Episode 416: Dr. Courtney Conley - Foot Strength & Health

Dr. Courtney Conley is the creator of Gait Happens, an online education company helping people from around the globe improve their foot function. She has taken the past several years to develop online courses to educate clinicians on foot anatomy, the importance of foot health and the truths behind modern footwear.

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Timestamps:

00:00:00 Understanding Foot Health and its Importance

00:05:00 Evolution and Impact of Medieval Footwear

00:09:33 Transitioning to Minimalist Footwear Safely

00:14:49 Choosing the Right Running Footwear

00:19:53 Understanding Foot and Toe Dissociation

00:25:28 The Benefits of Running Barefoot

00:30:00 Transitioning to Barefoot: A Guide for Runners

00:35:01 The Importance of Proper Footwear for Children's Development

00:39:58 Reactive vs. Proactive Health Care for Runners

00:45:08 The Transition to Minimalist Running Shoes

00:50:10 Shoe Rotation Benefits and Strategies

00:54:55 Understanding Pronation and Foot Strength

01:00:00 Evolution of Shoe Dynamics: Heel to Toe Drop and Stack Height

01:04:53 The Importance of Strengthening Glutes for Longevity

01:09:47 Transitioning to Wider Toe Box Shoes

01:15:07 The Revival of the Minimalist Movement in Fitness

Episode Transcript:

