Footwear, Steps, and the Truth About Walking with Milica McDowell

Dr. Milica McDowell, Associate Vice President of Education at US Physical Therapy, joins the Will Power Podcast live from APTA CSM to break down the science behind walking, one of the most overlooked tools in physical therapy. Guest host Mitch Johnson sits down with McDowell to unpack her new book, "Walk," co-written with foot and gait specialist Dr. Courtney Conley, and backed by over 300 research studies.

McDowell explains where the 10,000-steps myth actually came from (it was never based on science), what step count actually reduces mortality risk, and why walking belongs in the same category as sleep and breathing for the human body. She also covers footwear myths that are hurting patients, why most adults are wearing the wrong shoe size, and how simple "movement snacks" can shift a patient's mood, cognition, and recovery in minutes.

Key takeaways:

• The 10,000-step benchmark came from a 1960s Japanese pedometer marketing campaign, not research.
• A baseline of 3,500 steps per day is linked to a 15% reduction in all-cause mortality compared to 2,500 steps.
• Five-minute "MicroWalks" improve mood and cognitive clarity, especially for patients recovering from surgery.
• Patients on GLP-1 medications are losing muscle along with fat, making weight-bearing activity like walking essential.
• McDowell's stack, switch, and swap framework gives patients a realistic way to add walking without finding extra time.
• Over 60% of adults wear the wrong shoe size, and foot length changes with weight, hormones, and age.
• Heavily cushioned, rigid footwear blunts the sensory feedback the foot sends to the brain, which affects balance and movement patterns.
• Babies are not born with bunions. Bunions develop over time as a footwear and stress-related adaptation.
• Relationship walks (partner walks, "Grandma Walks," and walks with teenage kids) show measurable benefits for communication and mood, especially outdoors.

If you work with patients, coach athletes, or just want a simple way to move more without overhauling your schedule, this one is worth your full attention. 

Grab the book "Walk" by Dr. Milica McDowell and Dr. Courtney Conley, available on Amazon. 

https://www.amazon.com/Walk-Rediscover-Natural-Health-Longevity-One-ebook/dp/B0FPC9X2FG

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Transcript

Live From APTA CSM

SPEAKER_00 0:00

This is the Willpower Podcast, live at the APTA CSM. We're here with physical therapy leaders and practice owners from across the country talking about where the industry is going and what it takes to grow in today's landscape. And today I'm joined by Dr. Melissa McDowell, Associate Vice President of Education at U.S. Physical Therapy, discussing the underrated power of walking and how a simple science-backed movement practice can transform patient outcomes and become an essential tool in every PT clinical toolkit. And it's a very special episode because it's hosted by my best friend, Mitch Johnson. Let's get into it.

SPEAKER_01 0:39

Well, I'm excited to be here. My name is Mitch Johnson. I am the first uh guest host for the Will Power podcast. This is a big deal because Will's been doing this for going on two years. He's gotten the movers and shakers, and now I think we have one of the best interviewees that we've ever had here. My name is Mitch Johnson again. I'm with the stress-free PT Newsletter, and I'm grateful for this opportunity to meet Melissa McDowell. Hello.

SPEAKER_02 1:01

Good morning, Mitch. Thanks for having me, and thanks, Will, for having us on the show.

SPEAKER_01 1:04

Oh, yes. Thank you both. And again, it's so excited to have you here because I read your book and I've always wanted to be able to tell an author that. Like when you meet him face to face, I read your book. I'm so excited. But as a physical therapist, this one got me very excited just because I think it's something that we majorly, majorly overlook as far as the benefits that come from it. And if you can, could you please start off? Tell me a little bit about yourself and how this led you on the path to create this amazing work of art.

Melissa’s PT Story And Why Walk

SPEAKER_02 1:33

Yeah, thanks, Mitch. So Dr. Melissa McDowell, I'm a physical therapist. I currently sit as the Associate Vice President of Education at U.S. Physical Therapy, which is the third largest physical therapy country or company in this country. I think you're familiar. And U.S. Physical Therapy is a business that supports locally owned physical therapy clinics, mostly outpatient. We have 800 locations across the country in 44 states. So my background is as an orthopedic and sports physical therapist. Typically, lower extremity has always been my passion. And I became a physical therapist because I had a foot injury in high school. I was a highly recruited basketball athlete, going to go get that D1 college scholarship. Of course, this is before NIL money. So we were getting paid in Reebok shoes at the time. But at any rate, I had an injury and had to sit out a year of sports. And so with that, I was a patient. And my uh track coach at the time, Coach Mark DeVinny, took me under his wing and rehabilitated my injury. So that took me on the path of becoming a PT. And then I've been practicing for 20 plus years now. And as you mentioned, walking is often overlooked, right? People think of it as how do I carve out enough time to do it? Is it enough bang for my buck? What's the payoff? And so my colleague, Dr. Courtney Conley of Gate Happens, she is a chiropractor, foot and gate specialized person, excellent clinician, owns a company that educates both consumers and medical professionals about foot and gate.

