Click on NOTE CATEGORIES to browse by topic, read through the entire archives, or type a topic in the search box.In this episode, Katy is talking foot pain and minimal shoes with podiatrist Dr. Ray McClanahan. Dr. Ray attended Pennsylvania College of Podiatric Medicine and completed a two-year podiatric, surgical residency training in Portland, Oregon, at Legacy Health Systems and Kaiser Permanente as a Podiatric Physician and Surgeon.
We've got all these moving parts called feet--parts that need regular movement in order to keep being able to move--stacked beneath the weight of the entire body. That means we ask a lot of our feet because our feet bear the brunt of our body weight. And whether you’re new to movement, an athlete, a young adult or a goldener you must prioritize keeping your feet as strong as you can (perhaps through the use of minimal footwear). Why? Because a significant portion of your lived experience depends on them!
OVERVIEW
(time codes are approximate)
00:05:30 - Interview with Dr. Ray (Jump to section)
00:09:00 - How Do Podiatrists View the Feet? (Jump to section)
00:12:15 - Dr. Ray's Journey to Minimal Footwear (Jump to section)
00:16:50- Toe Abduction (Jump to section)
00:21:30 - Changes in Podiatry (Jump to section)
00:26:40 - Rehabilitation with Shoes (Jump to section)
00:29:55 - You Don't Have to Exercise! (Jump to section)
00:32:46 - Transitioning Protocol (Jump to section)
00:37:50 - Closing Thoughts (Jump to section)
LINKS AND RESOURCES MENTIONED IN THE SHOW
Katy’s Books on Feet and Shoes
Dr. Ray’s NWFootAnkle.com site
Dr. Ray’s CorrectToes.com site
PODCAST TRANSCRIPT
(Theme Music)
This is the Move Your DNA podcast, a show where movement science meets your everyday life. I’m Katy Bowman - biomechanist, author, and wearer of minimal footwear. All bodies are welcome here. Let’s get moving.
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Friends, I have written two books on feet and shoes - Whole Body Barefoot and Simple Steps to Foot Pain Relief: The New Science of Healthy Feet. So, why have I done this? A few reasons. First, the feet are some of the most complex musculoskeletal anatomy in the body. Although they are small they're smaller than your thighs or your upper arms or your pelvis - the feet simply have more moving parts than in any other area of the body.
So you’ve got all these moving parts - parts that need regular movement in order to keep being able to move - stacked beneath the weight of the entire body. Meaning we ask a lot of our feet: That the feet bear the brunt of our body weight when we're up and moving around And that’s fine because their anatomy is so very capable of movement.
But then we keep our feet, and all of their moving parts, from moving the bulk of our life, the bulk of their life, through really stiff footwear. And so all of those moving parts, they start losing the ability to move well. But the feet still have to carry our body weight around, and this gets harder and harder because we offer no training to the feet. We remove their training but ask that they still carry us around. Until they can’t anymore. One joint or one area just gets loaded too much and soon you can’t move your entire body at all. So this is why I’ve written two books on feet. A lot of people’s feet will keep them from moving their entire body, and this has less to do with having genetically bad feet or having feet that are just too old and more with the fact that most people have neglected moving the parts in their feet their entire life. So, they’ve got movement-starved feet, which I know is counterintuitive because aren’t the feet moved just by us getting up and moving around? And my answer is, kind of, but not really. You have a lot of parts in the feet, as I’ve already said, all of those parts need their own movement, and they’re just not getting it.
So the solution to stronger feet I lay out in both books almost always involves transitioning to minimal footwear. These are shoes - types of shoes - that allow the foot to move much, much more than conventional shoes do. But when you have foot pain, it can also, again, be counterintuitive. Don’t I need to move my foot less? Wouldn’t less movement make my already aching feet feel better? And that’s a tricky question. Because sometimes injuries do need to be immobilized to heal. And sometimes, wrapping our feet in stiff shoes makes the foot move a lot in one spot, but not much in others. So the solution is to keep that one spot from moving, but also moving all the other parts more. And this takes learning. It takes investing the time to understand how feet work. And also how shoes work so that you're able to keep the features that you might need but let go of some of the features that you don't.