Awesome. Well Courtney, welcome to Austin. Thank you so much. I'm so excited to be here. Yeah, yeah, I think this is going to be fun. I was listening to your podcast episode with Peter Attia, and it was you guys really got into the weeds on that one with foot strength and foot health. So you get into the weeds all day about foot strength, foot health. You know, it's one of those topics where I think, like if you have trouble with your feet, it's almost like paralyzing. Yes. Because there's just so much that you could consider and probably to some degree, so much you need to consider if you ever want to fix the problem versus throwing a Band-Aid on it. Yeah. I mean, I think when you consider most musculoskeletal injuries, there's nothing that will stop you in your tracks more than foot pain, because you literally can't walk every step that you take. You know, we have so many thousands of receptors on the bottoms of our feet, so they tend to be a more sensitive area of our bodies. So when something doesn't feel good at your feet, you really feel it. Yeah. Yeah. It makes sense because it's like the first point of impact. Yes. You kind of got to start there. Yeah. It's really shocking to me because I think from a rehabilitation perspective, we've come so far in rehabbing pretty much everywhere in the body, but for some reason, at the foot we've either ignored it or have approached it very differently than we would other parts of the body. And, you know, when we think about being biped, walking on two feet, it literally is our feet in the communication our feet have with the ground that allows us to be upright and balanced. So it's definitely a part of our body that I think needs to be paid attention to. Is that what got you interested in foot health originally was just like, this has got to be the starting point. Or did you have foot issues that you fixed? I mean, I think when you have a passion for something, there's always some personal quest that drives you there. I was a dancer growing up. I spent a lot of time in pointe shoes, and then I was a triathlete. and I did. I had bunions and aromas and foot pain. And so I was kind of on the search to figure out what was going on. I ended up going to chiropractic school, and unfortunately, we only had about. Gosh, maybe half a semester of education as far as foot and ankle. And it really was, you know, if something hurts, here's an orthotic. And when I got out of school, I was obsessed with the foot and ankle. And then I actually worked in different orthotic labs. And that's what we did. And, you know, things were getting better. I think sometimes you mask symptoms, but I never just felt strong. I never felt smooth when I was running. And so then I went down the road of, you know, we need to start looking at our feet a little bit differently. And so I started to peel back, started to look at what would happen if I started getting my foot stronger. And here we are. And I just bought that education into my clinic. And that's what kind of got this whole thing going. Yeah, yeah. When you think of orthotics, I always think like, okay, this is something where we got to orthotics because we made a mistake prior to that. It's like, I mean, I'm sure there's probably some cases or use cases where someone's like maybe born with an imbalance or something where an orthotic is their reality. But that's going to be a pretty small percentage, I'd imagine. And then from there it's like, what did we do lifestyle wise that got you to the orthotic? Yeah, it's really interesting. you know, there's this concept of an evolutionary mismatch, right? Where we are, bodies were designed to function a certain way. And then due to modern society and the rapid growth of what's happening, things start to change. And especially when you look at our feet. With all the layers of intrinsic muscles and how the foot was really designed to handle all of this load. What has happened because a lot of people have foot pain. You have a lot of people with four foot deformities now with bunions and hammer toes. And, you know, those things don't match well with what our feet should be able to do. And I truly think it's, you know, footwear plays a very big impact on that. And, you know, the fact that we're ignoring the health of our feet. Yeah. So is footwear where it all started essentially, in your opinion, was that like the advent of the shoe? Or at least I'm writing this book right now and I'm doing a lot of research on footwear. And it's really interesting because when they look at, you know, in like the 14th and 15th centuries and the introduction of the Krakow, which was, you know, in the medieval times, that shoe that like, was really pointed. Yeah, yeah. And there was a study that looked at the remains of people's feet, and they noticed that in the 14th and 15th century, they noticed more incidence of hallux valgus or a bunion. Yeah, yeah. And then they matched it with the introduction of this type of footwear. you know, and there's always arguments. Is the footwear causing this? You know, and I think it's a little bit of both. I think when you have footwear that restricts the function of your foot. So whether it constricts the toes or changes how the foot is supposed to function, you are going to see structural change and you're going to see weakness in the foot. I mean the biggest example I'll give to my patients is if you were going to balance. And you had your toes splayed. Would you balance better like this? Or if you had a rubber band wrapped around your toes? I mean, this is not a hard sell, right? It's a tripod. Yeah. It just makes sense, you know, from a muscular perspective, when you look at certain length, tension, relationships within the musculature of the foot, you know, the foot has to be able to splay tissues that have to lengthen before they can contract. So all of those things just play such a big role in how we're producing force and how we're propelling forward. Yeah it makes sense. And it kind of leads into some of the topics I think I wanted to touch on too, in terms of just like where some of that force is being kind of typically pushed through if you don't have shoes on versus kind of how that gets changed when you crunch the toes together or, you know, build up the back half of the shoe and things like that and add a bunch of a bunch of stuff. But I do want to touch on one thing you mentioned before, we get into some of that, which is like the pointy shoe. I was told once that the reason they started the point issue was for horseback riding, because they had to slide into the stirrup easily, and the pointy shoe would obviously slide right in there a lot easier. Yes. And it's just wild to think of how things started like, and it's societal. Right. So when you look at when all of this footwear started, it was, you know, worn by the noblemen and, you know, the upper echelon. And so, you know, and that happens today right? When we see basketball players wearing a certain kind of shoe or, you know, we want to have that shoe. Yeah. And it was the same back then. And it was certainly not from a functional perspective. More from fashion and society and high ranking. And then unfortunately that's been adopted for many, many years. Yeah I remember when ultra first got started and to a large degree this is probably still a hurdle. But it was a much bigger hurdle back then where you just look at the shoe and you're like oh that's such an odd looking thing. Like that is such an aesthetic issue too. And like I remember I was at a, I think it was like a, some convention where there was a, like a medical convention or something like that. And I was helping ultra kind of just like showcase their products. And, this group of college grad students came in that were going into, I think, podiatry or something like that, and they were really interested in it. They were like, okay, they want to put the shoe on, and they're just looking at each other and the shoes, and they look down on themselves like, you know what? It doesn't look nearly as weird when I'm looking at you versus when I'm looking down at me. No, no, no. So I'm like, yes, that's how we have to frame this going forward. It's like, look at your friend's foot, don't touch your foot. But it is funny. Like you'll see that in running, especially shops too, where, you know, staff gets busy. They're trying to kind of get to all the customers and everything like that. So to some degree, you're going to work with the customer with what's going to actually produce a sale. And, you know, they look at the wall and they're like, you know, I don't mean, sometimes it's even color too. It's like, I don't really like that color. Do you have this one? No. Well, then I'll take that shoe even though it's less comfortable. I have that conversation almost daily with my patients. I'm like, we just need function over fashion. Just, you know, you can still wear your, you know. Super shoe, your heel, whatever it is that you're going to wear. But for the majority of the time, help yourself out. Put your foot in an environment where it can get stronger. Yeah. Yeah. And I think that leads me to kind of what I really want to get into, which is like, how do we actually do that? Because the way I always view this now is I just assume people have very, very weak, restricted feet. Yeah, for the most part, unless they've actually gone into this and like dug into it and and actually to some degree the running world has been kind of interesting to me, especially with the ultra running where we're getting a lot more strength athletes, non-traditional runners coming into the sport see a way less issues with them, because a lot of times they're used to being in the gym wearing like a more or less restrictive shoe or no shoe at all in some cases. And they're just stronger usually. Yeah. So they tend to be like them, it's like if I put them in like a shoe that's a lower profile, more open, less restrictive. They're almost just off to the races, whereas I get a traditional runner that's been in kind of their built up shoe for a while, restricted toe and stuff like that. They go into anything that if you're changing multiple variables for them, it's like, oh, now they get an injury and then they blame it on the shoe. Yeah. And we saw that with Vibram, I think with the first kind of minimalist movement in the 2010 era where people thought, oh, this looks great. And then they went from their built up shoe with corrections in it to a Vibram five finger shoe, which is like multiple variable changes. It's like I describe it. It's like if you decided you wanted to bench press £300 and you're currently bench pressing 170, the move isn't to go to the gym and put £300 on the bar and then try to lift it. You got there's steps between. I always say, you know, I really preach this concept of a shoe spectrum. and on one end of the spectrum is your very minimal footwear. So thin, flexible sole, wide toe box, zero