Transcript: Walking Isn't Optional — Dr. Courtney Conley #005

Daniel Vitalis (00:01.457)

Dr. Courtney Conley, welcome to the show. I'm so excited. I love this topic. I love what you talk about. I wanna start off by saying you look like a very fit person.

CC (00:04.28)

Thank you so much for having me.

CC (00:12.664)

Well, thank you. try. I'm turning 50 this year. I'm turning 50. Yeah. And I have to say, I do feel better now than I think I probably ever have.

Daniel Vitalis (00:13.849)

Yeah. You're turning 50. Yeah, so you're a Gen Xer then.

Daniel Vitalis (00:26.291)

It's an interesting thing, right? mean, also I'm turning 48 this year, so we're from the same kind of generation, that forgotten generation, the sort of Mad Max apocalyptic X Games generation. people always say that, I would always hear stuff like that, well I feel better. in some ways I really genuinely do. What do you attribute that to?

CC (00:49.378)

You know, when I was younger, was a triathlete. So I did a lot of, you know, swimming, biking and running. was like a cardio queen. I loved all that long endurance, kind of the slow grind. And then when I turned 40, things started to talk to me a little bit. And I was introduced to more strength training.

And then I really switched gears and I still, you know, lot of my training now has been converted to heavier lifting and that, you know, it's interesting. A lot of that goes into my strength training at my feet. So it's been kind of this whole journey from not only getting stronger overall, but also from the ground up.

So yeah, my training looks much different than it did in my 30s and 40s. I wish someone would have told me how important lifting heavy things is when I was younger, because it really has taken, I mean, I had neck pain and back pain and, you know, I'm riding my bike for five hours at a time. And not that those things are bad by any means. I just wasn't complimenting it with, you know, the strength work. So I think that's...

You know, and now I'm doing more HIIT workouts, if you will, a lot of VO2 max training. And that's really, can I swear kick? I usually say it's kicking my ass. I don't know if I can say that on here or not. So, but yeah, so it's a little different these days.

Daniel Vitalis (02:11.623)

Yeah. Yeah.

Daniel Vitalis (02:19.091)

Please feel free, my friend.

Daniel Vitalis (02:27.025)

It's a lot to balance everything I find, you know, I, I'm, I've gotten big into cardio in the last few years, not as big as triathlon or Ironman cardio. But you know, I put several hours in a week, but I really like strength training as well. But then it's like, you get to where you're like, okay, well, cardio, like, I want to do some zone to work, I want to do some zone five work, strength training, I want to do power stuff.

but I wanna do muscular endurance stuff. And it gets to where the laundry list of stuff and then you're like, how do I manage all this and have a life at the same time? And I want longevity, I would like to look good now too. It's like all that balancing all that stuff. And not many people, it's like a narrow path. Not many people get good at balancing it, right? People get kind of spun out into these weird extremes a lot.

CC (03:07.918)

That's right.

Well, so you can imagine the conversations I have to have with my patients when I tell them that they have to exercise their big toe. They're like, and now I have to do what? I was like, there's ways to do it. So you don't have to make it an extra thing.

Daniel Vitalis (03:17.349)

Yeah, right now I gotta add that. All right.

Daniel Vitalis (03:25.529)

Let's start from the ground up then I'd love to hear a little bit about your background, how you got here. You know, I first saw you on Diariva CEO, which seemed like that was such a huge interview. mean, it just was talked about quite a bit and still is. But I'd love to hear about gate happens all you know, kind of catch me up. So I understand the background and how you come to be here.

CC (03:45.838)

Yeah, I was a dancer as a child. I spent a lot of time in pointe shoes. I was a dancer for the Pittsburgh Ballet Theater. And I, you know, I always used to watch these ballerinas and they'd shove their feet into these pointe shoes. And I just could never, I'm like, this does not feel good. It hurts. And then I developed bunions at a very young age. And then I kind of jumped right into running in the triathlete world. And...

Daniel Vitalis (03:52.211)

Hmm.

CC (04:14.358)

really my Achilles heel, if you will, was always foot pain. I had bunions and neuromas and stress fractures and Achilles tendinopathy and plantar fasciopathy and heel pain. And it was just so frustrating because physically I felt like I could perform, but then when your foot hurts, you can't do anything. So it became kind of my personal quest. And I was like, how can I, I really want to stay in the movement world, learn how to, you know, move better.

And so I ended up going to chiropractic school and we got maybe a half a semester on foot and ankle mechanics with the solution being if it hurts, cast them for foot orthoses. Which was, you know, I didn't really think about it at the time.

Daniel Vitalis (05:02.383)

me crazy.

CC (05:05.758)

which we would never do anywhere else in the human body. Like here's an extrinsic device to stabilize you or modify load that you're gonna use forever. But that's what we knew. So I got out of school and I was obsessed with foot and ankle. And so I did what I knew, which was.

Daniel Vitalis (05:08.893)

Mm-hmm.

CC (05:25.198)

I casted a lot of people for foot orthoses. I worked in two orthotic labs. I was constantly trying to tweak mine to like help my foot and help my heel. And, you know, and then I, one day I was so like done and I was like, this is, this does not make sense. That's when I backpedaled and was like, we can, my foot needs to get strong. It looked atrophied, you know, like my foot just looked thin and weak.

Daniel Vitalis (05:41.232)

You

Daniel Vitalis (05:51.508)

I mean, you're using the word casted, right? It's like in orthotic is a crutch of the foot, right? So you end up, of course, not having to develop musculature when the foot's being supported mechanically.

CC (05:53.483)

Yeah.

CC (06:01.484)

Yes. you know, we were getting, was, you know, patient's pain was getting better, but now I look back and it wasn't that it was getting better. was changing. Something might have improved, but then that load was going elsewhere.

So I just went down this very, deep rabbit hole 20 years ago, 15 years ago and completely switched gears. And that's when I started integrating it into my practice. So I've gone very heavily kind of on the other end of the spectrum going, hey, we need to let our foot feel the ground. And I'm not saying that there's not a time and a place for foot orthotic intervention or therapy, but the majority of us,

can really use strengthening from the ground up. So I, this is actually a funny story. I have a clinic in Colorado and I was teaching for a company and one of my friends said, you know, you really like this foot stuff. You should start just posting it on Instagram and use that as a marketing tool for your business. I was like, really? And she's like, yeah.

So I got home from our trip and she's like, just do me a favor, be consistent. So for seven days a week, probably for three or four years, I consistently posted on Instagram every single day about like something I thought was cool about the foot. and hence gate happens. So it now has grown into this animal where, it's no longer a marketing agent for my

Daniel Vitalis (07:33.554)

Ahem.

CC (07:41.71)

brick and mortar, has now become its own animal. it is, we have like online, I'm just so grateful because that's how, you know, I'm able to spread this message on foot health and education and how important it is. And I've seen some really amazing things happen in my clinic and I just want to continue to do it.

Daniel Vitalis (07:42.781)

Right. Yeah.

Daniel Vitalis (07:52.474)

Mm-hmm

Daniel Vitalis (08:01.671)

Have you ever had anybody come in and you look at their feet and you say like, you're just good? Or what percentage of modern humans need intervention, strength training, mobilization, some kind of work on their feet?

CC (08:18.402)

Yeah, it's a great question. Prior to some of this education going more global, I was in a clinic. So most people would come in with pain. And they'd be like, you know, I had a sprained ankle or my bunion hurts or my foot hurts or my knee hurts or my back hurts. And so then people start paying attention, right, when there's

Daniel Vitalis (08:42.45)

Yeah.

CC (08:42.606)

There's really no other musculoskeletal diagnosis, I believe, that will stop you in your tracks faster than foot pain. Because even if you have chronic low back pain, the research will tell you, hey, go for a walk. Go for a fast brisk walk. It's good for you. When someone has foot pain, they don't want to go for a walk. They don't even want to put their foot on the ground.

So it really alters movement when every step that you take hurts. But now since I'm hoping that people are paying more attention, I'm getting a lot of people in the clinic now who are being more proactive. Hey, can you test my toe strength? Why, you know, I want to know how strong my toes are, which I get very excited about, you know?

Daniel Vitalis (09:29.084)

you

CC (09:29.58)

People are like paying attention. We need to be proactive, not reactive. It's much easier to address things and to get people stronger and more mobile when they don't have pain.

Daniel Vitalis (09:33.917)

Hmm.

Daniel Vitalis (09:40.947)

Mm-hmm.

When I think about how this first got came into mind for me, it was when I was 16 years old, I started working out in a gym, you know, it when I first started training and at that time, the world was still really drunk on the wine of bodybuilding, I think, you know, and and like Schwarzenegger and for a new and all those guys and, and so you go into the gym and it would be like the poster of all the, you know, human and musculoskeletal anatomy.

all labeled and everything. And that was when I first started to learn anatomy. And I remember that this chart was all color coded, each muscle had a color code with exercises associated. And then it just was blank white from like the mid shin down. And I remember being like, well, that can't be right. How you know? Yeah, so was like, wait a second, something's wrong here. And so I always thought about this was like, okay, well, and I came across, I would have had to have been 16 or 17. I found this book called The Barefoot Hiker.

