Feel Better, Live More with Dr Rangan Chatterjee

Born To Walk: How To Reclaim Your Feet, Fix Your Pain & Transform Your Health with Dr Courtney Conley #629

February 25, 2026

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  • Walking should be considered a physiological necessity, on par with breathing and sleeping, as rhythmic motion benefits every bodily system. 
  • A person's walking gait acts as a 'window to their nervous system,' reflecting their emotional and physical state, though efficiency can be improved. 
  • Modern footwear often prioritizes fashion over function, leading to foot pain (affecting one in three adults over 45) by restricting the foot's natural anatomy and strength. 
  • Foot function is the priority, and footwear is secondary, meaning strong, functional feet can tolerate varied footwear, while weak feet won't be corrected by a new shoe alone. 
  • The big toe is possibly the most important joint in the body, crucial for stabilizing and propelling human bipedal locomotion, requiring 65-70 degrees of extension for optimal function. 
  • Walking speed should be considered the sixth vital sign, as a slower cadence can predict cognitive decline, such as dementia, up to seven years in advance. 
  • Sustained walking speed, potentially achieved using a metronome, is crucial for improving overall body efficiency and gait, linking directly to foot exercises. 
  • Walking at a brisk pace constitutes power training, which is vital because humans lose power faster than strength as they age. 
  • It is never too late to improve foot health due to neuroplasticity, and walking remains the most accessible, underutilized treatment available. 