So I am going to keep talking feet, but I’m not going to continue on alone. Today my guest is podiatrist Dr. Ray McClanahan. He attended Pennsylvania College of Podiatric Medicine and then he completed a two-year podiatric, surgical residency training in Portland, Oregon, at Legacy Health Systems and Kaiser Permanente as a Podiatric Physician and Surgeon.
Dr. Ray’s current practice is Northwest Foot & Ankle in Portland, Oregon. In his 25 years as a podiatrist, he has learned that most foot problems can be corrected by restoring natural foot function. He is also the inventor of Correct Toes. These are silicone toe spacers. And we’re gonna talk about toe spacers and toe abduction in this episode as well. His professional goal is to provide quality natural foot health services with an emphasis on sports medicine, preventative and conservative options, as well as education on proper footwear. He is also a longtime minimalist practitioner and advocate.
He is also an active runner and athlete. We're gonna talk about his journey a little bit. In 1999, he finished 14th in the U.S. National Men’s Cross-Country Championships and had a near Olympic Trials qualifying 5,000-meter mark of 13 minutes and change. He then qualified for the World Duathlon Championships in 2001.
(walking crunching noises)
KATY: Ok so, Dr. Ray, welcome to the Move Your DNA podcast.
RAY: Well thank you so much, Katy. It's great to be with you.
KATY: I just got to meet you in person and we had a nice dinner together not that long ago. I just wanted to bring you onto the podcast because I thought your story was really compelling. We definitely have a very large audience of minimal footwear-wearing folks. But a lot of times the questions I get are "my podiatrist actually says not to wear them." Or that "this wouldn't be a solution." And I know minimal footwear can be - it's more complex than we think it is. I think it's just like, "Look for these features in the shoes." And that's all you need. But I thought that discussing it with you might give more food for thought for people out there and they would know how they could talk to their own health care team or reconcile the difference of opinions on what they're hearing.
RAY: Yeah, absolutely Katy, you're definitely right. Not all minimal footwear is created equal. In fact, this has been such a problem over the last 15 or 20 years that a group of us got together and we actually published a paper called The Minimalist Index. So we really just broke down all the various characteristics of the minimal shoe. Because you're absolutely right, they're not all created equal. You've got something like a Vibram 5 fingers, very close to being completely barefoot and you've got some shoe companies describing their shoes as minimal but they're large and they're heavy and they've got features that we wouldn't consider to be healthy. So you're right. There needs to be more education and more defining about what shoes are gonna be good for what person and for when because these things change too as you well know. The farther along our journey we get we become less reliant on some features that we previously might have needed. There's a wonderful woman out there now, I'm not sure if you've come across Anya. Anya's reviews?
KATY: Yeah. I've met her online - is that a thing? But yes, I know who she is.
RAY: Yeah, she's great. She's done a really good job of breaking down different categories of shoes including the shape of the toe box and what kind of foot would that be for. So yeah, we definitely need to keep having the conversation about how to define it and how to make sure that we get the right product to the right individual. And then the other thing I'm hoping that you and I can touch on briefly is something that I'm sure you talk to people about which is the transition period.
KATY: Right.
RAY: You just mentioned the podiatry community is telling these folks that this kind of footwear, whether you call it minimal, whether you call it barefoot, whether you call it - I like the term functional or natural - you're right. The podiatry community is actually trained to tell people to never walk barefoot. I just had this conversation with a patient an hour ago. There's also been a couple of studies that were kind of faulty when the book "Born to Run" came out. I'm sure you're probably familiar with that book. A lot of people saw the wisdom and value in using our bare feet more and wearing footwear that's healthier for us. But you may also be familiar with the reality that a lot of people did it suddenly.
KATY: Mm-hmm.
RAY: And I know you're very wise about the body and changes that can take place in the body but those changes take time. And there was one study in particular where they did an MRI study looking at people who suddenly transitioned from their regular athletic shoe to I think it was a Vibram 5 fingers and didn't change anything else. And then did an MRI of their metatarsal bones 8 weeks later and saw bone marrow edema. So not only was the study way too small, it wasn't necessarily a predictor of any kind of foot pathology. But those were the kind of things that were leading the medical community, I think, to discourage people from pursuing minimal shoes, barefoot shoes.
KATY: You have got such a body of knowledge of "here's what we're told about feet". But I'd like to inform those listening: how do podiatrists view the feet?
RAY: Yeah.
KATY: What's a short way of saying "We see feet as this and shoes as this?"