CC (10:23.532)

Yeah.

CC (10:27.756)

Throw the magic happens too.

Daniel Vitalis (10:41.171)

And it was by this guy, Richard Frizzine. I just looked it up this morning to see if I could find it. It's on Amazon now. It's just a little booklet, but it was encouraging people to hike barefoot. And so I got really lucky. This sort of came into my mind early in. And so I've always been doing things barefoot and training barefoot. The results now that I'm in my late 40s, when I see people take their shoes off, I'm often like, it's like, you know, the troglodyte emerging from the cave and it's all pale and shriveled and moist and

CC (11:08.009)

Thank

Daniel Vitalis (11:11.067)

toes are all pressed together and you're like, that looks bad. So I feel really lucky that that's been and then I grew, know, obviously now it's we've been in this era of like barefoot shoes and all this stuff for a little while. So do you think my earlier question was like, what percentage of people don't have foot problems or emerging foot problems? And then you've seen obviously a tremendous amount of change happening. Is it trending? Right? Do you think?

CC (11:40.91)

great questions. I think that. Well, let's put it objectively. in my office, you can measure your toe strength. Okay. So we have, it's what's called a dynamometer and it's a device that measures how strong your toes are. most people don't have this device at home, but sometimes I'll tell people to use like a credit card or something. So put your foot on the ground, put the credit card underneath your big toe.

Try to pull the card out and see if you can engage the muscle of your big toe. And then you would do the same thing with your four toes. At a minimum, we should see about 10 % of your body weight, producing 10 % of your body weight out of your big toe and about seven to 8 % out of your lesser toes. I have been doing this for 20 years.

and I can tell you I can probably count on both of my hands how many people have hit that number.

Daniel Vitalis (12:43.773)

I need you to count on your toes, not your hands. So, okay, so it's most everybody.

CC (12:45.614)

Fair. It's very fair. It's really shocking because I don't think people pay attention to their feet. They don't when I don't even think people realize what a healthy foot looks like. You know, like when you look at I'm going to bring out Eddie here. It's my foot bottle. When you look at a foot.

Daniel Vitalis (13:01.883)

Yeah. Yeah.

CC (13:13.132)

The widest part of the foot should be our toes. So when you look down at your feet, that's what I love about the foot. It's so cool because it's the only place in the human body where you can start to see something and be like, hey, I should probably pay attention to this. You'd have to get an x-ray at the knee or at the hip, right, in order to see aberrant loads. But at the foot, all you gotta do is look down. So when you look at your foot,

If your big toe and your pinky toe look like a tapered shoe, yes. Then that's not what your anatomy of your foot should look like. And I think because we have been putting our feet into footwear that does not respect the anatomy of our feet for many, many decades, we don't even know what a healthy foot should look like. We certainly don't know what a healthy foot should function like.

Daniel Vitalis (13:47.013)

shoe.

CC (14:09.646)

And so that's why I think I see so many high numbers of people with foot pain. One in three Americans over the age of 45 suffer from foot pain. That's a lot. Three.

Daniel Vitalis (14:19.366)

One out of how many?

man, that's not right. I've been thinking about this one question for a really long time. I'm wondering if you have any insights. So I always think about the foot being shaped naturally like a swim fin, you know, like you put on your foot like this, and every shoe is shaped like that. And is this like, okay, so I started asking myself why, you know, and then I started thinking about the foot binding that was going on in China.

CC (14:42.882)

Yes.

Daniel Vitalis (14:52.379)

and like the fetishism of it. And when I look at high fashion, I mean, if you look at runway fashion, you're like, this is fetishism. This isn't these aren't clothes to wear out. This is fetishism, right? Like that's its own thing. Is this like what is this? Is this fetishism? Or is it just how have so many cobblers had it? How is this possible? I know Nike and you know, these companies have not just engineers, but biomechanical engineers who

CC (15:00.803)

Yeah.

Daniel Vitalis (15:21.981)

who study elite runners, like how have they missed this? It makes no sense. That can't be, I wanna be like put my tin foil hat on, what's going on here?

CC (15:25.998)

It doesn't.

CC (15:32.568)

Trust me when I say this, they know. They know. If you look at when all of this really, like when I was doing my research for the book, it was really in the 14th and 15th centuries where it was the introduction of Krakow and Poulain boots, know, the medieval kind of pointy toed shoes. And those were worn by men in a higher socioeconomic status.

Daniel Vitalis (15:35.065)

Yeah.

Daniel Vitalis (15:58.59)

Mm-hmm. Yeah.

CC (16:00.628)

And it was funny because when you look at the skeletal remains, well, not funny, but interesting, of that period versus say the 12th and 13th centuries, you see more skeletal remains with people with bunions. So we're starting to, we started to see this introduction of very narrow toe box shoes and then the sequela of changes in the structural positioning or remains of the feet.

And then that started this whole fashion over function. Why wouldn't we all want to dress like the higher socioeconomic people? You know, we all want to strive to look like them. So thus started to change our footwear. When you look at running shoes, Irene Davis talks a lot about this on running related injuries and

there's not too much research prior to the 1970s. And when you look at the 1970s and forward, that's when we start to have the shoe companies really starting to alter running shoes. And if you see what's happening today, I just want to like shake my head. It's like the alien invasion of footwear. I'm like, we don't need three pillows underneath our foot to run. It's really pretty wild. So I think that

Daniel Vitalis (17:21.137)

or like what are we talking about here?

The my friend calls them maximalist shoes. Yeah.

CC (17:27.596)

Yes, it is. It's a maximalist environment. So I think it really started decades ago and we were warned. There's a lot of people and research saying, hey, this is not what's good for your foot, but society kind of overruled and we have fashion over function. And now most of the shoe brands out there, when you talk to the people developing the footwear, a lot of them don't have an anatomy or foot function background. They have a fashion background.

Daniel Vitalis (17:56.978)

Yeah, dude. I see that. Can I just interject something I've noticed I've seen with so my wife's a CrossFit coach. And so in that space, I'll watch a new company come in and they'll they'll have usually shorts and t shirts. And after they get rolling, they always roll out a shoe. And every time I think who's behind this because you guys don't know about shoes. But now you have a full shoe line. And I've seen this dozens of times where I think, are they do they go to some white label shoemaker who just

CC (17:58.634)

And so.

CC (18:20.567)

I know.

Daniel Vitalis (18:27.079)

Like how does that happen that they...

CC (18:28.334)

I don't know. And it really should not be. It's like medical malpractice, especially in a CrossFit environment. if you, you know, there's always the right tool for the job, you know, so, you you want to have certain footwear for certain activities. If you want to talk about CrossFit where you are lifting heavy loads, right, and heavy weight, your foot has to feel the ground because when you're

Daniel Vitalis (18:34.885)

Yeah.

CC (18:56.45)

barefoot or you have a shoe that has a very thin flexible sole, you can sense the ground. You gather sensory information. So if I was going to deadlift, for example, I want a wide foot. I want it to feel the ground and I want to feel stable so I can drive through my foot when I lift. Now, if I lift on a shoe that has 55 millimeters of cushion, you compromise sensory acuity and it's like you're standing on a pillow.

You know, what do you think the information you're going to get into your knee, into your hip, into your back? It is, you know, I'm at the gym and it's very hard for me to, you know, and I just, can't, I gotta shut up sometimes.

Daniel Vitalis (19:36.232)

Yeah, you probably want to go talk to everybody. I'm sure. Yeah. Well, you know, when you see like the sensory homunculus, are you familiar with that? So that's something to that where feet for the listener, the sensory homunculus, imagine a human body that all the proportions are shaped around how much neurological sensitivity each body part has. So the lips are obviously huge, and the fingertips are huge, and the genitals are huge. The feet are obviously disproportionate.

CC (19:44.226)

Yes.

Daniel Vitalis (20:04.049)

because they have so much more sensory information. So I used to say to people, this would be like cutting off another sense or like living with your hands in mittens all the time, right? But, obviously our feet give us a tremendous amount of information about I'm in such an outdoors person. When I'm walking barefoot through the forest, man, I'm getting so much information about like, sometimes I know what plant communities to expect by what I'm feeling under my feet.

CC (20:33.582)

That's really cool.

Daniel Vitalis (20:33.799)

you know how much moisture what's the texture of the soil is silty is it soft is it muddy is it clay there's so much information people are obviously maybe it's not top of mind for people on how much information they're missing from their environment already because this is just one thing but wow there's a lot there

CC (20:52.8)

It's so cool to me to hear that because that's what our foot was designed to do, is to feel. If you were going to walk on stone or grass or sand, you would adjust your stride. You would adjust how heavy you're stepping based on what you feel because you're gathering information. When you can't feel anything, you're just, you know,

striking away and overstriding or whatever other gait adaptation or compensation pattern that you've acquired. But that foot was designed to feel and it will make the appropriate adjustments stiffening. It's a

neurological adaptation that occurs. The will adapt, will pronate, it will lengthen, it will supinate based on the central nervous system. And when we compromise that, you're setting yourself up for problems.