drops where the heel and the toe sit in the same plane. In that type of footwear, there is the most load going through the foot, so you have more load going through bone, tendon, muscle and that environment creates a stronger foot. I always say you have to earn your right to wear that footwear all day long, because you can't just be wearing an aggressive shoe and an orthotic and say, oh, this sounds really cool. I'm going to go into a minimal shoe and then go 0 to 100. You have to earn your right to get there. So it's a transition. On the other end of the spectrum, let's say you're a super shoe, right where the shoe is doing some of the work for you. I also say you have to earn your right to get into that shoe, because that shoe is now changing your gait mechanics. So you know there's more load going through certain tissues, your hamstring or your Achilles. You have to have strength. In control to run in that shoe or else injuries happen. So when we're, you know, choosing footwear, we have to know when to dance along the spectrum. So as if I wanted my training, for example, maybe I train more in a shoe where my foot can get stronger, right? And then on race day, if you want to gain the 2 to 4% running economy that some of these shoes you know can give, then when you put a strong body and a strong system into a shoe that's going to give you increased economy, then, you know, I always say it's like you're, you know, you're flying. But, you know, when you live in a super shoe and you don't have strength in capacity, you're going to run into problems. So I think, you know, I think about this all the time, because if we really want to spread this message of foot health and how important it is and, you know, I know we talked to runners all the time, I also think it's important to have the conversation of longevity because we want to be running today, but we also want to be running 20 years from now. We want to be walking. And when you don't take care of your feet. And you do not have good foot strength. That's a problem as we age, you know, and there's really wonderful research looking at a weakness into strength, for example, as being a very big predictor of falls when we get older. You don't want that. So I think knowing when we can kind of dance along the spectrum, you know, this is my first time, at the running event. And to see the type of footwear out there is very interesting to see people walking around in super shoes. I mean, I got here last night, I was like, it's like an alien invasion on people's feet. you know, time in a place we're not going to, you know, my message is not going to be, everybody get out of the super shoe and everybody run around barefoot. I mean, ideally in my perfect world, that is exactly what would happen. But to have the conversation, I think where we can start to get more people to accept this message and understand, hey, this is a shoe for race day. This is a shoe for tempo day, right? Speed. But take care of your foot when you're not in that shoe, or else you're going to run into problems. Because I see it every single day in my clinic. How much can it be done independent of their running shoes? What if someone did say like, hey, I really like this name brand shoe that is more restrictive. But the average runner, I don't know how many hours a week they run. It's probably like, less than ten. Yeah. So most of the time, they're not in that running shoe. Well, they could be, but they don't have to be. Yeah. So is that something where you can almost look at the running shoe in general to find what works for you, but make sure you're doing all the natural footwear stuff outside of that. Or is that just too much loading in the running activity so it's maybe a mismatch, like a minute per minute isn't a trade off when you're standing versus running. That's a great question. You know, I think that if you had the if you think of it as like a pie chart, right, how many hours a week are you? Right. And what type of footwear do you have on during that day? The more time you spend in natural footwear you have, the more opportunities to improve your foot health. You also have to look at what type of runner you are. You know, if I'm running without pain and things are great, then yes, you can wear what footwear you want I guess potentially, but if you have, you know, foot pain or Achilles pain or knee pain or back pain, I think you have to consider what you're putting on your foot when you're running. So you know, and how you're running and your strike patterns and things like that. So, you know, we could get into the conversation about. What happens when you put all of this stuff underneath your foot and you run? but that might take a very long time. Well, let's hit on at least the toes, I think. Like, that is an interesting one to me, because I remember when I think I can remember how long ago it was. It was it was a while ago I was talking to somebody and they were like, well, when you run, you whether you're jumping or you're running, when you actually kind of propel forward through that gait cycle, most of the power is actually getting channeled through your big toe, and then a smaller percentage is getting channeled kind of through those other four toes. Is there any data on that to kind of quantify like is that an accurate inaccurate or. Yeah, I mean, when you look at the structure of the foot, I'm, I'm a very big fan of the first Ray. I don't have my foot model, which is I can't believe I didn't bring it, or the big toe. Uh-Uh, and the big toe is bigger and stronger than the lesser toes for a reason. So that when we're propelling forward, the majority of our load is going through the big toe in the second toe. when we start compromising the function of the big toe. So whether that's because we lose strength there, or if it's been in a toe box, it's been restricted. It starts to compromise the stability that we have at push off and how we can propel forward. So why would we want to alter something that not only affects the function of our foot, but the implications that can have up the kinetic chain and the, you know, diagnoses that can be a sequela when you don't have a strong or aligned big toe. I don't want to I don't want to do that. Yeah. Is it or do we know even is it more like a little compromise in power if you start creaking that big toe in, or is it an efficiency thing that costs people with that? I mean, in my office, we have a way to test the strength of the toes. So I use this little dynamometer and it's basically the foot on the ground. And then I have this little card and I have the patient press the big toe into the card. Okay. we should be able to produce about 10% of our body weight through that big toe. Okay. And that's typically what I'm looking for in my office. If you were to press the big toe down. When the foot is in this wide, stable position, you can produce more force versus if my big toe is in an angled position. So think of a bunion and someone tries to press their big toe into the floor. You'll see a compromise. In the midfoot. You might see changes in the structure of the arch because they don't have the integrity of that foot. So when you think about that from a push off perspective, I want to have a strong, stable foot. I want to be able to push off of a strong, stable platform. And when the big toe is compromised, that simply is altered. Yeah. No, that makes sense. If there is step one then regaining that ability to kind of straighten that big toe and splay your toes out. Yeah. It sounds a lot easier than it is. Yeah. You know just throwing some toe spacers. You're all good. I mean, it's literally why I wear mine every day. I've had bunions since I've been, you know, like I said, when I was younger, as a dancer and I, you know, my foot has gotten so much stronger and I don't have any pain in my foot anymore, which is why I'm on a mission to kind of spread this word. Because foot surgeries, it's a whole nother conversation. But you don't want to go there. but you know, when. You look at someone, one of the first things we'll have them do is see if they can do what's called toe yoga. Right. So can you press your four toes down and then lift your big toe up and basically have what's called foot dissociation or toe dissociation. If they can't do things like that, then I know that we have we're start at ground zero. We have to bring awareness back to their feet. it would be like if I asked you to lift your thumb on your hand and you couldn't do it, you know, you'd probably freak out. Yeah, but for some reason, at the foot we're like, oh, that's okay. I know I shouldn't be able to do that. It's like, no. Yes you should. Yeah. And so that's where you have to start making the connection between your brain and your foot. And so toe yoga, can you lift all of your toes. Can you spread them? Can you reach them forward? Once those things are established and we start to get better awareness, then we start to, you know, increase our stimulus. How do we get the toes stronger now, you know, how do we get the foot stronger? Is there a best practice about going about regaining that, like independent mobility between the big toe and the other four toes? Is there like. Yeah. So I've seen people do this online where they'll take a resistance band and they'll put it under their big toe and they'll like to literally manually kind of force that movement. Is that kind of how you would suggest people kind of get started with that? Yes. I mean, start wherever you can. I always say just fake it till you make it. If you need to take your finger and start moving your toe, you know, just bring some awareness and then what's really cool that happens at the foot because I think we have so many receptors there that are just screaming for information. Once you start doing this stuff, you'll find that it actually becomes easier relatively quickly if in fact you haven't, you know, developed any structural problems because that will eventually happen. Yeah. Right. Where you have bunions that are rigid or hammer toes that are rigid. once those things start happening in the foot becomes rigid. That's a whole nother conversation. But when you have the opportunity to start moving the toes around, those changes can happen relatively quickly. Strength, as we know, takes time and consistency. Yeah. So it's kind of a combination of strength and mobility just like any other. Oh yeah. For the most part, I mean, a lot of, for example, one of the common diagnoses I will see at the foot is a restriction of the big toe. so mobility of the helix. If you were running, walking and a running gait, we need about 40 to 45 degrees of big toe mobility. If I wanted to sprint, I needed about 65 degrees. I just need more range through the foot. when we have poor foot strength or we have a first ray or a big toe that cannot extend appropriately, you can start to have pain at that joint. and if you have an inflammatory response there