the big toe. And you hold that. People's like feet start cramping and their calves start cramping just because they're engaging their foot. You know, that should, we shouldn't be saying like, oh, why does, why do one out of three people have foot pain over the age of 45. I mean, those statistics are crazy. It's because the feet aren't strong enough.

9:44Courtney Conley:But I think what people don't think about, like with bunions, for example, is it's not just a foot problem. You know, it's an instability. So when you look at, you have to ask yourself, why is the bunion there? Right? And a lot of people say, well, my mom has a bunion and my grandma has a bunion. Well, and my response to that is, well, you don't come out of the womb with a bunion, right? That's so true. You know, when you go to the doctor and they ask you about your family history, like do you have heart disease in your family? They want to know that so that you can be proactive, right? So you can like change your diet, exercise more.

10:22Courtney Conley:So if you know your mom has a bunion, do the same thing. Be proactive, wear the right footwear, pay attention to why it's happening. A lot of that is instability at the foot, but also above the foot. So knee, hip, back, where is the changes in the load coming from?

10:44Courtney can tell a lot about a person's foot strength by assessing their posture, walking gait, and basic mobility. The body is far more interconnected than many people realize. For example, when we were together, Courtney showed me there was a visual difference in her bunions when she shifted her pelvis in and out of alignment.

11:02Courtney Conley:People have to start paying attention to their feet like they pay attention to the rest of their body. So like take your shoes off and look at your foot. The widest part of your foot should be your toes. When your toes can splay, you have better stability. You can engage the muscles of your feet. Most of the injuries at the foot, so when we're walking or we're hiking or we're running, when you go to push off, there's a lot of multiple times your body weight going through that part of the foot. It was designed to handle those loads though when it's splayed and strong and stable. So when I'm with my patients, we'll just start with some like foot awareness drills.

11:44Courtney Conley:Like I'm like, if you can't do these, then this is where we need to start. And it's simple stuff. Like, can you lift just your big toe? Can you lift your four toes? Can you lift all of your toes and see daylight between each toe? Like, can you spread them? These are all important, you know, drills and exercises for awareness of your foot to make the connection between what your foot is doing in your brain. What if you can't do that? You practice. I feel like I practice like spreading my toes all the time and they just don't move. Toe spacers help interlacing your hands like in your toes and like mobilizing your foot.

12:19Courtney Conley:You just got to work on it. You've got toe spacers on underneath your shoes. I've never seen that. I do. I literally wear them like I get up in the morning and they're on my feet and then I take them off right before I go to bed. So awesome. And they're not like those crappy things that I've bought on Amazon before. They're the ones you made. Yeah. Cool. I have some. I put them in my shoes. All right. Now I'm going to start doing that. I was a little scared, but I had no idea. Well, it's that big toe, right? Like I also have bunions. That's what kind of got me into all of this. And they wanted to do surgery, but I was like, no way.

12:51Courtney Conley:Smart. So I work on the strength of my foot, but I also wear those toe spacers because it keeps my big toes straight. And so when I run and I hike, I want to have the ability to push through my forefoot. The foot can be strengthened just like everywhere else in the body. Like you can really do things like sled pushes and, you know, farmer's carries. All of those things put more loads through the foot and we have to really start training the foot in that perspective. The sunshine is back and I'm planning to spend the next few months outside catching waves, camping, and hiking the trails all around San Diego.

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15:20Dr. Courtney Conley is a foot and movement specialist who helps people move better, recover from injuries, and build strength. For me personally, Courtney's work has been transformative. She's taught me about the small muscles in the postural chain and what I can do to develop them. It turns out those muscles make a big difference in our overall strength and balance, whether we're training for a through hike or just want to stay mobile as we get older. So for someone who might be preparing for a race, a marathon, a half marathon, an ultra, maybe even a backpacking trip, a through hike, what can they start doing to prepare their feet to lead up to this big adventure?

16:02Courtney Conley:I think from a range of motion perspective, like there's two joints you really, I mean, there's a lot of joints, but the ones that I really look at are the mobility of your big toe and your ankle mobility. Oh, those are the ones that I struggle with the most. So people don't realize when their big toe hurts or they start to get arthritis in that joint, it's a showstopper. It really is. I mean, all the professional athletes that I've worked with, they say to me all the time, I didn't realize how this could affect my performance by simply my big toe hurting. Because you literally can't push off.

16:42Courtney Conley:You can't cut. You can't accelerate. so maintaining the range of motion at that big toe is crucial in a walking gait we need about 40 to 45 degrees out of that guy so it's like if you had your foot on the floor and you could take your finger lift your big toe up you want a like a minimum i would say about 40 45 degrees okay i failed that test i can tell but i'm excited to work on this ankle mobility is a big one too And ankle mobility, what can you do besides like sit on like a slant board and lots of ankle drills and rolling your ankle? Make it active. Like things like squats, walking on your heels, like heel to toe walks.