RAY: Yeah. That's a fantastic question. And that's probably one of the more important questions you can ask. Because I frequently talk to folks about ... the podiatry community is very much like an allopathic community. In other words, if we can make symptoms go away we consider that success. The definition, or what podiatry usually considers the pathology of feet to be coming from is either overuse, heredity, biomechanical issues (which is your area of expertise), and maybe a few rarer conditions. But they don't necessarily consider footwear to be a causative agent. In fact they often times look at footwear as a health tool. Cushioning is good. Arch support is good. One of the sad realities is that we accept a lot of money from athletic shoe companies whose footwear design is not shaped anything like a natural human foot. So two words that come to mind, Katy, to answer your question. Podiatrists are taught that feet are evolutionarily flawed, meaning that feet haven't kept up with the rest of the body. There's literally a belief system that because our fifth toes are dysfunctional that they're vestigial organs and that they have no purpose.
KATY: Right. We could have a whole podcast on the definition of vestigial because just because something is obsolete in an environment - if that's the definition, so be it. But make sure that you're clearly making it a relative to an environment versus relative to a person argument. You need to be really clear when you do that.
RAY: Exactly. So we're taught that feet are gonna need help. We're taught that the reasons why feet break down are the reasons I mentioned: hereditary, runs in your family, nothing you can do about it, you're overpronating. And thankfully the literature is pointing out that that's not necessarily the case. So there's a negative mindset. In fact, it persists to this day which is why I think that not that many podiatrists are that keen about strengthening people's feet, aligning them, and rebuilding them. And that's the nature of our work. So, I think podiatry maybe overemphasizes protection of the feet rather than rebuilding or rehabilitating the feet. And I feel exactly the opposite now, Katy. I feel like feet are so much more capable than what we ever accomplish until we challenge them. And for your audience, it might bear mentioning that I've been around the world. I've lived in the jungles of Africa where people didn't own shoes. And I saw some feet that performed remarkably well in all kinds of environments - climbing trees barefoot, playing soccer, running across gravel. So I think podiatry unfortunately doesn't really understand the developmental capabilities of feet and that's really what I'm excited to partner with folks like you to teach.
KATY: So what was your journey to minimal footwear? So, I'm assuming, because we've talked a little bit, that you got your perspective on minimal footwear sort of after podiatry school? What was the story around that?
RAY: Yeah. In 1999 I received a journal podiatry management magazine which I received monthly and there was an article in there titled "Why Shoes Make Normal Gait Impossible." And I watched everybody on the treadmill, looked at their pronation and early heel off and things I was taught to look at but Dr. Rossi who wrote that article was a very rare and unique podiatrist. He traveled all over the world. He worked in a shoe store. He retired from podiatry because he didn't want to just treat people. He knew that the feet were way more capable than what he was taught in podiatry. Your audience might enjoy the articles. There's four of his articles on our website. But when I read the article, I didn't hear anything about what he taught me in podiatry school and quite frankly it didn't sit well with me for a few days. He planted the seed in me that maybe we could rebuild feet. And maybe the foot structure that people had in podiatry school wasn't necessarily really the one they were going to have for the rest of their lives. So he was my early mentor, if you will, and my early inspiration. He got me thinking about a few concepts which we've since changed the definition in the footwear world, but he talked about a flat shoe. He didn't have the term zero drop - he just said flat. You don't want to have a heel elevation on your shoe. It shortens your calf muscle. And subsequent to his death there's been medical research that has proven that. He also referred to flat being he didn't want a toe spring. For your audience members that aren't familiar: you don't want the end of the toe box above the ball of your foot. And I think the most important feature that he got me thinking about since I had bunions on my own feet at the time was a tapering toe box. So for your audience members that's where the ball of the shoe gets narrower from the ball of the foot. He also taught me that the metal measuring device that we're using in America today, the Brannock device that you'll see occasionally in the shoe store...
KATY: Mm-hmm.
RAY: ...it's literally made to fit fashion footwear. And I know the kind of work that you do, Katy, and I do sports medicine, so I talk less about fashion and I talk more about functional movement patterns. And you can't move well in your body if your feet aren't lined up. And I know you know that. So Dr. Rossi got me thinking about, first and foremost, what I was doing to my own feet. And then I got to thinking about what if I can change my feet - which I have. And that's the nature of my work today. So I have to say he was my early influence. He subsequently published three or four more papers before he passed away. He wrote, "Why Shoes Make Normal Gait Impossible" at age 92.