then you can start to firm or form arthritic change. Right. So these are the diagnoses like a halex limitless or a halex. Regardless. If you don't have good mobility with that big toe, you will compromise what is happening above the foot. You know, I mean, big toe mobility gives us knee extension and hip extension when we're running and moving. And you know you can't rob Peter to pay Paul. Right. Yeah. So you know there's a lot of sequels that can happen when you start compromising mobility and stability from the ground up. Yeah. Are you familiar with Graham Tuttle? He's like the barefoot sprinter on Instagram. Yes. I always think of him when I think of the toe yoga and stuff, because he could literally play the piano with his toes. I think, like, all of them move, like not just the big one versus the other four. It's like he can manipulate just the pinky, just. Yeah, it's pretty crazy. And I mean, he's obviously spent a lot of time on interesting things. I mean, you have to spend time on what I think is really interesting because there are a lot of people that run barefoot, you know, and it might not be for everyone especially. And I think this is a conversation to have, you know. If you have some type of structural change in your foot. So a bunion or a hammer toe or hallux limitus or halex Rigidness, those types of diagnoses, running in barefoot or minimal shoes can be difficult because you've now compromised the structure of the foot. But when you have a healthy foot maybe it's just weak and you start training your foot and your foot strength gets there. I mean running in a minimal shoe there's no better thing. You know I mean you're mimicking how we should be able to run. And so when I see people that can run like that I think it's you know it's very, very impressive and it's a beautiful way to run. Yeah. The other thing that I always think of when I think of gram is when he was over here in Austin. This is probably a couple of years ago at this point. But we went down to the Austin High track and we were just doing some exercises and stuff. And he had me run barefoot on the track. And the first thing I noticed is when I would accelerate into something I didn't do like an all out sprint barefoot, but I got going pretty quick. When you start to like it, slow down. You feel everything just working in a different way that you and I remember. That was a light bulb moment for me because I'm thinking, oh, when I have my shoes on and I decelerate, I'm like, literally not activating muscles that are at least in the same way that are meant to make that more efficient. Yes. And when I was barefoot, thankfully, I've got strong feet, relatively speaking. I mean, I've done 100 milers and minimalist shoes and stuff like that. In fact, kind of a sidebar I did one year I was doing this race called the Desert Solstice Track Invitational, and it's just this ultra marathon on a 400 meter track, and I got my feet strong enough where I was going in there with this pair of shoes that were like, it was actually the original ultra vanish before converted to their super shoe. It was like 3.9oz or something like that. I was like, there's no way anyone's got lighter footwear here than me. Three actual minimalists showed up that year. No shoes. I'm like, how do I have a 3.9oz minimalist shoe? And I've got the fourth or only the fourth lightest footwear out here. I mean, you're getting me excited with this conversation here. when you take your shoe off. And you run barefoot. It's like a completely different animal than running with a bunch of stuff underneath your foot. You feel things differently. I mean, the trade off with cushioned footwear is, you know, when you have a cushion or a lot of stuff underneath the foot. It's protection on a manmade surface. Right. but you compromise sensory acuity. You compromise sensory perception. You will not feel what you are designed to feel when you have a bunch of stuff underneath your foot. So when you start running, if you were to take your shoes off and go run in grass, it will be an extremely different experience. There was a cool study that came out in the small cohort. It was only about 20 people, I think. But they looked at runners, recreational runners with chronic heel pain. And we know that our, you know, treatment for plantar heel pain, which, you know, was the correct term now as it's no longer called fasciitis or fashion, has been to offload orthotic real cushioned shoes. And what they did in this study was they had everybody take their shoes off, and they were to run barefoot for 15 minutes twice a week for six weeks. And I think it was like 19 out of 20 of them reported with less pain. Wow. And it's like everyone's going well this doesn't make sense. And it kind of does because tissues need progressive load. Muscles need progressive load. When we want to get stronger you just can't keep modifying load in decreasing load and expect something to change. So when you have changed the strike pattern you know when you're running without shoes on you're not going to hit hot and heavy on your heel because it would hurt. You know the beautiful thing about the fat part of the heel, the calcaneus fat pad, is there are a lot of mechanoreceptors and a lot of nociceptors that are designed to tell us, hey, don't do that. If you hit too hot and heavy, it gives us information. But when we can't feel that, you take away that information. So when you can run in the fourth quarter, you're running more where the foot is closer to your center of mass, you change how everything is feeling, and there is more load going through the foot and through the ankle. And so if you do it progressively, you know you're creating an environment for a stronger foot in the ankle. And so that's where I think we need to really rethink how we're treating some of these chronic diagnoses at the foot that we see with our runners, because it can't just be continued to offload with no foot strength and no mobility. You will not get anywhere. You might get somewhere in the short term. Hey, my pain's a little bit better. But if you, you know, follow those people over an extended period of time, something else will eventually pop up because the foundation hasn't been established. Yeah. Yeah. No it makes sense I think like the hardest part for people probably are I know like for me this is how it usually happens is like I get excited because it's like oh this is cool. This is new. This is an opportunity to improve. And then it's like then I have to figure out, well, where am I at? Just like I would with running, you know, like if I get injured and can't run for two months, when I start resuming, it's not right back where I was when that injury happened. It's like, okay, I need to reestablish my baseline and then build back up and then hopefully exceed. So to some degree, this feels almost like you might need to take a step back in order to take a couple steps forward when it comes to gaining some of that strength and efficiency with your feet. so if someone is like, just, I guess maybe let's just go with the average runner who's had probably, you know, a few running injuries, they're probably wearing a pretty typical running shoe. Super shoes on race day. Is it enough for them to just start with, like, walking around barefoot in their house if they're not doing that already? Exactly where I would start. Okay, start walking around barefoot in your house. And here's the wild thing. People who have had chronic pain when they get up to go to the bathroom in the middle of the night, they're like, I put my foot in a slipper. Yeah, because their feet have not seen the ground in years. You have to start slowly, let your foot feel the ground, and start walking around at home for five to ten minutes. If things are starting to feel better, add a little bit of time. You know, and I think that slow transition is very, very important. Is there an assessment thing they can look for to like when to progress. So like is it something where. Well if I do five minutes, if I'm sore the next day I should probably let it rest. And then is it similar to strength like that? Yeah. I mean you want to. I always say monitor how you feel that night and the next morning if things feel a little sore, just slow it down. Stay at the duration of time that you are currently. And then you can just slowly begin to add more time on your feet. I think being able to, you know, just some good assessments, like we said, can you do toe yoga? Can you spread your toes? You know, I'm a very big fan of all things calf related when it comes to, you know, both walking and running. Our soul is a powerhouse. It is a powerhouse muscle of our lower leg. I think, you know, especially from a running perspective, you have to have strong plantar flexors. That's our push off. So when you're making this transition, if you can't do you know I can't just throw out numbers here. It's based on age and things like that. But I mean 30, 35, 40 single leg calf raises. There's a strength issue here. You know so those are always good things to know about self assessment. Can I do single leg calf raises? If I can't give a solid number I can't single leg hop. Your capacity isn't there. Which means you're probably going to need a super shoe because your foot and ankle can't do the work. And here's where the cycle begins, right? Because oh, my calf hurts. Instead of doing the work, I'm going to go wear this shoe because when I run it's going to be easier. It might be but your foot's not getting stronger and you're not creating an environment where you can get stronger. So you just keep bigger bigger shoes bigger orthotic bigger this bigger that. And you're not solving the underlying issue which is I need a stronger foot and ankle. Yeah. Yeah I mean my fear with super shoes specifically is people are looking at it through the lens of, oh, I need to adapt to the shoe. So like on race day, I need to feel better in the shoe. So I need to start wearing it more. And really, they need to try to maintain their normal gait pattern and mechanics inside that shoe as best as possible, which means not wearing the shoe very often. I mean, I can't stress that enough. The shoe is icing on the cake. That is icing on the cake. If you pay attention to what you're putting in that shoe, which is a strong foot, a mobile foot, then if that's your gig, if you want to wear the super shoe on race day, then you know, that's that's your call. But you better have the environment that can handle that type of footwear. It's not one I mean, I have a lot of young runners coming into my office now, right? And it's all like media hype about all of this. They've never run in a, you know, their first initial running shoe was a super shoe. And I'm like, hold on a second, you know, and they're coming in with Achilles issues and plantar fascia issues and, you know, hamstring issues because that is not the shoe you train or start to run in. It's just