Segments

Walking as Physiological Necessity
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(00:00:00)
  • Key Takeaway: Walking is a rhythmic, low-intensity movement that facilitates every system in the body, forming a necessary trilogy with breathing and sleeping.
  • Summary: Every system in the body, including cardiovascular, musculoskeletal, nervous, lymphatic, and endocrine, benefits from the rhythmic motion of walking. This activity is considered a physiological necessity, potentially on par with sleeping and breathing, and when one suffers, the others suffer too. For example, poor sleep can increase cortisol and reduce the desire for activity, showing their symbiotic relationship.
Gait Signature and Efficiency
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(00:07:04)
  • Key Takeaway: Each person possesses a unique walking gait signature influenced by environment and past traumas, but the goal of gait work is to maximize efficiency.
  • Summary: A person’s walking gait can reveal emotional states like happiness, sadness, or pain, acting as a window to their nervous system. Improving gait efficiency allows individuals to remain on their feet longer and cover greater distances, thereby maximizing the health benefits of sustained walking. Simple observations, like noticing if only one arm is swinging, can indicate inefficiencies that affect momentum.
Causes of Widespread Foot Pain
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(00:10:37)
  • Key Takeaway: Foot pain, affecting one in three adults over 45, stems from an evolutionary mismatch where modern footwear prioritizes fashion over the foot’s functional anatomy.
  • Summary: Many people underestimate their low daily step counts, and foot pain is a major deterrent to movement. Unlike other body parts where strength and mobility are proactively addressed, foot pain is often met with passive solutions like orthotics or cushioned shoes instead of rehabilitation. Modern footwear has historically trumped function, often deforming the foot rather than respecting its structure, leading to widespread issues.
Footwear’s Role in Weakness
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(00:15:43)
  • Key Takeaway: Rocker-bottom shoes, designed to ease push-off for those struggling, create an unintended consequence by causing the feet to become even weaker as the shoe does the work.
  • Summary: Conventional footwear, especially overly cushioned or rocker-style shoes, compromises sensory acuity by interfering with the thousands of receptors on the soles of the feet. This cushioning acts like standing on a pillow during strength training, preventing the foot from feeling the ground and thus weakening the muscles over time. People must be aware of the trade-off they make when choosing comfort over function.
Proactive Foot Health Assessment
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(00:20:43)
  • Key Takeaway: Foot health should be addressed proactively by looking for structural changes like bunions or hammer toes, which indicate aberrant loads and increase fall risks.
  • Summary: By the time foot pain occurs, underlying issues have often been building for a long time, deterring movement. Visible foot changes, such as bunions or hammer toes, serve as indicators of poor foot health that can impact the entire kinetic chain, not just the foot itself. Simple self-assessments, like single-leg calf raises tracked against age-based charts, reveal deficits in strength and mobility.
Protecting Children’s Foot Development
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(00:33:18)
  • Key Takeaway: Children’s feet require sensory stimulation from feeling the ground to develop properly, meaning restrictive footwear during early mobility hinders brain and foot development.
  • Summary: The foot is a sensory powerhouse, and restricting a baby’s foot motion with stiff shoes prevents necessary plantar flexion and sensory input required for nervous system development. Ideal children’s footwear must have a thin, flexible sole, a wide toe box to allow toes to splay, and zero heel-to-toe drop. Parents should allow children to be barefoot as much as possible to maximize sensory gathering.
Footwear Selection Criteria and Transition
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(00:44:32)
  • Key Takeaway: The non-negotiable criteria for functional footwear are a wide toe box and zero heel-to-toe drop, with a thin and flexible sole being the final component to transition toward gradually.
  • Summary: Footwear that compresses the toes deforms the foot structure, losing the integrity needed for propulsion, which is why a wide toe box is paramount. For those transitioning from decades of cushioned shoes, moving too quickly to zero-drop, thin-soled minimal shoes can cause injury; functional footwear (low to zero drop with some stack height) serves as a necessary bridge. Elite athletes who grew up with minimal footwear often possess superior mechanics, highlighting the importance of formative foot development.
Footwear Tolerance and Rehab
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(01:07:57)
  • Key Takeaway: A strong, functional foot can tolerate occasional high heels if the majority of time is spent in correct footwear, necessitating specific high-heel rehab afterward.
  • Summary: Tolerance for non-ideal footwear like high heels depends on the baseline strength of the foot; specific rehabilitation exercises should follow wearing them. Confidence and feeling stable are linked to how one interacts with the ground through their feet. The options for appropriate, minimal footwear have significantly increased over time.
Foot Function vs. Shoe Choice
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(01:10:05)
  • Key Takeaway: Achieving well-functioning feet through dedicated strength and mobility work is more critical than simply switching to minimal footwear.
  • Summary: If an individual’s feet are not working well, changing shoes alone will not correct underlying issues; the priority must be the foot itself. The shoe is described as the ‘icing on the cake,’ emphasizing that what is put into the shoe (foot function) is paramount. Elite athletes train in challenging environments so that when they use performance footwear, they possess a strong, resilient system underneath.
Multifactorial Pain and Footwork
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(01:13:06)
  • Key Takeaway: Chronic pain is multifactorial, and poor foot function can be a significant physical contributor to issues like severe back pain.
  • Summary: The speaker’s personal journey with severe back pain resolved after addressing a functional issue in the right foot with specific exercises. This experience highlighted how foot mechanics directly influence pain patterns higher up the kinetic chain. The priority must be strengthening and mobilizing the foot, regardless of the shoe choice.
Training Lateral Movement Capacity
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(01:15:42)
  • Key Takeaway: The foot’s ability to invert and evert (move laterally) must be trained, rather than avoided, to build resilience for activities like paddle sports.