KATY: Mmm.
RAY: And then he followed that up with three other papers in his mid-9th decade of life. "Children's Footwear - a Launching Site for Adult Foot Ills." He talked about how we start it early in life. "Fashion and Foot Deformation". "Fashion Footwear: Primary Cause of Adult Foot Deformity". And again, Katy, if you go through podiatry school, the deforming nature of footwear is heavily downplayed if not outright denied. So when Dr. Rossi taught me about this was a huge mind-expanding moment for me, which I've since just built upon. I've subsequently become very influenced by other folks who have done similar to what Dr. Rossi has done like Dr. Philip Hoffman, an orthopedist, who went around the world and basically mimicked what Dr. Rossi did. You and I talked briefly about the ancestral health community. Looking at what we eat in our culture and more recently how we breathe or don't breathe properly. So Dr. Rossi is who changed my mind about everything. I basically gave up surgery. I basically teach now, as opposed to do things to people. So he was my early influence.
KATY: I also found, too, in graduate school, the importance of a cross-cultural perspective when you're trying to make definitions and when you're trying to understand what's going on in a body. That you look at a very wide range of bodies. And the way that we've done research here in the United States, the fact that it was done oftentimes at universities, so it would be on younger people. Oftentimes in the sports department. Often mostly male people. You just did not have a very broad perspective of what feet were. You couldn't define the human foot based on this population. And of course a chronically shod population. As soon as you start looking outside of that a lot of your conclusions don't hold up across feet. They hold up in this sort of narrow perspective.
So I'm just gonna go back to that narrowing toe box. In all of my books, you'll see mention of toe abduction - ab-duction. Exercises that's toe spreading. For those of you out there listening, look down at your fingers and spread your fingers away from each other. As far away from each other as you can get and toe abduction exercises is doing that but with your feet. It's trying to move the individual toes away from each other. So I also mention toe spreaders. So that would be a passive device that you can put between your toes that helps support this movement. Helps make it even possible for many people who are trying to spread their toes right now and be like, "I can't get them to move at all." So there's a wide range of toe spreaders. There are some that are meant to just be used short term. If you've ever gotten a pedicure or something they push between your toes to hold them apart. There's ones that aren't meant to be worn for a long time - that can be worn when you're sitting. And then you are the creator of Correct Toes. And that's a toe-spreading device that you can even wear while you are in shoes. While you are wearing shoes. So my question is, how did you come - there's many elements that you could focus on. You focused on toe abduction. What was it about you personally as a person or something in your training that got you not only to really focus on that feature of footwear but also that movement or that skill as a person enough to basically make a second career out of it? Or at least a career addendum.
RAY: Yeah. I don't remember if I shared this at dinner, Katy, but I had a bunion and an overlapping toe. So for your audience, that's where my second toe was a hammer toe and it sat on top of my big toe. And I hadn't thought my footwear was related because my podiatry training taught me that that runs in my family and that bunions are hereditary. But Dr. Rossi taught me that wasn't the case. Dr. Rossi taught me I should start looking at my footwear and realizing that it's not only not the shape of the natural foot, but really what changed my mind, Katy, is I was operating on about 10 people a week that had the same problems that I had and so instead of teaching them to abduct like you wisely teach in your book, we cut the adductor. So instead of rehabbing it and teaching it to do its job, we take a scalpel to it. And somehow I was conflicted by that and I didn't want that on my own foot, mostly because I'd seen some athletes get that and it doesn't turn out the way you want it to turn out. And so I got to thinking more along the lines of rehab potential, physical therapy principles. And so I started talking to physical therapy people. I started looking at the osteopathic literature and so forth. And I started putting single silicone splints between my big toe and second toe and I started wearing Croc's and I started wearing Birkenstocks because there weren't any good shoes then. This was 22 years ago.
KATY: And what were you wearing before then? What was your primary go-to shoe before then?
RAY: Size 9 Nike Pegasus. And I'm a 12.
KATY: Wow.
RAY: And then when I ran, I run long distances so I was running 5000-meter track races with shoes that were way too small holding my foot in that deformed position.
KATY: On your hooves. On your tiny hooves.