not. Yeah, it's doubling down on the problem we originally had. Where I know you've talked about this in the past, where it's like it for most adults, listen to this podcast. It's too late in terms of correcting it this way. But if you have it too late, it's never. It's never too late to make improvements, but to go back and do it optimally where it would be like really catching this in the development phase when your feet are growing. So like if you have a young kid, like getting them at the very least, probably barefoot, often if they're not able to wear a shoe that's got wider toe boxes and things like that. Yeah, I always say, if we started this footwear conversation with our children, I'd be out of business. I always tell people, put me out of business. put your kids in footwear. I mean, every baby on the planet, right? Take their shoes, take their socks off because their little brains are screaming for information that comes from our feet. So when we start off the kids with footwear where their feet can actually play and be flexible and gain strength, rather than starting them off in an environment that's going to compromise their structure and function. We are going to see way, way better results. And I think that's the issue of why, you know, I do see so many people because a lot of people have foot pain. A lot of people have been in the wrong footwear for many, many years. The conversation has not been had about what this footwear is doing to their feet. And, you know here we are. Is it true with children's footwear that like or I shouldn't say children's footwear. Like when you look at just the way their feet are relative to their size, if you put on like the same, if you just took an adult shoe and shrunk it down, it would almost feel like they needed to be way more pliable, right? Like it's like something like three times as restrictive for them. Oh, I mean, on a scale or something like that. The kids feet, I mean, the widest part of our feet should be our toes. And if you look at any shoe, the most shoes, there is a difference between a wide toe box and a wide shoe. And especially when you look at the children's feet, toddler's feet, you do not want to put anything on their toes that are going to start compromising their function. And their feet are flexible, and they need to be able to feel things in order to have appropriate development. So yeah, I do not think that putting something stiff and rigid on a child's foot is the way to go. Yeah. So you're only addressing part of the issue if you just have space up front with, especially with the, the children's shoe. yeah. So they almost need minimalist or at least real flexible. Oh yeah. And you know, without naming any names, there's a pretty big shoe company out, that recently came up with the toddler shoe. Oh, yeah. The biggest shoe company. Yeah, I saw this. I was going to ask you about this, actually. Yeah. And I've got a conspiracy theory about this. By the way, when I saw this, I was like, wow. Are they getting it? Because in their research and in their marketing, it literally says, we've designed a shoe for your child that is going to help its development, help proper foot development. We have a wide toe box. We have a flexible sole, and they start rattling off all of these like beautiful features of the shoe to put on the toddler's foot. And there is if you look at every other shoe this company makes, it is the exact opposite. And I wanted to call them and be like, why are you doing this to adults? Like, yeah, if you've done the research and you know what happens with development from a child's perspective, why are you screwing it up for the rest of us? Because everybody wants to wear their shoes and it's like, ah, yeah, I have a theory with that where I think what they're doing there is they've basically just kind of said, well, it's not worth our time or energy to fix the problem with the adults. So they like the aesthetics of our shoes. They're comfortable in our shoes, even though they're getting injured at a 9 to 10 rate. But we see that as a problem down the road. We'd like to clean that up. But what we do here now is we fix the kids or not fix them. We just don't hurt them in the first place. So then when they become adults, then we start launching the adult version of that shoe. But they're going to wait ten, 15 years to do that. Yeah, I mean, it's. You know, certainly a good way to look at it. I because I'm in the business of helping people, I have to take the role of, you know, with all these adults running around with, you know, foot pain and weak weakness in their feet. We have to have these conversations. And like, these companies really need to pay attention to adult to adult feet and what's happening. Well, the reality too is it's long term. It's better for their bottom line. Because if I'm a runner and I run all year healthy, I'm hitting for me personally, I'm hitting 5000 miles. If I get injured for two months, I'm running 3 or 4000 miles and that's less shoes. It's like to me it's a no brainer. But I talk about this stuff all day long, right? It's like if you want to sell a lot of shoes, keep people running. And the only way you're going to keep people running is if they're not injured. So that's where the conversation is. The foot has to get stronger. You know, take care of your feet, put people in the right footwear. That's going to promote an environment where people can stay healthy. Yeah I think they're I think they maybe are thinking about that, but they're thinking about it with more BandAids versus less. So their option right now or their solution right now is okay. We've got injured runners. How do we take this runner who's injured and put a bigger Band-Aid there so they can keep running even though they're still injured? Well, I mean, it's our health care system, right? It's a reactive health care system. Rather than saying, hey, let's do something proactive. It's. Let's do everything reactively. I mean, one of my missions in life, like when you go into a grocery store and you go to the footwear section or a pharmacy, every single foot product there is to treat a symptom. Here's an orthotic to treat your heel pain. Here is a toe spacer to treat your bunion. Here is a you know whatever they have to treat pain. And I want to go in there and take those things off and be like, this is proactive stuff where the toe spacer prevents some of this, here's a toe strengthening device to strengthen your foot and take it from that approach. Get your foot stronger so that you don't have to deal with all this nonsense later. And you know, I think that's a societal thing as well, if we tend to react to problems rather than try to prevent them. And that's my mission in life to prevent this stuff. Yeah. It's an interesting topic. I wanted to ask you about the plantar fascia and kind of that because that injury, if I just like kind of scanned all my coaching clients and people I've worked with or met in the running community over the years, that particular injury is got to be the biggest, like kind of unknown in terms of like where. I guess maybe the way to say it is like other injuries, I feel like there's more of a like, even if it's not the best, there's a little bit of a more clear path we can get you back going here. Plantar fascia. It's like, oh yeah, it might go away in a month, but it might just bug you for the whole year, and then it might just disappear all of a sudden. And it can be the most nagging injury. And I think that the rates of plantar fasciitis and plantar fasciitis is an evolutionary mismatch, like the amount of people that have that diagnosis should not have that tightness. If you think about it because I see it in my clinic all the time, if you think about the plantar fascia and its location on the foot, I always say the tissues have best friends. You know, they're all about sharing loads. So we have intrinsic muscles in the foot. So flexor digital and brevis, for example, share load with the plantar fascia. Right. So when you have muscles that are weak or you have a structure of a foot that is compromised, you're not sharing the load anymore. And so this load has to go somewhere. And when those things start to happen, you can start to get these diagnoses. And you know, when I treat, you know, this is a great case, but I had a person with and this is not unusual with chronic pain for, you know, over a year and they come in with their bag of orthotics and their aggressive footwear and they've tried more orthotics, more posting, more this, more that. And I literally have to have the conversation with them. And it takes me a very long time because I basically have to challenge their bias of everything they've ever heard on how to treat this heel pain. Because I do the exact opposite it is I'm going to slowly get you out of all of this stuff because we're going to bring flexor digitalis brevis, for example. We're going to bring his friends back to the party. We need to share some load here. We need to get your foot in a position that is going to make it stronger. Your toes need a display. So, you know, I had this guy that had chronic pain. He was hiking out in Rocky Mountain National Park all the time. and he had, you know, his 40 pairs of orthotics and his really aggressive shoes. And he emailed me the other day saying that he hiked in a pair of zeros, which, it's a very minimal shoe. Yeah, right. all over Rocky Mountain National Park, which is. It's a nothing shoe. There's, you know, there's nothing supporting his foot. Flexible rubber, basically flexible. And his capacity is better and his, you know, and I get very excited about that because that's hopeful for many people. and not only that, but from it, from a longevity perspective, you know, his foot's getting stronger. This is going to help prevent falls. He's going to be able to walk longer distances as he ages. And that's exciting to me. But it's really spinning, taking an extremely different approach to what we have been taught about how to treat some of this stuff. Yeah. When someone's running and they're deciding okay, I've started walking around barefoot, I'm starting to do some more strengthening and stuff like that. My toes blades are improving. Is there a spot where you're like okay, let's do a test run with a pair of minimalist shoes? Or is there a point of entry for that that you typically recommend, or does it really depend? Yeah. I mean, you know, and I think this is important to say on the flip side of that, if you're one of those, you know, I've been wearing all of this, you know, orthotics and shoes and now I'm just going to go run barefoot. That can also create a diagnosis at the foot if you don't have the capacity there. So that's why this progressive load and strength these things happen. you know sometimes slower than we'd like as runners. But yes I mean I will have them start running you know even if it's 5 or 10 minutes. You know, and it's going to put a