Daniel Vitalis (21:54.334)

Yeah, when I think of like the two, if I tried to, if you said, give me a list of worlds where people not only ignore their feet, but go even further and just like tape them together because they don't want to think about it. I would think ballet and triathlon are two that come to mind. Like ballet, obviously just notorious for this, you know, and the amount of tape and splinting that has to go on in order for some of those positions to be held or whatever. And I can't even imagine what happens to your toenails and stuff.

But and then in triathlon, especially because you're transitioning from like wet to dry and all of that and then but I just see people relying on a lot of like external stuff to hold themselves together. Almost like this attitude like well, you know, we die tomorrow so I just got to make it through today kind of a thing where it's like almost no thought about you know, and if you get up to like Iron Man, it's like crazy how much people harm themselves in order to accomplish these feats. So I think like

people from outside see it and go like, so cool, so noble, like that people do that. And it's like, yeah, but they're sacrificing, right? Really big. That's like one extreme, but you must have just saw people constantly like having to tape themselves together or somehow hold themselves together.

CC (22:56.366)

Yeah.

CC (23:05.74)

Yeah, it's treating symptoms, you know, rather than going after why. You know, a perfect example is, you know, forefoot pain, bunions, for example, very common. They, when you talk about a bunion surgery or bunionectomy, you know, and you start doing a performing a surgery based on a symptom.

have to figure out why it got there in the first place or else you're gonna fix the bunion and then you're gonna have what's called transfer metatarsalgia. You're gonna have loads going into different parts of the foot. So you really have to be able to assess the why between why all of this stuff is happening.

I've worked with a lot of people across the board, right? From kids to your grandmother to professional athletes. And the professional athlete world is really interesting because athletes are getting bigger and stronger. Like we're getting all this information, like we got to strength train, we need protein and people are getting bigger and they're getting stronger.

Daniel Vitalis (24:13.329)

especially the pros like I stayed at a hotel recently with a football team and it was these didn't even look like regular humans to me.

CC (24:20.61)

Yeah, I mean, it's, you know, fine, great, bigger, stronger. I'm here for it. But you can't train, you can't build this jet engine of a body on a paper airplane of feet. Okay? We put two to three times our body weight through our foot when we're walking.

Daniel Vitalis (24:37.363)

Yeah. Right.

CC (24:44.044)

When we're running, there's certain places in our foot where that number jumps up to eight to 11 times our body weight. So when I get these calls from these teams and they're like, Hey, a lot of our athletes are having foot pain and Achilles issues. And I'm, and I go and assess these guys, these professional athletes, the best of the best. And I'm doing some of these foot and ankle assessments. I'm like, goodness. Like if you would just use the powerhouse of your body, which is from your knee down.

You're already running faster, right? But what if you got stronger and you were actually able to propel through your foot? You would look at injury, decreasing injury risk. I mean, it just, it's really interesting to me when I talk to these guys, because I ask them about their training and there's minimal, if any, that occurs below the knee.

Daniel Vitalis (25:37.972)

Okay, now if somebody wants to start, well, when you were just talking about those loads on the feet when we walk and when we run, I don't want to get too far away from the average listener here. But obviously, our skeleton is a piezoelectric structure, right? It's a crystalline piezoelectric structure. So when forces travel through our bones, they leave an electrical charge that tells our body where to lay down new bone, right? So if we do a little thing that changes our gate or changes

position of the pelvis or changes how we step on our foot. If we do that consistently, does not our skeleton remodel around those compensatory patterns. And then so if I want to then drop my shoes, it's not like just like, now I just go back to normal. It's like now I need to go through months of skeletal reconstruction, right?

CC (26:28.994)

Yes. Yes, it's a, this is where I think, you know, the conversation of walking barefoot and minimal footwear is not new by any means. I mean, this is, I think 2007 was when the Vibram five finger shoe came out. And I think what happened and I think why this time around people are understanding it more as the education behind it.

If you wore a shoe that restricted its function and your foot has never felt the ground and you said, this makes sense to me. It makes sense that my foot should be allowed to feel the ground. I'm going to go from zero to 100 overnight. I promise you that you more than likely you will be in my office because you wouldn't tell someone who's squatting a hundred pounds one week to squat 200 pounds the next week.

It's the same concept at the foot. There has to be graded exposure and sometimes that graded exposure is very slow. Because when I put my foot on the ground, I have more load going through my muscles, through my tendons, through my bones, which is good because that creates a strong foot. It's a good environment. But just like with anything else, if I go to

hot and heavy too soon, that load becomes too much. So our demand is greater than our capacity. So instead of, answer your question, having good bone remodeling, which is, you know, we're building new bone and the bone is remodeling, now we have too much and that edema in the bone turns into stress reactions, for example.

Daniel Vitalis (28:21.405)

Mm-hmm.

CC (28:23.722)

So that is where I'm educating all the time. You're starting at five minutes a day. That's it. Barefoot walking. your, if your foot has not seen, if your bottom of your foot doesn't have a callus on it, you're starting at five minutes a day. That's like, I was just reading some research on that this morning of, you know, calluses on our feet and everybody wants to run to the, you know,

Daniel Vitalis (28:30.099)

of exercises or barefoot walking.

Daniel Vitalis (28:37.792)

Yeah, yeah.

CC (28:50.882)

get a pedicure and get all the calluses cut off. I'm like, please don't do that. Okay, there's a reason those are there. You know, because when you're walking barefoot, you develop these calluses, it's a protection mechanism. You know, and obviously, you know, and then it's like, my foot hurts. I need more cushion.

Daniel Vitalis (28:54.525)

Yeah.

Daniel Vitalis (29:04.147)

Yeah, it's like cutting the pads off your dog's foot or something.

Daniel Vitalis (29:10.491)

Mm hmm. Right. Yeah. You know, having had the opportunity to travel to some places and see indigenous people in the forest and you see their feet, it's like a completely different organ than what we have. mean, the you know, and we talk about having your toes played, they sometimes have like a big toe that's doing its own thing like a thumb, you know, it's like pointed almost like to the side and the way they're gripping things and moving around, you know.

CC (29:31.2)

yeah.

CC (29:35.502)

It's a beautiful thing because I love seeing like a strong foot, you know, it's like, man, they got some resiliency, they're gritty, you know?

Daniel Vitalis (29:43.228)

Yeah, same, same, but you know, I've been watching my wife slowly, you know, she was always about doing everything in her shoes and so I've been like slowly coaxing her out of her shoes, but I mean, she started with a foot that was sort of shaped like a shoe. And I've watched too with the, you know, and now obviously like it's changed tremendously, but watching also, in fact, it was funny, we were just, we just got back from the West Indies and she was,

CC (30:01.451)

yeah.

Daniel Vitalis (30:12.709)

every day wanting to walk barefoot in the sand. And I was a lifeguard on the beach growing up for many years. And so I got a lot, it drives me crazy. So I wanna actually ask about that ground reaction force. Because if you're like, hey, do you wanna go for a walk? I'm always down, but like, sometimes it's nicer to walk on a stable surface because you have that sense of every step propels the next step. And then if I'm walking on like soft sand where you don't have that,

it's like every step or right now it's melty snow so it's no longer snowshoe weather up here in Maine but it's not fun to walk in this snow it's every step is like your feet are now I'm sure that's strengthening my feet but for walking it's not very enjoyable you know what I mean so I would love to get your thoughts on that too because I love to walk a trail or a dirt road I used to be a Vibram five finger guy I remember when to your point

CC (30:50.242)

Yes.

Daniel Vitalis (31:11.123)

remember getting a letter in the mail for the class action lawsuit against them and I was like, my, who are these people who want to suit that's so ridiculous to me. I felt so bad. I thought they produce such a cool product and that really sucked. but I found like running in those on pavement makes no sense to me. It really hurt over time. I wanted to get your opinion on that. So surfaces because it's not like we all just like

CC (31:27.98)

Yeah.

Daniel Vitalis (31:34.575)

inside our house, we have natural surfaces, right? So it's unnatural surfaces. So if I try to take my natural foot and put it on a natural surface, how is that different than if I want to walk outside?

CC (31:42.284)

What? That's a great question. And I think it's one that does need to be addressed because some of us don't have the luxury of, you know, walking around in the woods or on dirt. Those environments, the foot is adaptable. So when we are stepping on dirt or a softer terrain, the foot can kind of adapt. It can feel there's less force, you know.

And that was really, you know, original footwear was used for protection. There was a lot less concrete around, you know? So the foot was able to adapt to the terrain, to the variable terrain. I have a lot of patients, like I also am in New York City a lot. That's, you know, you're a concrete jungle. And you are what?

Daniel Vitalis (32:28.659)

And you walk there, man. It's nothing to log six miles a day or something.

CC (32:33.26)

And I've been doing, like I said, I have been working on my feet for years. And when I go there, I have different footwear. So if I'm going to be walking around for maybe half a day, I have my minimal footwear, which is defined, I define this in the book as wide toe box, not a wide shoe. So a wide shoe is wide at the...

metatarsals, right, or at the ball of the foot.

Daniel Vitalis (33:03.731)

Like you mean like if you buy like the D wide shoe, is that what you're talking about?