RAY: Yeah.
KATY: You're wearing rock climbing shoes and then putting all those miles on them.
RAY: It's crazy what athletes do not knowing how much better they could do if their footwear allowed them.
KATY: Well you're taught to suck up the pain so why shouldn't that go for your feet too, you know what I mean?
RAY: Right. What I've learned is that once our feet aren't in pain, we can shift the pain somewhere else and get a much better performance out of our body.
KATY: There you go. There you go. It's all about distribution.
RAY: Right. So that's where I started changing my life, Katy, and I started noticing my toes were changing and podiatrists told me that could never happen. They told me what I had was hereditary. And so thankfully I decided to experiment on my own body and it's been successful. Now we've been on the market for about 20 years. To your point, our product is meant for activity.
KATY: Yeah.
RAY: So you put it in appropriate footwear and you line up the origin to insertion of all your plantar intrinsic muscles and some really fantastic things happen that I know you conceive of. I love to show off my abductor hallucis because it hypertrophied. It did exactly what the studies said it would do. It got 10% bigger. And obviously, my body functions better. I'm so happy to be able to get out every day and exercise and feel good in my body. And I don't think I would be doing that without Dr. Rossi teaching me what he taught me. And then allowing that to get tapped into other people like you and your work and some of the shoe companies. And there's no going back now.
KATY: No. No. Do you think podiatry is changing at all? Have you seen trends? Do you take interns or anything?
RAY: Yes. I do take interns. I've had one with me recently and she said to me after the second session, why are we not learning this in podiatry school? So the younger ones are more interested and they have literature that they can look at which I did not have when I started rethinking my thought process. There were no studies and if there were they were poorly done or small subsets and if I ever quoted them I was told I was cherry-picking. Well, nowadays there's been so many reproducible studies on foot strengthening and toe spreading like you're teaching. One of the problems though is podiatry is sort of incestuous in that we read our own literature and go to our own seminars and listen to each other. And to your point about cross-cultural examinations, I think we should have interdisciplinary examinations in medicine.
KATY: Absolutely. And for everything really. Absolutely.
RAY: Yeah, I think if we did that if we could tap into the physical therapy studies and some of the biomechanical studies. Not the podiatric studies. But yeah, the younger generation is changing. I received a very disappointing letter from the editor of the same magazine that I read Dr. Rossi's article in saying that podiatry schools are suffering a shortage now. And so I'm not sure what the future of podiatry's gonna be. It's largely a surgical profession. We're teaching our residents 3 years of surgery. And unless they come see a guy like me or read somebody like Dr. Rossi, they're going to perceive of themselves as being purely surgeons.
KATY: That makes me so sad. It makes me... because feet are so important and relatively speaking they're the least physically active part of your body. And they're under the greatest load. So they are asked to do the most, they are cared for the least and now, sort of the profession responsible for understanding their mechanics and how they work, doesn't ... My best friend was a podiatrist. She passed away ... but we spent ... other girlfriends might have hung out and did I don't know what. We just sat around and read journals to each other and practiced foot exercises and talked about what do you do when you have a whithering away of the foot strength and of the science of the foot? The science of the surgery of the foot can be quite robust but the science of the movement of the foot and the integration, the ecology of the foot, just falls off the radar. We are there. This is what it looks like. It looks like a very large prevalence of foot pain and a lack of - that's enough in itself but then there's always some falling off. I mean usually, with foot pain there's other associated joint pain: knees and hips and foot pain all tend to come clumped together. And then the metabolic health that comes from simply I can't move my whole person around anymore because my foot doesn't work. And then as far as efficacy and aging goes, I can't do functional activities anymore. Which means I can't live on my own or have sort of a robust end part of my life, all because of foot pain. All because of foot weakness. All because a lack of just awareness of this tool that we've used every day of our life that we never read a manual on. Never knew that we had to oil it and care for it, just like all the other tools in sewing machines or auto parts that we sort of have a basic understanding. We just stuff these into our shoes and go. So I definitely appreciate you being out there, continuing to do podiatry. And maybe more people will go into podiatry knowing that they could be - there's a non-surgical way of doing it as well. Or not just non-surgical but beyond surgical way of being able to tend to people's feet.
RAY: Absolutely. That's what I tell my surgical residents. It's not an either-or proposition. You don't only ever do surgery or tell everyone to go barefoot. Every patient is on a spectrum.