SPEAKER_01 3:01

A lot of energy.

SPEAKER_02 3:02

Yes, amazing amount of energy. And so she asked me, she said, Hey, I want to write a book. I need your help. And that's sort of how the story began.

SPEAKER_01 3:10

Now, one thing I was totally impressed with was the amount of data and research. How, who, how did you come about with this? I mean, I guess the the process of writing this book, could you please just tell us a little

Writing A Science Based Walking Book

SPEAKER_01 3:22

bit about that?

SPEAKER_02 3:22

Yeah. So the process of writing a nonfiction book that's based on science is kind of like writing the biggest research paper of your life. Uh, but you want that story to be approachable. So one of the checks and balances we had as we worked through this process, is your mom gonna understand that chapter? Is your mom gonna understand that paragraph? And so we really were writing with the lay audience in mind, um, saying that this is something a physical therapist could give a patient, the patient would totally understand where to go. And with that, you can't just write a book like that that's prescriptive based on anecdotal conjecture opinion. There are over 300 research studies in this book, properly footnoted, Chicago style, the whole nine yards. So any of you physical therapists out there who've written a research paper and had to do a bibliography, we had 300. And so it was uh times it by yeah, yeah, it was a massive, massive effort. Um, but we really looked at this book as a parallel to the books Why We Sleep or Breath. And if you as a clinician haven't read those books or recommended them to a patient, I'd highly recommend reading both of them. Why We Sleep is by Matthew Walker. It's a phenomenal book about humans are bad at sleeping. Here's all the problems we have because we're not doing a great job. Here's how to fix it. And then Breath is a book by James Nestor. Same premise. We're doing a bad job of breathing. Here's all the diagnoses and diseases we have because of it, and then here's how to fix it. And so, with that, as we approached walk, we really thought about it from the audience of like, what's in it for me? So, what can I learn from this book? And so what we did is we unpacked it in a similar fashion. Humans used to walk a ton, we're walking less. You know, the pandemic was right around the pandemic, it was an all-time low. It did get a little bit of a bump from uh work from home. And then it sort of settled back down to not an ideal amount of walking per day. And so we really approached the book with that standpoint, making it a recipe card for success.

SPEAKER_01 5:18

I love, like you said, you had the data, but then you have amazing stories. You have with the individual patients. Uh we're talking about sea sprouts. Um, one story I love.

Where 10000 Steps Really Came From

SPEAKER_01 5:27

If you could please tell us a story about where 10,000 steps came from.

SPEAKER_02 5:30

Oh, 10,000 steps. So if you ask, quote unquote, the proverbial man on the street, woman on the street, how many steps should you take per day? What do they say, Meg?

SPEAKER_01 5:37

10,000.

SPEAKER_02 5:38

Yeah. And do you know you read the book, so you know where it came from. So I see behind the scenes. Yes. I'll ask the audience do any of you know where that came from? And I'll wait. Because most of you probably don't. No. So 10,000 steps per day is a hangover from the 1960s from a Japanese pedometer marketing campaign. Following the Tokyo Olympics, uh, being physically active became very popular. And Japan was the first uh country to create a pedometer. And it was the kind that like clipped on your belt almost like a pager used to be. If you're old enough for a pager, you know what I'm talking about. And a pedometer used to actually go click, click, click every time you took a step. And those early pedometers only topped out at 10,000. That was the farthest the clicker went, and then it stopped and turned over. And so the Japanese term for it was a 10,000 step meter, and that's where the 10,000 steps A came from.

SPEAKER_01 6:32

And I think that's so important because then you said, I believe what, 3,500 to 8,500 is more of the recommended. So I think a lot of times we hear 10,000 and automatically it's discouraging. It's absolutely I can't get that.