CC (33:06.478)

Yes. It's like my patients are like, I got a new balance. It's a triple E. I'm like, it's still tapers at the toe.

Daniel Vitalis (33:12.825)

man, they just can't get it right,

CC (33:15.234)

You know, so why toe box? you can take out the factory insert of the shoe and put your foot on it. And if your toes extend beyond the factory insert, the shoe is probably too narrow, but keep this in mind. Most people's feet look like a shoe, not a foot. you have to, know, minimal shoes, zero drop. So that basically means that the heel and the toe sit in the same plane. There's no elevated heel and a thin and flexible sole.

Daniel Vitalis (33:27.293)

Yeah.

Daniel Vitalis (33:32.115)

Yeah.

CC (33:44.91)

So most shoes that kind of fall into that minimal category are anywhere from 20 millimeters of stack height or less. Typically, like, you know, 14, 15 is more minimal.

Daniel Vitalis (34:00.084)

14-15 millimeters basically under the foot.

CC (34:03.086)

correct. So if you're walking on concrete all day long, or you're walking through an airport, your foot might not like the thin and flexible part. It's gonna love the wide toe box, which is my non-negotiable. It probably will like the heat zero heel to toe drop depending right some people still need that low drop if they have weak feet, weak calves. That's a different conversation. But it's that stack height.

Daniel Vitalis (34:16.115)

be a killer.

CC (34:33.986)

So that's where I think if you're going to be on concrete or standing in one place, or I call museum walking or grocery shopping, where you don't have that faster paced gate where you can roll through your foot, that stack height is an important conversation.

Daniel Vitalis (34:53.779)

Okay, I wanna talk about that. just to clarify museum walking, sometimes people who work in an office building will be like, I've got 8,000 steps today. And you're like, I'm always, I never feel like that's really 8,000 steps because there's such a difference between unimpeded walking versus like shuffling around from place to place. Like I don't feel like I'm getting the same thing from those different types of steps. So if I walk from

you know, this gate in the airport to that gate in the airport, that is really different than if I'm like moseying around in the shops or something, right? That's my experience. Can you help disambiguate all that?

CC (35:31.052)

Yes. So I kind of define it as ambient walking versus intentional walking. Something is better than nothing. So, you know, if you're taking less than 5,000 steps, you're really considered a sedentary individual. So that is like where I start with some people and some people that are have been in chronic pain. I mean, I've had patients that have had 2,000 steps a day. Okay. That is, that is not really moving at all.

Daniel Vitalis (35:39.847)

Of course, yeah, of course.

CC (36:00.682)

So I will take, yeah, it is not a lot of steps. To put it into something a little more objective, about a five minute walk, intentional walk, will get you about 500 steps.

Daniel Vitalis (36:02.247)

You get that like going to the bathroom every day and like going to your refrigerator and stuff. Yeah.

CC (36:18.018)

Five minutes. So with those people, that's what I'm saying. I know you're kind of moving around your house, but if you can give me five minutes three times a day of an intentional walk, that means you're going outside and your pace is a little bit faster or you're on a treadmill if you can't get outside, you're going to grab yourself another 1500 steps. Now for some people, that is a very big deal.

for people who suffer from depression, getting to that 5,000 step mark can reduce the symptoms of depression, by quite a bit. So it's like a no brainer to me. like, this is the conversation we need to be having. It's like on every doctor's prescription pad, should be like some type of block.

Daniel Vitalis (37:03.869)

People take drugs for they're taking drugs because they're not walking. That's so sad. Like, I'm not judging it. I'm my heart hurts that this is the scenario we're in. my goodness.

CC (37:12.108)

Yeah. Yeah.

It's why I do what I do, Tanyone, because on the other side of it, it's like the most rewarding, like it's like what I was meant, like put on this planet to do. And it's so, I had a recent patient who was from out of the country and she came in in a wheelchair and she stayed in the U.S. for five weeks and we worked together. And she had had a foot injury three years ago.

Daniel Vitalis (37:18.045)

Mm-hmm.

CC (37:46.944)

Now, tissues heal.

This no longer was a conversation of a musculoskeletal injury. This was now a complicated conversation of a whole bio-psycho-social issue. It was an emotional thing. It was a mental thing. So we worked not only on improving her strength, right? Because things had atrophied, but more importantly, building her confidence and movement. you know,

Daniel Vitalis (37:54.995)

Right. Right.

CC (38:19.144)

She, told her, you're making me cry. I was like, when you leave here in five weeks, you're leaving that wheelchair here. You know, you're going to walk on that plane. And I spent a lot of time, I would like text her pictures of like the mountains when I'm hiking in Colorado and like all those little things that like, I think were so important to retrain her brain.

outside of just she is identified with this foot pain. There's a person behind that diagnosis and you just can't treat that foot. So I know I went, that was a little, I digressed.

Daniel Vitalis (38:47.475)

Yeah.

Daniel Vitalis (38:52.955)

Mmm.

That's okay. That's okay. You said we were talking about steps and number of steps and I'm wondering about two tools in particular. Do you recommend people have a pedometer? And do you recommend people have a dog? Because people are it's like who's walking who here I would not my dog walks me a mile a day. You know, my dogs like take me out every day. I can't say no to them.

I have to do that walk every day. So I often tell people like, take the dog of your body for a walk, like, you know, get a dog and you'll find yourself walking. I'm just curious, both of those things, how important they are to you.

CC (39:29.132)

Yeah.

CC (39:33.902)

I do think that people need to have some way to monitor what they're doing. I have a Garmin, a lot of my patients have some type of Fitbit or some way to monitor that. think it's also nice if, when I'm at my office and I'm like, we talk about that ambient walking, you're like, well, I got 5,000 steps, but I was just walking around my office. That is different than going for an intentional walk.

So at the end of my work day, I'll look down at my step count and I'll be like, huh, I could probably use another thousand steps here. So I get outside, I go for 10 minutes brisk pace. I grab some more steps. I'm outside. It's like a good, I'll usually go after dinner. You know, that's a nice way to kind of monitor where you are. and as far as the dog, I have a little, mini golden doodle.

Daniel Vitalis (40:30.266)

haha

CC (40:31.476)

And we moved to the mountains in August. And I'm always like, come on, you know, like he just that he does. He's not a mountain dog just yet. Right. So, you know, it depends on what kind of dog you have, but I will tell you this dogs will get you outside walking. So, you know, the, some of the things we'll talk about with my patients is if they are going to be with their dogs for a while, I'll recommend they get one of those belts. So they're not just like.

Daniel Vitalis (40:42.378)

Okay, he's not walking you.

Daniel Vitalis (40:47.325)

Yeah.

CC (41:00.244)

Arm swing is very important with dates. So walking is all about rotation. Same with running. It's how it's basically this like corkscrew. That's what gives us kind of free energy. That's why humans are such good endurance walkers, because really it's a. We've we've been designed to walk for long, long periods of time, but that comes with being efficient and being able to rotate. So when people are walking and they like.

Daniel Vitalis (41:02.183)

Yeah, great, I wanna talk about that.

Daniel Vitalis (41:17.063)

that spinal engine.

CC (41:29.186)

they were holding their dog on a leash, they're kind of impeding some of that rotation.

Daniel Vitalis (41:33.81)

Yeah, sure. What do you think about man, I don't want to lose hold on. I got two two things going on. First, just quick step count question. And then I want come back to this question about weightlifting. But I my kind of optimal running distances, I like 5k is I think I think it's like moderate enough that I'm not going to beat myself up too bad. But it's long enough that I feel like I get some good work in. So I run a few a week and we were just on vacation, you know, I did 10 in a row. So

every day I would look down at my pedometer and I would feel like, am I counting these steps or not? Because like, let's say I do a 5K and I get 7,500 steps out of that. And then I hit my 8,000 step goal like five minutes later and it's nine in the morning and I'm like, do I still need my steps or are those my steps?

CC (42:23.574)

You know, that's a great question. There is, when you're looking at just step count, there's a law of diminishing return. So I'll have patients that'll say, I'm getting 15,000 steps a day. I did my run and then I was done and then I wanted to get my walking steps in. And so they're coming in at 15,000 steps, for example. And then my next question to them is, are you strength training?

Daniel Vitalis (42:30.867)

That makes sense.

CC (42:50.766)

And they say, well, no, I don't have time strength training because I'm getting 15,000 steps a day. Okay. This is when we have the conversation of at after about nine to 10,000 steps, we kind of plateau. So it is.

Daniel Vitalis (42:54.003)

just getting on these steps.

Daniel Vitalis (43:06.131)

That's good to hear, that's good to hear. That takes pressure off, because some days I'll be like 24,000, need more days like this, you know?

CC (43:12.962)

Yeah. And so that's when you can, you know, be able to free some time up for yourself, you know, maybe don't go on, you know, try to hit 20,000 steps and free up some of your time to do other things.

Daniel Vitalis (43:28.913)

makes some that makes perfect sense to me. I always say to people it's like, you know, you can tell the difference between a $5 bottle of wine and a $50 bottle of wine, but it's hard to tell a $50 bottle from a $5,000 bottle. You just can't. Okay, on a weightlifting question, coming back to the rotational conversation, you know, I've really switched up a lot of my weight training now for rotational movement. So I've been doing clubbell, mace, Bulgarian bag, all these things that are rotational, because what I was finding

CC (43:39.468)

Yeah, that's right.