KATY: Right.
RAY: You're absolutely right. I don't know if podiatry will or not. I hope they will. I'm certainly putting all my effort into it. But we did start a natural podiatry group - it's an international group - where we're trying to influence our young students. And it's been an eye-opening experience for me because I've learned that podiatry in America is very different from podiatry across the globe. A lot of podiatrists internationally are not surgeons. So they see a clearer path to embracing some of these natural methodologies.
KATY: Well and as we were talking, if podiatry is surgery, of course, if someone comes to you for podiatry it'll be surgery. If you can't do surgery, you will see a different toolbox for podiatry. So again, words are challenging. You always have to clarify what everyone means. So many feet have developed problems. I assume that you see many...that your office is full of them. What is your guidance on rehabilitation?
RAY: Yeah. I always start with what is natural anatomy. I wasn't taught that in podiatry school. Most adult Americans don't know what that is. Most podiatrists don't know what that is. I saw a 72-year-old lady the other day that was surprised to understand that the shape that she came into the world with, widest at the tips of the toes, was literally the foot shape she should have for her whole life. And I told her about some of my international travels and getting out in the jungle where people haven't worn shoes. Their feet still have that look like that natural baby foot shape. So I always start with the footwear, which is different from traditional podiatry where I'd put the patient on the table, pushing on the tender area and making the diagnosis, and then trying to make the pain go away. So we educate on the footwear. We teach people not to use the metal measuring device unless they're getting measured for a shoe they're going to wear at the wedding. We encourage them to pull the sock liner out of the shoe - also known as the insole. Stand on it. Look at how their foot relates to that. Then we talk about the design features in footwear that are harmful: elevated heels, shorting calf muscles, toe spring in the front shorting the front of the calf muscle causing hammertoes and so forth, tapering toe box relationship to bunions and tailors bunions, and so forth. Then we begin the process of definitely we give a good exam. We get hands-on. We try to figure out what the problem is. And then we set up a natural treatment protocol. We don't discourage treatment but we discourage treatment without rehab. In other words, we don't just try to make the pain go away without teaching them where did they get their pain. but quite frankly, Katy, if you could be a fly on our wall, we do very little to people. We just empower them with education.
KATY: Yeah.
RAY: When they find out how their foot is supposed to function and what kind of shoes they should wear, if they're slow and purposeful in their transition period they do really good. If they rush it then sometimes they'll have some setbacks. But we basically education people which is really interesting. Because my first degree was an education degree. And I thought I'm never going to use it again. And now I used it, I don't do surgery, so... we talk a lot to people. We touch people. We give them a take-home program. So we've got a shoe store here in the clinic so after they get their diagnosis and we write up their treatment plan we set them up with footwear. If they need toe separators they get toe separators. If they need metatarsal pads, special socks, these kinds of things. And then we put them to work rehabbing themselves.
KATY: And by rehab do you mean exercises?
RAY: Yeah, so we have them do a toe spreading like you're having your folks do: We have them do the dome-ing, the short foot, Janda, whatever you want to call that. But quite frankly a lot of people prescribed exercises don't follow through. In fact today several of them were saying "Yeah I forgot to do it."
KATY: None of you listening. Everyone here listening does their exercises all of the time.
RAY: Of course.
KATY: Of course. This is for other people.
RAY: This is the Katy Bowman show.
KATY: So like all medicine, they would say... like I would say most health care practitioners, allopathic practitioners recognize the importance of movement and will mention it. Not directly prescribe it or refer to physical therapy. But even generally "we need to be moving our bodies" but there is an adherence issue. There's an exercise uptake issue. What do you do about that?
RAY: This is what's so cool about this work, Katy, is, I'll tell the patients, I'll show you the exercises. I've done videos on them. There's a bunch of write-ups in the medical literature. They definitely help. There's no question. But what I tell them is if they don't do their exercises, all they need to do is get their feet lined up and start wearing footwear that's gonna challenge their feet. They will still get 10% stronger.
KATY: Yeah.
