Functional Footwear and Daily Steps Enhance Longevity and Cognitive Health

Key Quotes

"yes we don't do much of that these days it seems to have gone out of fashion with all the ubers and the other ways to to get around and all the sedentary behavior that we do living in living and working in offices what what should we know about walking and how important it is because i'll be honest i don't walk that much"

Courtney Conley highlights that walking, a simple and accessible activity, has become unfashionable due to modern conveniences and sedentary lifestyles. Conley suggests that understanding the importance of walking is crucial, even for those who admit to not doing it frequently.

"yes it's um i always say it's the most underrated underutilized easily accessible activity that most of us are not doing if you think about if you look at the research on average step count that most people globally are taking it's about 45 to 4 900 okay which means that there's a lot of us that are taking less than that"

Conley emphasizes that walking is an overlooked yet readily available activity that many people do not engage in sufficiently. Conley points to research indicating that the average global step count is below optimal levels, suggesting a widespread deficit in daily walking.

"so when i'm working with my patients we always look at baseline numbers what's your baseline so for example if you had a person who was walking 2 500 steps a day i mean some of us would be like wow that's not a lot but for a lot of us it is if you were to walk an additional 500 steps in a day your baseline is 2 500 you can reduce your risk of cardiovascular mortality by 7 wow here's the bigger wow if you have a thousand step increase you can reduce your risk of all cause mortality by 15 dying of anything all cause mortality 15 that's a big number for a thousand steps"

Conley explains that assessing a patient's baseline step count is a key part of their work. Conley illustrates the significant health benefits of increasing daily steps, noting that even a modest increase of 500 steps can reduce cardiovascular mortality risk by 7%, and 1,000 steps can lower all-cause mortality risk by 15%.

"so i have a story for you this is a patient of mine and it just you know warms my heart to talk about him because when i saw him he was two years into a diagnosis of heel pain 27 years old so he had um gone to see a bunch of people and the last doctor that he had seen told him to limit his step count to 2 500 steps a day why to rest to rest the foot now this is chronic pain now we're not talking acute heel pain we are two years into this song and dance and he's being told at 27 years old to take 2 500 steps a day"

Conley shares a compelling patient story to illustrate the impact of chronic pain and restrictive advice. Conley describes a 27-year-old patient suffering from heel pain for two years, who was advised by a doctor to limit his daily steps to 2,500, highlighting the severity of the condition and the patient's limited mobility.

"so we had a conversation and i knew i needed to get him outside and i needed to get him walking that was my goal forget about the heel pain we didn't even focus we didn't even talk about the heel pain i knew i needed to get him outside and start loading his foot two years this foot by the way when you're walking four to six times your body weight it can handle four to six times your body weight when you're walking but you don't load it appropriately and muscles atrophy"

Conley recounts a strategic decision to prioritize getting the patient walking outdoors, shifting focus away from the heel pain itself. Conley explains that the goal was to reintroduce load-bearing activity to the foot, which had atrophied due to disuse, despite the foot's capacity to handle significant weight during normal walking.

"so while we were doing that we were strengthening his foot i had him in different footwear and at the end of each week we were also talking about three good things tell me three good things that happened to you this week and in the beginning of treatment it was it was a struggle stephen it was a struggle for him to think about good things happening in his life"

Conley details the comprehensive approach to the patient's recovery, which included strengthening exercises, footwear adjustments, and a focus on positive reflection. Conley notes that initially, the patient found it difficult to identify positive events, underscoring the profound impact of his chronic pain and limited lifestyle on his mental state.

"my non negotiable is the wide toe box the toes have to be able to splay when you think of all the diagnoses that we talked about bunions neuromas hammer toes when the forefoot can splay the foot's going to function better so that's number one number two is having the heel and the toe in the same plane and number three is having a shoe that is thin and flexible"

Conley outlines essential features of a functional shoe, prioritizing a wide toe box that allows toes to spread naturally. Conley identifies a level plane between the heel and toe, and a thin, flexible construction as the other two critical characteristics for optimal foot function.

"if you don't use it you're going to lose it so there is research that shows when you put your foot in a position with toe spring you will weaken the intrinsic muscles of the foot so i'm not saying don't have race day and wear that shoe right you get the research will tell you two to 4 running economy people run faster because the shoe has the technology to facilitate gate but if you train in that all the time and you never let your foot get stronger it's just a matter of time you're going to say my hamstring my foot my this my that"

Conley warns against relying solely on shoes with "toe spring," which can weaken intrinsic foot muscles. Conley explains that while such shoes can enhance running economy, consistent training in them without strengthening the foot can lead to various injuries.

"so my conversation i have with my patients is listen what if we stacked therapies right what if you did plyometric work which is uh jumping you know once or twice a week and we worked on your strength and i had you in these shoes the majority of the time and then on race day you want to throw that shoe on it's like you're you're running you're like a running fairy you're like running and things look beautiful and everything is you know because you have a strong body on top of the shoe but if you put a weak body and a weak foot in that shoe you got to earn your right"

Conley advocates for a combined approach to training, integrating plyometrics and strength work with appropriate footwear for daily use. Conley suggests that using specialized shoes only for race days, after building a strong foundation with other therapies, allows individuals to leverage their benefits without compromising foot strength.