  • Summary: Just as the shoulder is trained in multiple planes of motion, the foot needs training in inversion and eversion, which are its natural planes of motion. The goal is to train the brain to control movements like inversion after an injury, not to avoid them entirely. Footwear choice for sports should be secondary to having a strong, mobile foot developed through varied training.
Foot Strength Gains from Footwear
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(01:21:07)
  • Key Takeaway: Simply wearing minimal footwear can lead to significant, measurable increases in foot strength (up to 62% in four months) without dedicated exercise.
  • Summary: People can choose to focus solely on wearing minimal footwear or on strengthening exercises, but combining both yields the best results. Studies show that switching to minimal footwear naturally provides a workout, leading to substantial strength gains that are comparable to gym training results. Listeners are encouraged to ‘do something’—either change footwear or perform foot exercises.
Assessing Big Toe Dexterity
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(01:23:15)
  • Key Takeaway: The ability to lift the big toe independently while keeping the other four toes down is a key indicator of foot awareness and function, often revealing asymmetry.
  • Summary: The first step in improving foot health is developing awareness of how the foot feels and moves. If the big toe deviates toward the second toe when lifted, it indicates weakness in the muscle that straightens the toe. Asymmetry in this test is common, and the side with poorer dexterity often correlates with where symptoms manifest.
Bunion Origins and Reversibility
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(01:24:46)
  • Key Takeaway: Bunions (Hallux Valgus) appear to be a modern condition linked to footwear, evidenced by increased prevalence in the 14th and 15th centuries coinciding with pointy boots.
  • Summary: While genetic factors like connective tissue laxity exist, lifestyle changes, particularly footwear, are crucial for managing bunion predisposition. For moderate to severe bunions, the goal shifts from complete aesthetic reversal to achieving pain-free function and building a ‘beefier,’ stronger foot structure. The primary goal for existing bunions should be less pain and more function, not just cosmetic change.
Foot Sensory Decline with Age
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(02:03:38)
  • Key Takeaway: By the fifth decade of life (age 50), 20% more pressure is required to stimulate the foot’s sensory receptors, a deficit that increases to 75% by age 80.
  • Summary: Aging causes a natural dulling of the sensory receptors on the soles of the feet, which impacts balance and gait stability. This sensory loss, combined with age-related muscle loss (sarcopenia) in the feet, increases the risk of falls. Movement and walking are the best ways to counteract this decline by increasing circulation and sensory nerve fiber branching.
Walking Speed as a Predictor
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(02:08:46)
  • Key Takeaway: Sustained walking speed, ideally 120 to 130 steps per minute for 30 minutes, is a crucial metric that can predict cognitive decline like dementia up to seven years out.
  • Summary: Researchers proposed that walking speed should be the sixth vital sign due to its predictive power regarding future health issues. A decline in cadence signals potential underlying problems such as muscle weakness, balance loss, or cognitive decline that require investigation. Improving foot strength and mobility through exercises can enhance walking efficiency and speed without consciously trying to walk faster.
Sustained Walking Speed Practice
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(02:11:29)
  • Key Takeaway: Achieving sustained walking speed, potentially guided by a metronome, is necessary for improving whole-body efficiency.
  • Summary: Sustained walking speed is more beneficial than short bursts; patients can use a phone metronome to match every footstep to the beat. Improving gait efficiency can occur over four weeks by consistently performing five minutes of targeted foot exercises daily. This improvement happens passively, without actively trying to walk faster.
Walking as Power Training
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(02:13:06)
  • Key Takeaway: Brisk walking is a form of power training, which is critical because power loss accelerates faster than strength loss with age.
  • Summary: Power training involves moving a load quickly, contrasting with strength training’s slow, heavy loads. An example of power training is descending into a lunge slowly and then shooting up as fast as possible. Walking at a fast clip is an accessible way to train this necessary power component.
Recap and Foot Assessment Review
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(02:14:06)
  • Key Takeaway: Key topics covered include walking’s essential nature, the importance of speed, footwear choice, and specific therapeutic foot assessments.
  • Summary: Walking has been established as essential, on par with sleeping and breathing. Practical advice included specific foot assessments like checking big toe extension, performing calf raises on the second toe, and single-leg balance tests. Listeners were also guided on how to choose better footwear.
Starting Foot Health Journey
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(02:15:25)
  • Key Takeaway: It is never too late to begin improving foot health due to the brain’s capacity for neuroplasticity and learning new stimuli.
  • Summary: The brain welcomes novel stimulus, making it possible to drive new information and change at any age. Beginners can start simply by putting their foot on the ground, while others can progress by walking faster or adding loads. Walking should be viewed as the most accessible, underutilized treatment that the body craves.
Foot Health Kit Contents
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(02:17:00)
  • Key Takeaway: The Gait Happens foot health kit includes toe spacers for active wear and a small ball for sole rolling and big toe range of motion work.
  • Summary: Dr. Conley consistently wears toe spacers throughout the day to promote toe splay, noting initial discomfort fades as tissues adapt. These spacers are designed for active wear while moving, unlike passive stretching devices worn during sleep. The kit also contains a small ball used for rolling the sole of the foot and improving range of motion at the big toe.
Contact and Final Thoughts
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(02:19:12)
  • Key Takeaway: All resources, including the book Walk: Your Life Depends On It and the foot health kit, are available via the online platform Gait Happens.
  • Summary: All content and products are centralized under the name Gait Happens, spelled G-A-I-T. Dr. Chatterjee encourages listeners to apply one takeaway and teach another concept to reinforce learning. Listeners can sign up for the free weekly email, Friday 5, for exclusive health insights.