little dent in the training. Right? So usually when we're trying to make this transition, we'll do it in the off season. Not when they're training for something. Right. So that, you know, the compliancy and the buy in is there. Because it does take time. But you know. Once you are able to start feeling how your body can respond when the foot is striking better, when the foot is stronger. There's not one person that I have met that says I really liked it the other way. Yeah. Yeah. Because it's just more it just feels better. Yeah I remember when I started kind of transitioning that direction like I was, I mean I started running in middle school and then high school and college started taking it serious and I just wore like the traditional running shoes up until my mid 20s when I decided, okay, I want to kind of focus on getting into more natural footwear and trying out minimalist shoes and things like that, and I probably spent six months getting to a point where I could, like, reasonably do all my running in a pair of low profile, flexible, minimalist type shoes. And then probably another six months before I felt like, okay, now I like I'm not even, like thinking about this anymore. It's just like, okay, this is because my feet are plenty strong. I'm not making any compromises, really. Like, I'm not going to eke out more miles by, you know, putting on a more traditional shoe or things like this or things like that. And, you know, so it is like a fairly long timeline. Oh, yeah. But, you know, you can get there and I think it can be helpful if you're willing to just kind of say, okay, I'm going to do a shoe rotation versus just fall in love with one specific shoe and wear it all the time. You can kind of just slowly phase it in. Totally. That's that shoe spectrum I was talking about. Yeah, right. Like, you know, if you want to make this transition, which I would highly recommend for everyone, it has to be slow. You dance along the spectrum, but as your foot starts to get stronger. I can guarantee you that you're going to be like, hmm, all this stuff underneath my foot doesn't feel good anymore. It's changing my perception. And then you end up, you know, my patients will come in and tell me because I'll start them off with, you know, if I'm trying to, introduce them to, kind of the natural footwear world, if you will. We'll start them off with the wide toe box, but I might match the stack height of their shoe. So we'll go with a toe box, thicker stack height. Right. So you start there then as we're working on the strength and you're right, this takes time. Then we'll start cutting down the stack height. And we're still getting stronger. And then we kind of move down the spectrum and then they will tell you, hey, I'm starting to feel better in this footwear. I'm like, yes, perfect. And then you can spend more time there. But when I was, When I started this myself, I first started wearing toe spacers. I think the first pair of or one of the first pairs of functional footwear, and the only functional piece of this was the wide toe box was the old ultra Olympus. Yeah, yeah. And that shoe has a ton of stack height on it. but I was, you know, I had been in orthotics for ten years. I was running around like, you know, again, not throwing out any names, but footwear that was so narrow. So it was a good shoe for me after about six months of wearing those toe spacers. That's about how long it took me before I could wear them all day long. I wear them all day long now. And now. You know, you just kind of. I've spent a lot of time with that transition, and now my foot's on the ground and it just takes time. But the consequence of that. Is so worth it, I mean, that's why I preach the message. You gotta do it. Yeah. I remember when I first actually went in, there's an old shoe store called Revolution Natural Running Company in Wauwatosa, Wisconsin, and I don't think it exists anymore, but it was based on this whole principle. So I went in there and, I mean, they sent me out with three pairs of shoes because, which some people are like, oh, shoot, I'm gonna buy three pairs of shoes, which to some degree, I mean, obviously there's a bigger upfront cost of that, but you're probably going to get more life out of those shoes where the rotation than you will just be hanging one pair all the time anyway. So if you really want to save money in the long term, buying a rotation or getting a rotation started is probably a better move. anyway. But yeah, they sent me out with three pairs of shoes because they knew like, well, this one just isn't something you're going to be ready to do all your training in. But this one is. But we don't want you to do all your training in this one. So we'll have you do X amount in here. You've got this one, you got that one. And they all had their purpose. And I sort of phased them all in and found the spot for them for the specific workouts. And depending on how my body felt like situations, I mean, I was talking to my good friend JD cherry about this, and he brought up such a good analogy, that I loved because I'm also a cyclist and he's like, you have a road bike, you have a mountain bike, and you have a gravel bike. Yeah. You know, I mean, you have different tools for the trade. And I was like, that's exactly right. So I have that same conversation with my patients. It's like, okay, we're going to have this shoe for this right now, and you're going to have this shoe for this. This is going to be your, you know, minimal shoe that you're going to start to wear a little bit each day. And, you know, it is an investment. And that's a conversation that, you know, we have to have. But I think it's worth it. And like you said, when you have that shoe rotation you know you can. Kind of dance along that line. And when we think about how long shoes last, by the way. Right. Yeah. I don't think people think about this, but the more cushion that's under the shoe, it packs down, right? The materials change. If you wear a shoe that doesn't have a lot of stuff, there's nothing to pack down. Yeah, yeah. So you're going to get more mileage off of a shoe that isn't going to, you know, alter in its structure. So yeah, that's something else to think about. The best way to maximize the amount of money you need to spend on shoes is put yourself in a position where you require the cushion, because that's the first thing that's going to go in most shoes is the cushion. You'll be replacing that thing in 200 miles. Yeah. Versus five, six, seven depending on the brand and the model and the durability of it all. But like yeah, I mean if you get used to firm, flexible shoes, sometimes you feel like the shoe comes alive in the later stages of it. And yeah, you don't nearly need to replace them as often. Yeah. And the stronger your foot and ankle get, the more cushion you have. You're just like, oh yeah. Literally you're just like, take this off because you don't get that. You don't get that feeling. And, you know, some of my patients, they'll come in with these really cushioned shoes that they've had for like a year, and I'm watching them walk and I'm like, oh my God, because the thing's all worn out. Whenever they go to heel strike, the, you know, they're basically it looks like they're going to invert sprain their ankle. You know, I'm like, you need a new shoe. A yeah. And B we got to cut. We got to get rid of some of this stuff underneath her foot. you know, because you just can't feel anything. Yeah, yeah, I noticed that with cushioned shoes for me because I supine. So, like, I'll just soar down that kind of front outside part of the shoe. And it fits a decent stack height, like a super shoe. It's like I got to get rid of them sooner than most people because I get that, you know, it just gets more and more extreme. And I basically like encouraging my body to knit more than I would have originally. So. Gosh. Bringing up supination. That we might need. Podcast number two. I had a patient come in this week and a very smart woman. And she said to me, she was a runner. And, you know, and I hear this often. I don't want to pronate when I run and I, I look at her and I'm like, why? Why do you not want to pronounce it? It's our body's shock absorption. It's the first place where the foot can unlock. It's the first place where our feet can lengthen and widen and feel. Because when we lengthen, we can then what? Contract and propel forward? The arch recoils. Our foot was supposed to do that. You know, there's so much cool research coming out right now looking at arch recoil and how important it is to allow that arch to actually move. And I think the implications from that from a footwear design or orthotic design surgeries. Right. So we are really going to be doing a lot of midfoot and ankle fusions like the foot needs to be able to do those things. So rather than say we don't want to pronounce. I say to my patients, I'm going to teach you how to pronate. I want your foot to unlock. You're going to do it with control. You're going to do it with strength because that's where it's like, we don't want to pronate well, you don't want to just come into the ground and not have any control, but you have to pronate and you have to control it, and you have to be able to get back out of it. And all of that comes with strength and mobility. It's not going to be a magic shoe. Yeah. And with like the pronation if someone's actually over pronation, is that just because the strength isn't there to kind of slow that down more, or is it or is it just maybe over pointing is even a wrong way to say, is it just like the rate at which that motion occurs versus how quickly your body can kind of slow it down? Is that where the problems occur? I think it's okay. I think it's both. I think that it's how strong the foot is. How can they, you know, control some of this internal rotation. Can they control some of this load? And they also have to be able to get back out of it. And. You know when people say they have flat feet. I really want us to get out of the mindset that that is a bad thing. It's like flat feet are bad and high arches are good. That is not true. And we're seeing that with all this research coming out that it's how the foot functions. Don't be fooled by what you see. So just because you may see a flat foot, that does not mean that this person needs an orthotic and a motion controlled shoe. It might mean that their foot needs to get stronger, but they also might have a very strong foot. So I think I really want to work on debunking the myth that flat feet are bad and high arches are good, because you can see diagnoses on either end of it based on lack of function. And, you know, the over pronunciation. We've kind of demonized pronunciation. And I don't think that we need to switch gears there either. Yeah. It's interesting. We kind of talked about it a little bit, but I want to dive in a little bit further. Is like the drop of a shoe. Yeah. So. I think probably a question