RAY: So I tell them if you want to do exercises great. You're gonna get stronger quicker. You might get better a little bit quicker and if you're an athlete you probably want to. But the cool thing about it is, if they forget to do their exercise but they're wearing healthful shoes and their feet are naturally aligned, they're still gonna get strength gains. So that's very cool. Whereas you might not in another part of your body. Like a shoulder... like you said, you're not loading it, if your shoulder needed rehab you'd have to do those exercises. Whereas our bodies - our foot, since they're foundational, all we have to do is line it up.
KATY: You're always exercising your foot. You're always exercising your foot.
RAY: Exactly.
KATY: Even if you barely move. Every time you get up and moving around you're exercising your foot. And I have found that just putting on minimal footwear, not during athletic time, not during the runs, but just wearing to the grocery store, in and out of your car to work or wherever you might go and if you do sit down, that's enough time to create an improved strength in the foot. Which is amazing, right? And I think that's why it's an easy step. In fact, if I'm already getting dressed, just give me the shoe that I can buy to make me better. We're all looking for low investment of our time and our physicality. And that's great. But I do, I still really stress the need to transition. I want to talk about transitioning next. What you would call rehabilitation. Because I think a lot of times rehabilitation is for when people already have an injury. Where transitioning could also encompass those who are just making the transition and they can feel their body feeling differently in other parts because they have switched to minimal shoes. Trying to explain mechanically, you're basically exercising your entire body differently and there's some things with, you know you talked about biomechanical issues, there are biomechanical issues that can arise when you transition to minimal footwear without doing a lick of movement. Obviously, there are some populations that can tolerate transition without exercise better than others. But, do you have a really good transition protocol? Or is it pretty much the same as your rehabilitation protocol?
RAY: I've got a protocol and it's based on broad parameters, Katy. And you might agree, everyone's on a different timeline in terms of age, strength, balance, mobility, and so forth. And so that is the most difficult thing, I think, in coming up with a transitional formula is a 12-year-old child is going to transition so much quicker than a 65-year-old person and somebody who goes barefoot in their home is going to transition quicker than some folks who actually wear shoes in their house. So we've written several documents. Our partner Natural Foot Gear, good friends of ours out in Asheville North Carolina have written some fantastic documents on transitioning. But it depends on all of those variables. In our clinic, we're really treating a lot of runners. And so we've got some runners coming in because they are hurt and so we can start from ground zero and rebuild them at a very slow trajectory. We also have some runners that are running 80-100 miles a week and they just heard something favorable and they want to start to make the transition. Their transition is going to look entirely differently because we're gonna have to keep them in some of their footwear as we change their body. I think the most important take-home that you perhaps would agree with is everybody has a different rate and none of it should hurt.
KATY: Mm-hmm. I agree.
RAY: So if something is painful or people are limping ... we tell people nothing should hurt. You said it very well. They should start noticing some changes in their body and then we just try to add on a little bit more and a little bit more. I don't remember where the studies are that I looked at some years ago at how much a human body can adapt week to week with various stimulus. I think it's somewhere between 10 and 20 percent. And so that's kind of what we recommend here. If people are very highly active and they want to make the transition we'll usually have them start their warm-up for their run with their natural shoe or maybe barefoot. Do the rest of their activity in what they're used to.
KATY: Right.
RAY: Or conversely maybe they start their activity with their typical footwear and at the end up it during their cool down a few minutes start going less shoe, barefoot. The tendency as you probably have seen is way too much too soon because it does feel good.
KATY: Mm-hmm.
RAY: In fact, this time of the year here in Portland, when the weather gets nice people flock to the beach and the winters around here are not like Carlsburg so we do get a lot of rain and so people wear stiff boots. They haven't been very active and then they go to the beach and either go in their bare feet and walk five miles and they haven't been walking much at all or they'll go in a flip flop and walk twice as much. And then they'll present to my office and wonder why the bottoms of their feet hurt. And pre-Dr. Rossi, I would tell them well you're never supposed to go barefoot. That's why your feet hurt. Never wear unsupported shoes. But now I know it's a training error - that's what I call it. It's a lack of adaptation.
KATY: Yeah.
RAY: So I wish I had a perfect formula. In fact, I lay awake at night at times thinking about trying to factor in all the variables that could help us come up with it.