Daniel Vitalis (43:57.502)

doing a lot of CrossFit type movements. Everything being in this sagittal plane. It's like, wow, all actual activities are rotational. All sports are rotational. And then weightlifting, it's not just a CrossFit thing, but it's so single plane. And then what I've noticed and have been guilty of all my life and watched this all my life is how everybody starts to walk all stiffened.

And I used to think we were just doing that because you know, you get that pump and you're like, Yeah, I'm huge. But then I started realizing notes because I'm constantly bracing my spine in one plane. And so I've got friends who do not know how to rotate. And they walk in ways that look kind of ridiculous. But also like they're missing. They there was a famous thing that happened to CrossFit games many years ago where they decided to throw in this different activity and they had them throw a softball.

CC (44:32.098)

Yes.

Daniel Vitalis (44:51.443)

And these are the most incredible athletes I've ever seen and they cannot throw a ball, right? No rotation. It's like embarrassing. So yeah, that I'm curious how you're managing that. So you brought up deadlifting. It sounds like you're doing some heavier weightlifting. You know that feeling you put the weights down and there's that couple of moments where your body's like all stiffened together like a unit. But obviously that's not how we want to move. So any thoughts on mitigating that or the effects of that?

CC (44:55.438)

would have liked to seen that.

CC (45:19.832)

You know, I think it's interesting when you look across different sports, because you can always pick out a CrossFit athlete. Okay. There's in that there's nothing wrong with that. They're just a lot of their movements that they do is just what you said. So the first thing I'll usually ask them is what do you like better front squat or back squat? Okay. And the majority will always tell me I like the back squat. Right.

because I can hang out on my low back. Having to front squat and load the front of your body is more difficult. It requires different stability. I will tell my patients all the time, it is so much harder to turn tissues down or off than to turn things on. We need quiet, right? You mentioned this kind of like.

Daniel Vitalis (46:12.019)

Yeah.

CC (46:16.546)

you know, chest out rib cage flared, know, standing in this position. I am constantly cuing my patients. Drop your sternum. Just relax. Breathe. You know.

Daniel Vitalis (46:30.205)

So like a pair there like in a sympathetic posture, sympathetic nervous system posture all the time, evoking that kind of adrenal response essentially, versus you're talking about things that signal the body that it's okay to down regulate.

CC (46:40.61)

Yes.

CC (46:45.112)

That's right. And you know what? You just see something is really cool. And if I had time, I'd go back to school and research this. I think that when people have bilateral foot pain, bilateral heel pain, even chronic plantar fasciitis, I don't...

necessarily think it is a problem being driven from the foot. When someone is unstable or they're in this state of fight or flight, their nervous systems are jacked up, right? Everything becomes a grip, right? And that means my respiration rates are changing and I can't relax my pelvic floor when I inhale, right? So everything in the pelvic floor, everything is gripping. Gripping is not strength. So

That's when you'll start to see pelvic floor issues. And this is with like heavy lifters, you know, you start to people are like, women don't heavy lift because you'll have it get incontinence. I'm like, that is the biggest bunch of horse shit I've ever heard. We just have to work on how we can control these tissues. And when you can get the tissues to relax and then load.

Daniel Vitalis (47:41.491)

Yeah.

CC (47:52.422)

then my foot is also not gripping because my foot's like, hey, this person is unstable. I'm going to grip to high heaven because I got to try to stabilize them. Well, what do think you're going to get? You're going to get foot tension. So the foot has to be able to relax. It has to be able to absorb shock and so does the pelvic floor. So I think all of that comes into.

Daniel Vitalis (48:00.574)

Yeah.

Daniel Vitalis (48:12.979)

There's a lot there. Gosh, you know, I'm sure you're familiar with Tom Meyer's work and, you know, anatomy trains and he connects that deep frontal line. I think it's like the arches of the foot, the pelvic floor and the diaphragm are all sort of part of one line. And I agree with you that if you can, know, Andy Galpin talks about five minutes of meditating after heavy lifting and stuff. And one thing that I've noticed, again, I'll pick on my CrossFit friends who I love and I love my gym and the community is amazing.

A lot of the people are training very hard, they have a hard time staying lean and they're always injured. And I believe it's because their cortisol levels are jacked all the time because every workout is running from absolute peril. Like the timer goes and there's something so good about getting into that zone five heart rate and hitting those VO2 max workouts. But you got to tell your body after that you're safe again. And if you just carry that into your life day after day,

CC (48:53.518)

Yeah.

CC (49:07.798)

Yeah. yeah.

Daniel Vitalis (49:11.965)

the chronic stress seems to eat away people's connective tissue so that they're never recovering. And then they all kind of get fat because I think because their body's like, hold on to everything, we're in total stress. And I'm seeing that very often. And most people don't have any kind of meditation practice in their life or prayer practice or something or sauna even that down regulates their sympathetic nervous system. So.

CC (49:35.214)

So important. If that's like the one thing I think people are missing, it is not more and more and more. I used to be that person. Trust me. And I was like, you know, always, always injured. And it wasn't even until, you know, recently where I, you you practice what you preach and I'm like, man, there is something to this rest and recovery. There is something about, you know, down regulating your nervous system. And then what you find is you can actually lift more.

Daniel Vitalis (49:42.287)

Yeah. Yeah.

Daniel Vitalis (49:57.798)

Yeah.

CC (50:05.056)

and you cannot get injured chasing injuries all the time.

Daniel Vitalis (50:09.905)

Yeah. Wow, there's so okay, I know only have you for limited time here. I want to hit a few things. First, we were talking about shoes before. Can I run through a few shoes? I'm sure you you maybe have to be careful about what you say about different shoes. But okay, just how you feel about these.

CC (50:29.25)

Yeah, mean, that is you have the toes that are not inhibited. They're going to be able to splay. They're going to have a thin and flexible sole in that type of shoe. I always say you got to earn your right. You got to earn your right to wear that thing all the time because it's an environment where you need to be stronger.

Daniel Vitalis (50:41.01)

Yeah.

Daniel Vitalis (50:47.891)

Okay. I remember, so if you're just listening to this, this is a Vibram Fivefinger, the five toe shoes, and there's some other brands now, but I remember when this came out thinking like, finally we're using all this technology for something useful. Because what a cool, I think back to how many indigenous people have thought about doing it and it just wasn't worth the time when they were making moccasins or whatever, but such a cool idea. Okay, cool. wanna, this is pretty close. So this is a Vivo, you know.

fairly wide, basically a modern moccasin is what I would say that is. Thoughts on that?

CC (51:21.9)

Yeah, so Vivo Barefoot's one of like the OGs of the minimal footwear world. They create a great shoe. That Vivo Barefoot Motor Strength is one of my favorite shoes to strength train in because it's what you just did. You can roll it up in a ball, you can twist it, and it's thin and flexible so you can feel the ground. Yeah, that's a great shoe.

Daniel Vitalis (51:43.155)

One thing I just side note about shoes like that I love is that they're so easy to keep an extra pair like in your carry-on bag or something, right? Because they just don't take any space and they weigh nothing.

CC (51:51.212)

I love that's the best way when you travel, you're like, I have four pairs of shoes in here. It's the space of one, like, hoca.

Daniel Vitalis (51:55.621)

Yeah, exactly.

Okay, another question. didn't bring my any of my boots here. But of course, you know, I do a lot of outdoor activities, lot of hunting and fishing and things that would be very difficult to do barefoot and, and or just would really slow things down, you know. So often what I'm wearing is a rubber boot. You know, it could be I usually wear lacrosse is they could be mucks, they could be bogs.

CC (52:12.942)

Yes.

Daniel Vitalis (52:26.449)

typically that's the typical boot up here in Maine, we got a long mud season, it's just starting now. And I wear them in the winter ice fishing and all of that I typically wear them in such a way that they're fairly roomy inside and my foot just floats inside of it and I can fully splay and move. But the shoes often have a bit of a heel to keep you out of the mud and stuff. So I'm curious about your thoughts on that. And you know, because when I look at the companies like Vivo attempting to make winter boots, it's like

I live in a legit winter. It's like guys, you have to be up a little bit because the cold, you know, for insulation. So yeah, just curious with the winter boot thing.

CC (53:05.506)

Yes, it's like that, don't ever say always, never, you know? I think where I really want to educate people is just that exact topic. People in the barefoot shoe world or the minimal shoe world, they'll be like, I have to wear these shoes all the time and that is not true. For exactly the same reasons that you just said, there is a time and a place.

Daniel Vitalis (53:10.289)

Yeah

CC (53:32.386)

that you are going to want to wear, you're gonna be on rocky terrain. It's technology, it's okay. If your foot's cold, if you're gonna be on rocky terrain, if you're gonna be on your feet for longer distances, it is okay to have a stiffer shoe. It's okay to have that heel to keep you out of mud. It's this conversation of, in the book I call it a 24 hour shoe clock. So if you're gonna be out in the woods for three hours in X shoe.

Daniel Vitalis (53:56.765)

Yeah.