or a comment that would irritate you would be like, can you tell I get irritated about this? I'm just imagining someone coming up to you not knowing anything and just saying, oh, I can't wear zero drop because of my Achilles tendon or something like that, or I get injured if I wear zero drop and like I think people have, maybe this isn't as common anymore, but there are people who think that that's just off the table for them, regardless of what they do. Whereas I think it's like, well, you might not feel comfortable in Zero Drop right now, but there are things you could do where that would no longer be the case. Yes. You just answered it perfectly. you know, if you've ever. I will hear that all the time, right? I switched to a zero drop and I had all this foot in calf pain, so it must have been the shoe. And it's like, no, you either transitioned too quickly or clearly you don't have the capacity and the power from your foot and ankle to run in a zero drop shoe because you know, it is the way we should be running. But if you're not used to it, it's more expensive. You know if you mean I live in Colorado. when I run in my zero drop. So, you know, my. I have an ultra king mountain that I love. Yeah, yeah. I'm so happy that I brought that model back. I know, I was so stoked about that. when I'm running up the mountain, there's no. I feel it in my foot and in my calf. And I've worked very hard to be able to do that. Right, even if I were to put on. So the ultra, Wild. Yeah. With the four mil drop. Yep. Right. When I put that formal drop on, there's this difference. And it's not even that much. It's only four mil. But you know, it does change the dynamics of what's happening. But when you have a diagnosis like, you know, an Achilles issue, here's the conversation that I will have with my patients. You can continue to run in your 12 millimeter heel to toe drop, which is going to modify the load through the Achilles. But you're not creating an environment where your foot is getting stronger. So don't be surprised when you have another diagnosis or this is starting to, you know, it's like, why wouldn't we just work on getting our foot stronger, work on improving our dorsiflexion? Because then yes, you will be able to run in a zero drop shoe and you'll enjoy it. Yeah. Yeah. It's always interesting because it's like yeah you wouldn't think four millimeters would make that big of a difference. But it can, you can feel it. and I think that is worth exploring for people who've been in something. The one interesting thing I have seen with the shoe industry is it does seem most brands now are coming off as aggressive as a heel lift, at least with some options where when I was younger, I think it felt like everything had a 12 millimeter. Yeah, I know, same. I feel that too. But here's where I think they might be decreasing the heel to toe drop, but the stack height. Yeah. And the stuff is just getting like I said, I mean some of the shoes I've seen already, I'm like, I don't you can't even tell it's a shoe. Right. What is that? Yeah. Yeah. How does that dynamic change? If I had like a 12 millimeter offset in a really cushioned shoe versus. I mean, I have a hard time finding this, but 12 millimeter offset with, like, a really low profile shoe. Is that like, does that behave differently because of the firmness of the midsole? Doesn't allow for any adjustment of how that kind of offset works when you have a more rigid or I shouldn't say rigid, but more firm midsole. Yeah, that's a great question. I'm not sure. I'm not sure about the kind of, you know, change in the ground reaction force with the heel to toe drop on those different materials. But yeah, that is a good question. I'm not sure. Yeah. I was just thinking about that too, because like, if and if you get someone who's got a little bit puts a little more pressure on the rear part of their foot through their gait cycle, you know, they could pack that down more possibly. Although I guess through the full gait cycle, they're probably going to still put a ton of pressure on the forefoot even with that side, so that maybe it's still evenly distributed. But it'd be interesting to just get someone or like a group of people with different feet, like different things, impact or like landing zones, I guess. And look how their wear pattern on the midsole changes the actual, like statistical difference of the heel to toe over the course of the lifetime of the shoe and see if, because maybe someone starting out in a 12 millimeter offset and by the time they get rid of the shoe, they're in like a six millimeter offset and how it behaves. But yeah. Yeah, I think I find that all to be so interesting. Like, you know, why someone prefers a 12 mil over a six or a four. And, you know, I think even when you when you look at every other, you know, kind of activity, whether you're weight training or you're simply walking, you really need to pay attention to all of these types of things that you're putting on your foot, because it changes the dynamics of not only the foot, but everything else. You know, it's you know, the analogy I use is when people will, you know, be squatting and they'll say, I have to squat with a, you know, the lifts a lift on and it's like, okay. Or you could improve your ankle dorsiflexion, you know what I mean? Or work on your stability. So it's like there's a trade off. And there's always a trade off with everything. And you know, there's a time and a place and I'll say this to my patients so I am not anti. You know, it's you know I'm not anti anything but you have to be aware of what's happening when you're heavily biased towards one thing. Yeah. I mean if you just look at it all as tools and then recognize that if I overuse a tool or use a tool for the wrong thing, it's going to eventually create a problem, or at least an inefficiency where I could be using a different tool more effectively. And, and in some degree, like when people are kind of going on in the process of, okay, I've got foot weaknesses, I've got things I want to try to correct, how do I sort of go about that and avoid, you know, the worst case scenario of getting injured in the process of trying to get better? Yeah, I just tell them it's like, think of it this way. Like, if you like if you flex one of the tools we've talked about in terms of like kind of starting to start that process, just kind of ask yourself this. Like the thick of it the same way as how I would view a strength routine if I go into the weight room, the goal is to get stronger and I do a routine the next day, one area is more sore than the other. I'm going to think of it as like, okay, that spot is sore, which means I probably did a little too much, so maybe pull back or ease into it. And I also am probably weaker in that spot. So I've learned two things. I've learned I have a weakness that if I can improve, I'm going to get better, but I need to be mindful of that weakness and work it up. So the same thing with running is like if I go out and start running the next day, like my calves are sore, but everything else feels a little bit normal, I'm going to take that as well. My calf muscles are maybe a little weaker, and they need to be worked on to fix it versus thinking of it as like, okay, this is bad, now I need to get rid of that. Right? So it's all information. If you just take that information in and apply it properly, you eventually get where you're trying to go. It's so good. Pay attention. Right. I think that analogy that you had with strength training is great. You know, you wake up with your knees sore, what are you going to wear a knee brace forever. Yeah. It's like no, you're going to figure out, you know, strengthen your glutes, right? I'm always like, everyone wants to strengthen their glutes. Strengthen your feet. Yeah. but yeah, it's all information and we should be paying attention. Right. And I think if you were to ask anybody on this planet, what are your goals? And I asked that to every single patient that walks in my door, what are your goals? You know, it's to stay healthy, to stay active well into their later years. And I think that's why these conversations are so important, because I think we think about the right, the here and now. Right. And you have to also look at what is going to be the best for me from a longevity perspective as I age, because I want to be running till I can't, you know, till I'm six feet under, I need it, I want it, I love it, I want to be active. So these are the things that we need to start paying attention to. Because when things hurt it will stop you in your tracks. And as we age when we start to decrease little bits of movement over and over again, it impacts your health on, on every single level physical, mental, emotional. And you know, pay attention to all the information that we're given because it's telling you something. Yeah. Yeah. For sure. And I think to kind of summarize some of what we're talking about from like a transition standpoint, I always think like if I owned a running store and my goal was to improve the health of the feet of the people coming in, I mean, I probably carry a lot of the different brands, but what I would do is like when someone came in and they were wearing, you know, whatever kind of traditional model they had is I would prescribe them a natural footwear to go along with the other ones. So they're buying two pairs of shoes. Yes. And they're and I'm not going to tell them to like to phase it in and, you know, work on it slowly and that sort of thing. I think that's really the way if I could go back and start a minimalist or a natural footwear, and I sent out my field rep team to the stores, especially shops where a lot of people are getting this information and deciding on what shoes they're going to get. I'm telling you. I'm maybe even leading with that. I may even be leading with, hey, our shoes. Obviously you're going to if you have a brand like ultra where you have a wide range of different stuff, you can probably have a little more flexibility because there's just like you mentioned, there's like the Olympus and then there's lower profile stuff. But I'm almost saying like, look, don't just sell them this straight up unless you know, they're ready for it. Or if you're if you're concerned because they have some injury history and they're wearing a lot of orthotics, stuff like that, treat it as an add on and sell it as an add on like you would in orthotic or like you would the socks or the the shorts or whatever you're gonna try to get them to buy along with their shoes while they're in there. And I mean, it just makes so much sense to me. But I talk about this stuff all day long. I mean, you're selling things in a shoe store. There's really two, two things to consider, right? Keeping people out of pain and improving performance. Right. People either want to not be in pain or they want to run faster. So to me that's an easy conversation to have. You need