KATY: Let's do it! Let's do it because I have a big, sort of if you can imagine a connect four game where it's a grid. I feel like we're all on a grid. But the grid needs to have a lot of squares because the range is so big. And I think if people could see the grid and they could see movement volume, movement history, and also their specific footwear that they've chosen, right? Like as you've said. Flexible sole is such a simple category for a very wide range of flexibility. Right? Like you can have a flexible sole that's sort of flexible. You can certainly twist it all away. And then you can find something that's like tissue paper that completely crumples up. Well that's a whole line of progression. So if people could understand the principles of movement and adaptation which is what I'm all about across the board. Once you can understand the principles of how we adapt to movement gradually, they could toggle themselves along this massive grid in a way that worked for them. Maybe they can't increase their total volume of movement a lot, but they could progress through the support of a shoe over time. You know what I mean? Or maybe they can't for the way that their foot is presenting - they always want sort of a stiffer flexible sole, but they can increase in terms of volume. And so once you can see really how malleable and all the degrees to which you can be moving your body more. Be reaping the benefits of adapting your body to more movement in a scalible way, you're not trying to jump from one side to the other side too quickly. Because, again, I would agree that the biggest feedback that I get is really something is hurt. We went to school for a long time. We've read a lot of books. We've spent tens of thousands of hours learning about this and you're trying to distill it down to people to benefit from it but go to school on your feet. Read a couple books. Read more articles. Skimming bullets isn't always the best way to learn something, certainly when it comes to phisiology.
RAY: Indeed.
KATY: All right. Well what else would you like our listeners to know about when it comes to footwear. Foot pain is so prevalent and people just wanting to have healthy feet - what's your recipe?
RAY: I think the most important think I want to get to your audience, Katy, and anybody that cares about their body is that foot problems are preventable most of the time. It's not inevitable that we have to suffer a foot problem. So that's really the most important piece I would like to get across. Secondly, and it relates to the first piece, that is accomplished by learning about footwear. And then you can't have proper footwear unless it's properly fitting footwear too. So I guess I would encourage your audience to dive into our website in terms of the shoe characteristics and the fitting. Foot pain is not normal.
KATY: Yeah.
RAY: It's very rare that somebody should have to tolerate foot pain although too many of us do. So I guess I would say prevention is possible and pay close attention to your footwear.
KATY: Well thank you for coming on and sharing all of your knowledge. We'll point everyone... What is your website so the listeners know?
RAY: We've got two of them. We've got a clinical website at www.nwfootankle.com but probably the better one for education and video would be www.correcttoes.com. We've got a shoe list there. And if anybody is in Portland, Oregon come by and visit us. You don't need an appointment. Just come by and we teach people as a community service.
KATY: Are you open 24 hours a day? That's dedication.
RAY: I wish we were. We're not. 5 days a week though!
KATY: Do you have to get in by putting the sole of your foot up to some sort of scanner and it's like ok we'll let you in now?
RAY: Mm-hmm.
KATY: That's great.
RAY: If your toes are not spread wider than your foot you're not allowed access,
KATY: I think it's opposite. If your toes are spread wide enough, just keep on walking.
RAY: There you go,
KATY: But if it's so close say absolutely come on in, we have something for you.
RAY: We can help you.
KATY: All right well thank you, Ray, It was lovely to talk with you.
RAY: Thank you, Katy, enjoyed it very much.
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So the websites are CorrectToes.com and Northwest - NWfootankle.com. Dr. McClanahan educates on a variety of foot conditions - including many running injuries as well as plantar fasciosis, Achilles tendonitis, shin splints, heel spurs, bunions. You know - all the greatest hits! Etc.
I cannot say this strongly enough to all of you listeners out there, whether you are brand new to movement, or you're a seasoned athlete, a young adult, or a goldener - prioritize keeping your feet as strong as you can. A significant portion of your lived experience depends on them! Be well!
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Hi! My name is Brock from Vancouver Island, Canada. This has been Move Your DNA with Katy Bowman, a podcast about movement. Hopefully, you find the general information in this podcast informative and helpful but it is not intended to replace medical advice and should not be used as such. Our theme music was performed by Dan MacCormack. This podcast is produced by Brock Armstrong, that's me. And the transcripts are done by Annette Yen. Find out more about Katy, her books, and her movement programs at nutritiousmovement.com. And, if you want to record this little outro disclaimer bit and be featured on the podcast at the very end, like right here, you can go to NutritiousMovement.com/voicemail and record this little message. And make it your own. Have fun with it! That's NutritiousMovement.com/voicemail.
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