CC (54:02.242)

that is gonna be not as functional as a minimal shoe. That's okay, enjoy yourself. When you get home, take the shoe off and go wear something that's more functional. Just balance out your time a little bit. That's all you have to do.

Daniel Vitalis (54:12.957)

Yep. Thank you. That makes so much sense. That makes sense. I got one more shoe I want to show you and I'm nervous what you're gonna say. Okay, so this is my, this has become my favorite running on pavement shoe. I've got a true form treadmill upstairs. So, you know, like a curved self-propelled treadmill and I run that barefoot. And it's funny, my wife will run it with shoes and it builds up a static charge and her hair stands straight up. And if she doesn't,

CC (54:29.496)

Cool. Yeah, yeah, curved deck.

CC (54:38.622)

Daniel Vitalis (54:41.267)

If she doesn't touch the sides every couple minutes, you build up such a charge that, I mean, it hurts when you actually, when you discharge it. But so I'll run on that barefoot, but when I'm running outside, I've been running in these, those are the fluxes. So those are zero drop. The toe box has been fairly wide. And I just, these have been my airport shoe. I've been running high rocks races in them. I do a lot in them. So, but they're fairly tall. Like when I first,

CC (54:47.134)

I don't doubt it.

CC (54:54.19)

Okay. Yeah.

Daniel Vitalis (55:08.273)

got used to it was like, ooh, I could roll my ankle in that. It's like, if I just wore one, you know, I'm standing up fairly high over the other foot. So thoughts on that shoe.

CC (55:17.198)

Is it comfortable?

Daniel Vitalis (55:19.953)

Yeah, it's all knitted. I don't have to lace it. I just slip my foot in it.

CC (55:24.224)

If you look at all the research on what is the best shoe, Ben O'Nigg did a lot of this. It boils down to, are you comfortable in that shoe? Now, there's kind of a caveat to that because there's always a trade off, right? When people put on a super cushy shoe that has a big toe spring on it,

Daniel Vitalis (55:33.907)

you

CC (55:50.506)

and you see them running and it basically, which is not that shoe by the way, it basically looks like it's rolling them forward. Like the shoe is doing the work, right? I always say, nobody gets a free lunch. That, it's not, know, we, our goal in life should not be to be the most comfortable all the time. It's okay to be uncomfortable. You know, that's when growth happens.

So I always preface that conversation of discomfort is okay. We want to live there. but with that shoe that you have, it is allowing your toe splay. It has some stack height on it. You're running, but that's in that, like that's in that functional footwear, that footwear world, you know, and you're running on it. So yes, that's okay for me. you know, well, you mentioned, the stack height with, you know, spraining your ankle.

Keep that in mind. The further the foot is off the ground, you have a better chance of stepping on something and then you're going to go into excessive inversion.

Daniel Vitalis (56:59.153)

Now, I will say my wife's a little taller than me. So that's a slight incentive I have. And on that note, I wanted to ask you about shoes that, okay, like I agree with you about that clock analogy that you gave. So if we're going out to dinner, I've got a pair of cowboy boots I might wear or another pair of like dress boots. They're so uncomfortable.

CC (57:04.598)

yep.

Daniel Vitalis (57:23.091)

like I want nothing more than to get them off at the end. But I think you know, it's like wearing a belt out at a wedding. It's like or a tie. It's like I don't also want to do that all the time, but I'll do it for a few hours. But but as shoes get more and more aberrant from the human, you know, like obviously, the obvious one is high heels. I'm kind of curious your thoughts on that because now you're getting into changing the position of your pelvis, obviously, and gait dynamics dramatically, right? So as

And I guess I'm going to add one more piece of this. Sorry. The guy who wrote, you know, Shane Benzie, who wrote The Lost Art of Running. Familiar with him. So he's a running coach. And he spent some time in Kenya looking at, you know, the the elite runners there. And he wrote a really great book about it. He's really into using your fascia to run basically. And he said something to me, which I've been thinking about for a while something about that and you just echoed it something about in some cases, a little bit of drop can be appropriate. Now, obviously, if

CC (57:58.668)

No.

Daniel Vitalis (58:21.595)

drop is the same thing that's going on, correct me if I'm wrong, but a high heel is just very extreme drop, right? Like if somebody's like, well, what's drop mean in a shoe and what's zero drop? Like, well, a high heel would be one extreme and then a shoe with totally flat plane would be the other extreme, right? So how much is, when is it beneficial? Why do they even do it? And then what happens when you get to those extremes?

CC (58:43.15)

So to answer the first question about high heels and those types of things, as little time as possible. I'm not going to win the conversation of saying, when you go on a date, you need to wear your functional footwear. No, feel good. If wearing a high heel to go out to dinner makes you feel good, go for it.

But as little time as possible. I have had many patients in my office because of I wore high heels to this wedding or I've worn high heels to work all the time and there will be problems if that is your favorite footwear. If you have your shoe clock and you're wearing that high heel all day long, you will have problems. So limit that time. In the book, we have like a high heel rehab section. We're like, if you were high heels, do these things.

right, to accommodate for that. you know, that's one way to be aware of that. As far as the heel to toe drop, if you look at the research of low to no drop, it's six millimeters or below. So if you have a...

Daniel Vitalis (59:50.297)

millimeters between the heel and the toe differential will be considered zero drop.

CC (59:54.126)

Correct, that is considered to be functional.

All right. If you think of brands like ultra running, topo athletic, they have shoes that sit along the zero drop with the wide toe box, but also four millimeter drop, five millimeter drop. So those are also nice transition shoes for people versus other companies that are eight millimeters, 10 millimeters. That's a high heel to toe drop.

Now, if you have someone who has heel pain or Achilles issues, sometimes that's nice, right? It's easier. Run up a mountain in a zero drop shoe versus a shoe that has an eight millimeter heel to toe drop. You will feel a difference. It's a lot easier. Even when I run with the higher drop.

Daniel Vitalis (01:00:45.523)

with the drop.

Daniel Vitalis (01:00:49.297)

Because you have more surface contact and you're not working the gastroc and the soleus as much.

CC (01:00:52.726)

Yes, if I'm running up a mountain and my heel and toe are in the same plane, you better have a real strong foot and calf to be able to push you up. But if you have that heel that's elevated, you're getting a little assist.

Daniel Vitalis (01:01:02.429)

Okay, yep.

Daniel Vitalis (01:01:10.067)

Well, how do you feel about a lifter then like for somebody who's squatting?

CC (01:01:13.998)

You have to ask yourself why.

Daniel Vitalis (01:01:17.235)

I love that answer. You just got me good with that one.

CC (01:01:18.894)

You know, if I want to squat and I can't deep squat without a lift underneath my heels, I should be asking why can I not do this? Is it because I don't have good proximal stability? Is it because I have poor ankle dorsiflexion? Is it because X, Y or Z? And then figure that out and work on it. But in the meantime,

Daniel Vitalis (01:01:46.051)

That's a diff that's in a different category for you than the running uphill with some drop. You have those as different. Those are different.

CC (01:01:51.475)

no, because I think in both scenarios you are, you know, getting a job done.

Daniel Vitalis (01:01:57.885)

compensating to get a job done.

CC (01:02:00.194)

You know, there's some days where I'm tired and I'm like, man, I'm going to throw on my, you know, ultra experience, which is a four millimeter drop. It's a little, it's a little easier run for me, but I'm still going to go run. I'm still going to, you know, I don't want to compromise movement or steps or activity because I'm a little tired. I'm going to be like, all right, I'm just going to wear my formal drop today. But there's other days where I'm like, you know what? I want to go after my foot and calf strength. I feel good.

Daniel Vitalis (01:02:13.907)

Okay.

CC (01:02:29.302)

I go into my zero drop and run up the same trail.

Daniel Vitalis (01:02:31.729)

But if I'm strapping on lifters every time I want to go squat or clean or snatch, that might be leaning on a crutch a little too hard.

CC (01:02:40.75)

Most of us are not Olympic lifters. Where we're like, we're squatting 700 pounds. That is a different conversation. Yes, of course there needs to be some stability and other factors underneath the foot, but the majority of us don't live in that category. Which means we should be asking ourselves, hey, why do I need this?

Daniel Vitalis (01:02:47.047)

Yeah, I need to... Yeah, yeah, right, right.

Daniel Vitalis (01:02:59.431)

Right, right, good.

CC (01:03:07.81)

And then do both. Training variability is great. Movement variability, the more movement options we have, the less shit moments we have.

Daniel Vitalis (01:03:18.151)

Right. Well, on that, how do feel about do you have time for Can we go any further? Yeah. How do feel about I was talking before about unstable surfaces, like walking in soft sand, or something I really like doing is box step ups off of a stable, unstable surface. So I'll have like a balance board that I'll step down and try to do a controlled step onto that balance board. You know, unstable surfaces, I assume are working.

CC (01:03:22.019)

Yeah

Daniel Vitalis (01:03:47.06)

peroneals, tibialis anterior, you know, all the muscles of the calves, how important is that kind of stuff to walk in surfaces that don't necessarily react the way a firm surface does?