17:27Courtney Conley:You have to look at how the foot and ankle work together. And ankle mobility, it's one of those things that is very high on the list for fall risk. because think about walking downstairs, sitting in a chair, walking up a hill. That's all ankle mobility. Yeah. It just takes a long time. It feels like, you know, I think when I have patients that come in and they're like, I've been stretching my calves for 10 years, right. And everything still feels tight. You have to listen to them because I always say, if you listen to the patient, they'll tell you what's wrong. And if you listen to them long enough, they'll tell you how to fix them.

18:08Courtney Conley:And I use the word fixed loosely because I don't think anybody needs fixed. But if I'm stretching tissue and nothing is happening, right, I might get a little window where it's like, oh, this feels better. But then it goes right back. Maybe you're barking up the wrong tree. You know, if a joint is unstable or something isn't stable, your brain's going to win and it's going to protect you. So it's going to tighten up the tissues around the joint. It's neuroprotective tightness. So we have to treat that a little differently. It maybe doesn't mean stretch. It might mean strengthen. Give the system stability.

18:44Courtney Conley:And then the brain goes, oh, okay, I feel safe. I'm going to give you that range of motion.

18:55One of the simplest, most restorative exercises for improving our foot and ankle mobility is to just take a walk. The human body is practically designed to put one foot in front of the other. We tend to take it for granted, though. Think about when you walk across a parking lot to the grocery store or down the hall to the bathroom. It's automatic. We don't tend to feel our feet connecting with the ground. When something is second nature, it's easy for us to forget how powerful it can be for our bodies.

19:26Courtney Conley:Your book is about feet, but it's really about walking. So tell me about the benefits of walking regularly that we might not already think of. Like we all know it's good to walk. It's this like easily accessible, underutilized activity that we all have access to that I think a lot of people don't take advantage of. You know, I really want to reframe the concept of walking as a physiological necessity, similar to breathing and sleeping. You know, if I said to you, you can't sleep tonight, it'd be like, well, that's going to really affect my function as a human being. That's how we need to really view walking is this core biological input that has to happen every single day in order for every single system in our body to function well.

20:15Courtney Conley:I mean, it is this, you know, low to moderate intensity activity that stimulates the musculoskeletal system, our brain, our nervous system. So it has to be viewed as not optional. You know, I think if when we say walking is exercise, yes, on paper, but some people would view exercise as, well, I'm not going to do that today. You know, that's I don't want people to look at walking like that. It's you got to be out there. And if you look at the research from a longevity perspective, you know, it's not that 10 ,000 step marker. It really is around seven to 8 ,000 steps. And I think that's very digestible for people.

20:59Courtney Conley:I mean, the average step count is around 5000. So that means a lot of people are getting less than that. And that's not where we want to be. well if you're already a runner a hiker or i don't know maybe you're someone who does crossfit whatever why do you need to also incorporate walking into your day it's like i'll talk to my runners all the time and i was i was actually in this category also like i would get my run in in the morning and then i would you know go work and i'd sit at my desk on like zoom calls for eight hours a day. That one hour of running doesn't excuse you from moving your body for the rest of the day.

21:45Courtney Conley:So that's where this, that walking conversation of this biological input has to happen throughout the day. I mean, if you think about it from, if we were to talk about your digestive system, for example. When you eat, your blood glucose goes up. And one of the best times to go for a walk is after you eat because the muscle contraction helps grab the glucose and gets it into your cells. It takes some load off the pancreas from doing all the work, right? So like, that's what I always say to my runners, like, you still have to have this input happening to your body for the rest of the systems of your body.

22:24Courtney Conley:You don't get a pass if you just run in the morning. Oh, that's what I do every day. So what else do I need to do? Take little micro breaks. In the book, we talk about like a micro walk. A micro walk is five minutes, 500 steps. Easy. 10 minutes is about a thousand steps. Find little places in your day. And just like you said, I mean, you want to talk about like productivity and creativity and what it does for your brain. There was this really cool study I just read on dementias and how walking and at different paces actually increases the volume of your hippocampus, which is the part of the brain that is affected or shrinks with dementias.

23:03Courtney Conley:So it was really fascinating to me that we have this, you know, this activity that can grow parts of our brain. I mean, come on, that's, everybody needs to be doing this and doing it consistently every day.

23:26Do you have any stories of people who, you know, lives have changed by fixing their feet or walking?