to do these things with your feet. You need to either wear this shoe. You need to strengthen your right foot in order to prevent pain. We know also from a performance perspective, right? Throw out some anatomy here. Training Proteus brevis or the muscle on the outside. An even better foot makes us faster. Right training the spring of the foot, right. So, you know, plyometric work and strength training makes us faster. So you know, when you have those conversations with runners then I think it's you know those are easy cells. Yeah. Right. You want to stay out of pain and you want to improve performance. How about you do this stuff and then imagine how strong you're going to feel when you put that shoe on. Because it's icing on the cake. Yeah. Yeah. It makes sense I think it yeah I think fighting fighting with your body's normally doing or thinking of it this way. Like I want my foot to do what it would do with no shoe inside the shoe. I will choose eventually. So, you know, not having the shoe compromise your function. Yeah. Yeah. Right. Yeah. It's like. But yeah, I mean, the stronger you are before you put that shoe on. I mean it's a simple concept. Yeah. I had one last topic or question for you that I find interesting because I just see this one come up is like we have like I mean we all have toes, we all play them. You know, we all have feet essentially. but we do have different volumes to some degree. Yeah. How does somebody like one of the biggest pushbacks? I'll see when someone is like, maybe getting a little hesitant about trying out something with a wider toe box or a foot shaped toe box is, well, I got narrow feet, low volume feet. When I put on that shoe. I just swim around and it causes all sorts of issues because my foot's moving around in the shoe. And is there a solution for that, or is there something that people can do that has more low volume, narrow feet that helps with that sort of transition into something with a wider toe box? Yeah. It's a great conversation because I have it with my patients all the time. for people who are not used to wearing a shoe that is in the shape of their foot. Most people, when they put shoes on where they have the wide toe box, they're like, my toes feel like they're swimming in here. Yeah. Good. It feels sloppy right in. My response to them is always, well, wait till your foot starts getting stronger, because then your toes should be able to splay and fill up the toe box. Right? But because so many and you know, the majority of everyone that I see, there's so much weakness to the foot, their toes, even when they take them out of the shoe, their toes still look like this. Yeah, right. Breaks my heart. So, you know, toe spacers wearing toe spacers in the shoe helps with the splay. They can fill up some of that roominess, but. There are. That's why. I mean, people have different foot types. Some are more narrow. You know, with ultra, the different lasts of the shoe, like my non-negotiable when it comes to transitioning my patients into footwear, is a wide toe box. You have to have room for the toes to display. So when someone has a more narrow foot, ultra will have different lasts, right? So they might have a foot shaped position, but the last is a little more narrow. But I'm still confident in putting them in that type of shoe, because I know we're going to have toe splay. So you can, you know, based on the last of the shoe. But the majority of footwear companies out there, there is not room for those toes to display. So, you know, if you are someone that has more of a narrow foot, you could start with a more narrow but still wide toe box like ultra has. And then it's interesting because as the foot starts to improve strength and starts to get wider, then it's like, okay, maybe I do need to. A wider shoe. Yeah I do remember like after ultra had been around for a little while, you'd get people that were just like really really excited about that brand and they would, they would start requesting wider wider feet. Yeah. Because they're like this one worked for me originally and now or the other one I'll see now is now that ultra is a little bigger. And they do have that different last system. Yeah. You'll get some people they'll be complaining about like the slim last because they'll be like, oh well, it's way too narrow. You're going against your philosophy. It's like those shoes. Not for you. You've passed that level. You're you need the widest of the wide that we have offered here. And I mean, because it's funny because in the beginning that was the, the, the narrow foot person I think was the hardest one to get to actually engage with a shoe like that. And then, you know, they make one product for it and then it's like you get the people who don't. Well, I think ultra set a really good job on their website too, because they've got a lot of education that you look at there. You can literally say original, last standard, last narrow list. so, you know, I think that's important because a lot of people who were, you know, who have worn ultra for many years, used to just be the OG. It was just the original last. So, you know, I will get reports from my patient and say, yeah, it feels a little narrow. I'm like, well, because that's a more narrow last. Yeah. So we just, you know, put them back in the Olympus or the Lone Peak or they have that original last on it. hum. Yeah, yeah. It is interesting for listeners who are really new to this. Like elastic is basically the mold. They build the shoe around. So yeah, you know, if you have a wider last or more volume is last, it just means more foot to be in there for the most part. Yeah. And if you're, you know. This stuff doesn't happen overnight. You know, it has to happen, but it's not going to happen overnight. So, you know, don't make it hard on yourself. My patients will come in and be like, I tried to do this. And it's like, it's okay, let's start here. Maybe if you're more comfortable in choosing a more narrow ass, but still wide, right. So wide toe box, you know, maybe you start there and then we start working on your strength and your function, and then, you know, you can make that transition slowly. I hope I've stressed that enough today because I really want to know the importance and the impact that this stuff can have on not only your foot health, but the rest of your body. And I don't want people to get turned off by the process because they either went too fast, they didn't take their time, you know, and they didn't put the work in because it does. You need all of those things. Yeah. I just lost my train of thought but I did have one more question for you about Oh, I remember so. In around 2010 they had like the minimalist movement that just hit the running world, and it seemed like maybe I was just too isolated into the running world, but it seemed like that was like a big community. Born to run fanatics and all that. And it didn't seem like it necessarily branched out of the running world as much. And I saw a report that was looking at kind of like brand growth and just like just general market stuff. And there is another minimalist movement. I guess we're kind of in it right now where they're starting to see numbers getting close to kind of where we saw when that first wave came. But this time, I think it's not within the running world. The running world is kind of going towards super shoes. Yeah, but it's within the health and fitness world. And these folks are like, I guess the hybrid athletes, the people who like doing a lot of different stuff versus just being identified as a runner. Only they're really getting into more natural footwear, more minimalist footwear and stuff like that. So we're starting to see more brands, more options start to pop up. Despite there being, I think, the biggest, the biggest disappointment to me about the super shoes stuff isn't the fact that we have this super shoe available, it's the fact that it basically eliminated the need for a lot of traditional brands to even have a low profile shoe on their catalog, because that used to be the racing flat. Like you could always keep one around because then everyone needed a racing flat for certain situations now. Now the racing in the super shoe. So well, you keep going in that direction because you're gonna keep me very busy. Yeah, yeah. You know, and I keep saying, put me out of business. Don't make me busier. Right. And if that's the way it's going to trend. Right. I'm, I'm very excited about what I'm seeing from a, not from the super shoe perspective, but from this whole minimalist, conversation, because I've been doing this for 20 years, and you're exactly right. Before that, it kind of caught some fire. But I think this time around it is reaching not only the running community, but everyone, because everyone needs to walk, right. And now we have more research. We have more education. Yeah. There's more knowledge behind the why, I think, than there was before. There's more education on how to transition. There's more education on why this is so important. And that's where I think it's catching fire, because a lot of people are realizing and it's, you know, patient testimonial and people saying, hey, you're right. This does feel better. And I think that's really exciting. And I think we're going to be seeing more and more of it, because it just makes sense. If you sit down and think about it, it just makes sense that you would want your foot to be in a position that it was designed to be in so that it can function, and so we can get stronger from the ground up. This is not a hard sell. Yeah. No, it makes sense. Yeah. Cool. Well, Courtney, thanks so much for coming on. You're so welcome. Thank you. I definitely want to give you a chance to share with the listeners where they can find you. Because Instagram page Gate happens is amazing. If they're really looking for resources, that's a good spot to start. Yeah, education is kind of I'm very passionate about this work. I really, and not only for my running community, but I think we, you know, as a human species, we need to walk. We need to walk. We need to put, you know, mileage under our feet. So, yes, we have a lot of resources. My Instagram account is great. Happens. We have two different pathways. When you would go on to our website, both for the layperson as well as for the clinician. So people who are teaching this stuff. So we have foot health courses that you can take, to get your feet stronger. But then from a clinician, we also have assessment courses and treatment courses. And you know, we have toe strengthening and toe spacers and foot health kits and all those things to get your feet strong. Awesome. Yeah. Well, if all the Human Performance Outliers podcast listeners don't have super strong feet by this time next year, I'm gonna be very disappointed in them. That's right. We gave you the tools. That's right. Awesome, Courtney. Well, thanks a bunch. Thank you so much. Take care. Yeah.