CC (01:04:02.062)

So the first part of that question with the training piece, if you can't control it and you don't own it, then you have no business putting yourself on an unstable surface. That's when I train people. like, if you can't do it on the ground, you have no business putting your foot on a BOSU ball, right? Get control first. But then I love training the foot into inversion and eversion.

Daniel Vitalis (01:04:13.535)

Right, yeah.

CC (01:04:30.382)

Like I'm designing a board right now where you can actually put your foot on it at different degrees of slants so that you can like calf raise off of a foot that's inverted. You know, some people that had an ankle sprain, they'll look at that and be like, no way. And I'm like, oh yes. Oh, we're definitely doing this because your foot is going to do this at some point in your life. You're going to go outside and step on a curb and your foot is going to go into inversion again, and you better be prepared for it.

Same with E version. So we want to train all of those different positions to the foot.

Daniel Vitalis (01:05:06.707)

Do you like something like this? These footboards are getting pretty popular.

CC (01:05:10.23)

Yeah, those are great. It's like a sidekick or the BlackBorn.

Daniel Vitalis (01:05:13.115)

Yeah, mine's some knockoff from Amazon, anything in particular, do you think just do everything that it does or is there anything you're like, prescriptively you should be doing this with it or?

CC (01:05:17.464)

So see you again.

CC (01:05:23.918)

I think those boards are nice because it brings awareness to the fact that the foot needs to dissociate. Our foot, you know how you mentioned earlier about the fin, right? It's wide at the top and then narrows. But if you think of a fin, it's like a paddle. Okay? Our foot has, you know, a rear foot, a mid foot and a forefoot. This foot was designed to dissociate and move.

And that's what I think those boards and training people to kind of roll through their foot is important because I see a lot of people that their foot literally functions like a paddle. It's like their heel strikes and they slap their foot on the ground. And there's none of this beautiful roll that happens and that's shock absorption.

Daniel Vitalis (01:06:13.331)

So yeah, I appreciate you saying that because I never, I don't think embarrassingly, I never really thought about my heel moving independently from my forefoot before. And if you set it so that the forefoot of the board is stable and you can kind of roll the heel back and forth, I'd never actually felt that until recently.

CC (01:06:29.92)

It's the coolest part of the foot, I think. The calcaneus is like the coolest bone in the foot. It is a better shock absorber than any type of synthetic material. There's a calcaneal fat pad that sits along the heel that is filled with receptors that give us information. So when that heel strikes the ground, if we can feel it, right,

Daniel Vitalis (01:06:43.475)

Hmm.

CC (01:06:55.124)

it initiates an unlocking of the foot. The calcaneus starts to open up, okay, or we call it eversion, and that starts this unlocking of the foot, which is pronation, which is a very, very necessary movement. So that's why that heel has to move.

Daniel Vitalis (01:07:14.419)

That's so helpful for me. Couple injury questions I wanted to ask about. One was, okay, here's a big picture one. So I was doing some stupid young guy stuff in the mountains when I was a teenager and I got a pretty bad rotational tip fib break just above the ankle. I was alone while my friends were quite far away. I had to be like basically hauled out of these mountains and.

It was winter times. I mean, I could have died up there. so then I get out and I'm so dumb that I, well, I knew better than to let them do surgery on me. They wanted a pin and rods and all this stuff. And I basically said, can you just push the bones back and cast it? And they did. But it wasn't probably the best that they could have worked that could have been done. Then when I got the cast, which was over the knee, I walked on it.

the whole time I was hiking on it. I mean, just doing stupid things. Hindsights 2020. At this point, the way that it's healed. My foot is tilted outward just a little bit on that side. And what I noticed when I squat is that my talus bone is not sitting quite where it should be. So it impinges in dorsiflexion. So so that if I took a like a band and put it on my rig and set it low,

CC (01:08:30.477)

Yep.

Daniel Vitalis (01:08:36.753)

and then like walked into that band so that band was pulling back against my talus bone. It's like, I can go into like full dorsiflexion. I'm just curious if you have any thoughts on like anything there. Am I like stuck this way forever? I mean, I'm functional, of course, and I can run and squat and everything. I my squat, I'm better off doing staggered stepped or single leg squats than I am squatting bilaterally because

I've got, it causes my whole pelvis to rotate. I weight my left leg a little bit more. And so if I squat heavy, I'm at risk of back pain.

CC (01:09:10.466)

Yeah. I love all the single leg stuff. Anyway, I'm a big fan of that single leg work, but that talus. So the interesting thing about the tail is that there's no muscular attachments to that bone. The only bone in the foot there where there's no muscular attachment. So those posterior Taylor mobilizations that you're speaking of there, sometimes those have to be done consistently to kind of work on centration, if you will.

Daniel Vitalis (01:09:21.248)

it just floats in there.

Daniel Vitalis (01:09:25.606)

Interesting.

CC (01:09:40.006)

but there's a lot of parts of the foot that can be trained to help control some of that. think when we talk about, dorsiflexion, you know, we're always thinking about, I have to stretch my calves, you know, I have to like, you know, mobilizing my calf. we have another option there, which is strengthening the anterior compartment of the lower leg.

If you strengthen the anterior compartment, you will lengthen the posterior compartment. So with those patients, I'll do a lot of, you know, anterior shin work, if you will, certain gait drills, tibial raises if there's no pinching, working on pronation and supination, how to control the arch of the foot.

Daniel Vitalis (01:10:12.541)

Right. It's like reciprocal inhibition.

Daniel Vitalis (01:10:34.323)

because a lot of people are really, really calf focused. I actually have a lot of friends who live in fear of an Achilles injury and my coach has had both, snapped both Achilles tendons and then his wife actually, a couple years ago, jump roping, hadn't warmed up. I mean, it's so awful to watch somebody go through that. I wanted to ask you if you had any...

CC (01:10:42.008)

Yes.

CC (01:10:58.328)

us.

Daniel Vitalis (01:11:01.115)

Like for my buddy who every time I talk, if you even talk about this, I don't know why he gets so nervous and he's never experienced it. What do I tell him to do? Cause like, I don't even think about it. I feel like my feet and ankles are really healthy and I don't think about this, but he's thinking about it all the time.

CC (01:11:06.364)

yeah.

CC (01:11:11.502)

Thank

CC (01:11:15.8)

You load it. You have to load the foot and ankle like you load the rest of the body. If you look at research on Achilles tendonopathy, Peter Mallier's work, it's actually, he did a study and he looked at runners with Achilles issues. Some of the statistics are baseline measures for calf raises, a single leg calf raise. Okay.

holding half of your body weight six times.

Daniel Vitalis (01:11:49.843)

of your body weight is like a farmer's carry like in one hand.

CC (01:11:52.014)

So like, I'm 140 pounds, I would hold a 70 pound kettlebell. I should be able to do six single leg calf raises and they better be pretty. Okay, pretty means not this little half, know, my heels coming halfway off the ground. My heels up off the ground, it's good to roll. Okay.

Daniel Vitalis (01:12:01.876)

Yeah, okay.

Daniel Vitalis (01:12:11.024)

lock it up at the top.

CC (01:12:15.19)

And I think this research is telling us, not all of us have to get to these numbers, but it tells you the capacity that we can. If you were seated now, a seated single-leg calf raise, 1.5 times your body weight. These were the numbers in the study. Now, that's a lot of weight.

So when people are talking about their Achilles and they're, you know, I'm afraid of ruptures, tendons need load. When people feel, and when you wake up with an Achilles tendon issue, you're like, man, it's all sore. You have difficult time going downstairs. That will stop people in their tracks. And they'll be like, I better rest this thing more.

Rest is not the answer for tendons. I'm not saying you won't feel better because you're not doing anything. But when you try to return to sport off of rested tendon, it will most certainly come back.

Daniel Vitalis (01:13:16.061)

So just like bone, the body's remodeling or removing tissue if you're not getting the tension and strain that you need to put on. If that's not being loaded, then your body goes, we can take some resources away from this tendon. Is it like that?

CC (01:13:30.38)

Tendons in order to stay healthy as we age, tendons need load. And that becomes a very important conversation as we age, we need to train for strength and we need to train for power. So like your friend who was jump roping, you have to train the spring. You know, I mean, there's a lot of people that as they age, you say the word jump and they're like, no way. You know,

Daniel Vitalis (01:13:55.856)

Yeah

CC (01:13:58.22)

There's ways that we're like, we'll start with little bounces, right? If you're scared to jump, you just start with a little bounce. Then you can start with Pogos. Then you can even do assisted on the wall. You can do a TRX assisted. But we are going to train the spring of your foot and ankle because that is walking, that is reaction time, that is power, and that is all needed as you age.

Daniel Vitalis (01:14:20.563)

Thank you. Got two more injuries I want to ask about. I'll clump them together. Last two years ago, I'm walking out of the woods, just finished a shoot. We're just walking out of the woods, nothing going on, no stress. I step on an acorn. The number of acorns I've stepped on in my life, incalculable. I step on this one, right where my first metatarsal and phalange meat, you know, like at the base of the big toe, and get a pop sound.

that was not the acorn breaking and for nine months maybe it's just so painful. And I've wondered if I like detonated a sesamoid bone or something. Could that have been what it was?

CC (01:15:05.262)

I

You know, the big toe to me is the most important joint in the human body. You do not want to mess with the big toe. When you have an injury to the big toe, you have to make sure that you restore its range of motion. So I'm not sure what the actual diagnosis was with your injury, but following any injury to the big toe, you have got to try to restore its range.

You know, if we were sprinting, for example, we would need an average about 60 to 65 degrees of range of motion out of that big toe. A walking gait is a mid range range of motion activity. That's why it's so safe for people. You need about 40 to 45 degrees. A lot of people don't have that even, especially if there's been an injury.

So if you don't have 40, 45 degrees out of your big toe or it's pinching at the top, you have to either get that thing assessed, figure out why, try to restore it. But this is important. People will be like, man, my big toe is so stiff. I'm just going to keep jamming this thing into extension. If you have arthritic change to that joint and you keep trying to drive it into extension, you're going to piss it off and make it worse.

So that is an important joint that needs to be assessed. Yeah, so you can traction it and then try to go above, but you want to avoid pinching there.

Daniel Vitalis (01:16:35.827)

How about traction and extension?

Daniel Vitalis (01:16:45.203)

Of course, so no one don't force impingement in that joint. That's the other injury I'd wanted to ask. My wife has also dealt with that particular spot and she, I said, did you want me to ask Dr. Conley any questions? And she said, yeah, why does that injury, so it's that same spot at the mound of the big toe, it goes away, it comes back, it goes away, it comes back and seems like kind of hard to heal. Obviously, I'm assuming because you're walking on it all the time.

CC (01:16:48.526)

That's right.

CC (01:17:15.49)

There's a lot that goes into the stability of the first ray. So for example, when I'm walking, the first metatarsal has to drop down first. It's about timing. And so that my big toe can extend. If I have peroneal weakness, if I've ever had ankle sprains, if I have a weakness of an extensor, extensor callus is breath is the big toe. These muscles,

help drop the head of the first. So if there's some type of dysfunction there, if there's a tightness or a weakness, you can have pinching pain at the toe. You can also have pinching pain there if your foot is an excessive pronation, for example. So these are causes of limited big toe range of motion.

Daniel Vitalis (01:18:10.877)

So like what we would call a collapsed arch, that's pronation, right?

CC (01:18:14.69)

Yes, well, pronation is a necessary movement. It's when you have this excessive pronation that you can't get in and out of.

Daniel Vitalis (01:18:19.827)

Yeah, you're not returning to like anatomical neutral or whatever. Okay.

CC (01:18:23.854)

correct. So when you're standing, if you're driving too much load into the big toe, it's hard to extend that.

Daniel Vitalis (01:18:31.699)

Okay. And most of those muscles you're talking about them, it's like, they're not in the foot, right? They're in, their tendons run through the foot, but they're up in the lower leg or, right? Is that?

CC (01:18:38.04)

There's.

Yeah. So your peroneals, flexor, halus, longus, that can also be a cause of big toe pain. So you, would want to, I can send you some information for.

Daniel Vitalis (01:18:51.367)

That'd be great. Yeah, I was wondering, you know, obviously, this isn't the place for this type of an interview, but I'm assuming you must have a catalog of stuff you can point people to exercises or things like that. Where would people get all that?

CC (01:19:04.066)

Yeah. So gate happens is a, I've wanted to kind of develop a resource for people, for all of this stuff. we have on our Instagram page and on our YouTube channel, there are, I've for literally eight years, there's exercises, and information on all this stuff. The YouTube obviously is more, long format. So I do a lot more education speaking on there. we have on the website.

There are courses for both the individual, you're, there's a bunion course, there's a fit feet program, which is 12 weeks of like getting your feet stronger. And it's not only focused at the foot, but it's everything above it. I mean, your foot is only as stable as the hip that drives it. So shame on me if I don't train people above just the foot.

So that program, I think, has been really awesome. And we got that translated in like three different languages. So that's super cool.

Daniel Vitalis (01:20:03.603)

Wow, awesome. Wow, that's cool. And then I just wanted to close out talking about your book launch and tell us about the book. I'm really excited about it. I was saying to you off air, mean, there's only so many books that have been even written close to this topic, but this one I think is the first really in its genre that's dedicated to this topic. that's crazy because this is the fundamental thing humans do.

CC (01:20:09.079)

Thanks.

CC (01:20:25.528)

Yes.

It's really wild. Well, the book is called Walk, very simple. And I want people to kind of rediscover a lost art of what it is. also kind of the basis of it is that walking should be viewed as a physiological necessity.

Daniel Vitalis (01:20:33.607)

Like that that titles available is crazy.

CC (01:20:56.342)

like breathing and sleeping. If you were thinking of like a Venn diagram, we have breathing, sleeping, walking and food, right? You want to add food in there. But when those things are functionally, optimally, then we have this wellness. You know, if we're not sleeping and we're under high stress, you're not going to want to walk. So that's what I wanted to kind of

Daniel Vitalis (01:21:04.829)

Mm-hmm.

CC (01:21:19.476)

educate people on is this physiological necessity rather than exercise. Exercise I think to some people is considered optional. Walking is not. It is something that is a core biological input to our human bodies. Being a biped that is required for not only our musculoskeletal system but our nervous system. Every single system in your body depends on this low to moderate intensity

repetitive rotational movement. And that's what we talk about. And there's a lot of information on feet. There's foot assessments and foot exercises and footwear. And it was really fun to write. It was a labor of love, for sure.

Daniel Vitalis (01:22:05.811)

I want to let you go but I don't. There's just so many things like I assume when you're walking, it's for instance the sole is pumped being the second heart as they sometimes say like moving fluids out of your lower body or that rotation for the, I imagine your diaphragm is very impacted by walking and your organ systems are. So I just want to reiterate what you're saying. It's not like just because you need exercise. It's actually that the human animal needs this in order for it to like function optimally, right? When's the book coming out?

CC (01:22:22.669)

Very.

CC (01:22:32.13)

Yes. Yep. May 5th. It's pre-sale. Pre-sale is now, but the launch is May 5th.

Daniel Vitalis (01:22:36.816)

and

Daniel Vitalis (01:22:41.171)

Cool, where do people go for that? The pre-sale? Awesome.

CC (01:22:43.21)

anywhere. Amazon, it's all over Amazon now, anywhere where you buy your local books, it's on our website.

Daniel Vitalis (01:22:50.085)

I'm so excited for you. I hope I see it at the airport. That's always like my favorite thing.

CC (01:22:53.56)

Well, it's funny, we were picking like the colors. We were like, what's the cover going to be? And I'm from Pittsburgh originally. So when they came to me with a bright yellow color with black lettering, I was like, that's the one.

Daniel Vitalis (01:23:04.635)

That's you. Well, congratulations. I know how much work it takes and I just I'm really excited for you and I'm excited for how that is going to take your message even further obviously into the mainstream. So really exciting and thanks for your generous time today. I really appreciate it. Any final concluding thoughts?

CC (01:23:17.206)

Thank you so much. was a pleasure. Yeah, of course. No, just, you know, if I had to like recommend anything, I would tell people, regardless of age or anything, get your foot on the ground, even if it's for five minutes a day, you know, and keep in mind that a five minute micro walk can be life changing. So it doesn't take much.

Daniel Vitalis (01:23:32.019)

Yeah.

Daniel Vitalis (01:23:38.483)

Beautiful. Thank you so much, Courtney. Appreciate you today.

just uploading your stuff now. Almost there. I'm at 99%. So give me just a second and I'll let you know. This is Riverside. Yeah. I podcasted a lot in the past and it didn't exist then. So I'm just kind of getting started with new stuff and everything's changed and the tools are way better, I have to say. So I'm not sure why I have your full... Can you see your upload on there by any chance?

CC (01:23:49.218)

Yeah, this river is this riverside river view. Great. It's a great platform, I think.

CC (01:23:57.496)

Yeah.

CC (01:24:06.87)

Yeah.

Daniel Vitalis (01:24:14.579)

Do you see that like you're 99 % uploaded? I just don't want you to close. Yeah, I don't want you to close your browser till I have the hundreds.

CC (01:24:14.647)

It 99%.

CC (01:24:23.242)

Sometimes it usually pops up right away and other times it takes a bit longer.

Daniel Vitalis (01:24:27.731)

but I will, I'm afraid if I hit the stop button, I don't know, I don't know what will happen.

CC (01:24:31.212)

Yeah. One of these I just kind of walked away and just like let it. So just leave it open.

Daniel Vitalis (01:24:36.091)

All right, well, that works for me. Yeah, just leave it open and maybe come back in a few and shut it off. But anyway, I just want to say thanks again. Appreciate it. We'll be in touch and yeah, feel free to.

CC (01:24:45.39)

Yeah, it was great. Thanks so much. Yeah, let me know when it's up and if you have any like clips or whatever, I'm happy to share it.

Daniel Vitalis (01:24:52.584)

Yeah, we will. So cool. If I can ever do anything for you, let me know. Thank you. I guess yeah, like hopefully it just uploads here in a few minutes. Thanks, Carty. Bye.