SPEAKER_02 6:42

Absolutely. 10,000 is kind of discouraging. So you think the average person walks about 100 uh steps per minute. That's a pretty normal cadence for casual walk-in. We would characterize brisk walking as between 120 and 130 steps per minute. So if the average person takes 100 steps per minute, in about five minutes you can walk 500 steps. So if you take 10,000 and you divide by 500, you know, you're talking about a lot of time, 90 minutes plus, right? And so 10,000, I think, does discourage people. A lot of the um community health and community uh health promotion market or excuse me, science really indicates that it is discouraging for a lot of people. And so we do talk in this project a lot about step count. And I like to think of it like an a la carte menu at a restaurant. You know, you can have like a side of fries, you could have a baked potato, you could have a side of broccoli. And so the whole idea with the step counts is the same thing. You want to pick and choose what works for you, what benefits you're looking for. And so you are right, 3,500 is a very special number. We like to say that 2,500 is the absolute cement basement. If you're below 2,500, your risks of disease and death are astronomically increased. There's a giant research study with hundreds of thousands of patients, multi-center, multi-year, that tells us if you're at a baseline of a 2,500 and you increase 500, you reduce your risk of all-cause mortality, which means dying of any reason by 7%. If you go up to 3,500, so increasing a thousand steps per day, you reduce that all-cause mortality by 15%. That's humongous. Humongous. And when we think about if you take 500 steps in five minutes, 3,500 being what we recommend as the gutter basement, um, you know, do the math, right?

SPEAKER_01 8:28

The other thing I really liked is that you explained it doesn't take much to increase. You don't have to go from 1500 to 85. It's there's a nice sequential progression that you can follow. Yes. How we're not overwhelming ourselves.

SPEAKER_02 8:40

Yeah.

SPEAKER_01 8:41

Oh diving into the book, what was something that you that surprised you the most, I guess, with your research?

SPEAKER_02 8:47

Where to begin? Uh writing a book is like being pregnant.

SPEAKER_01 8:52

Oh, it's okay.

SPEAKER_02 8:53

You have this, are you familiar?

SPEAKER_01 8:55

No, not at all.

SPEAKER_02 8:56

You have this progression. I know people, and you're waiting for this thing to happen, and you're waiting over a long period of time. So we got our agent in March of 2024, we got our deal in May of 2024, and we turned in our book in August of 2025. So it was uh essentially a year and a half. When you turn in the book, then you have about six months of editing. And so our book is launching in the May of 2026. So call it a good, you know, two-year-long pregnancy, if you will. The thing that surprised me the most was how to actually do it. So my co-author, Dr. Courtney Conley and I, we have both written chapters and books, tons of articles, education courses, more blogs than I can even think about. I'd never written something of this size and scale. A typical book that's 200 to 250 pages is about 80,000 words, which is 300 word doc or Google Doc pages. It's a massive making. And so what surprised me the most was you know that adage you don't eat at once, you eat it bite by bite. So we had to eat the elephant bite by bite, and we had to really come up with a process of how do you get all this information out of our heads and onto paper and then reviewed and revised in a way that people are gonna want to pick the thing up and look. So that was the most surprising part. I I think I'd minimized how big of a project it would be.

SPEAKER_01 10:24

I actually have written a book myself, a novel about college buddies that took on zombies. It's on Amazon. It's no big deal. Really? Yes, it's on tell me more. Not right now, I'll tell you more later. I'll get you a copy. But there is tons of work. There's a lot of work to it. And uh I I didn't have to do research, so that's huge as well. But speaking of the research, what are the takeaways for clinicians out there that are listening? Um first of all, you can touch on all the aspects that it helps in the individual that walks, and then parameters, um, those types of things.

Micro Walks For Mood And Clarity

SPEAKER_02 10:57

So I would say if you're trying to educate a patient and not overwhelm them with information, walking can help with mood and cognitive clarity. That's a that's a big one. Um the micro walks, those five-minute, five hundred-step walks, they were included in a research study related to interrupted sitting. And so the researchers looked at if we interrupt people who sit at work and they go for a baby walk or they do squats, what happens to them? And one of the biggest takeaways from that study was just the cognitive clarity mood and sort of mental benefits that were immediate from that interruption. And we know that that has a lot to do with cerebral blood flow. We know it has to do with hormonal changes, we know it has to do with changing the physical position um for your blood pressure. And so I think that that is something that can just be really simple, especially for a physical therapy community. As I said, I'm an orthopedic sports PT. I would say in my career, 70% of my patients are post-op, right? So they feel like crap, they're on all sorts of drugs, they're bummed out. And even just getting people like to take a lap around the house can really make that shift from the mental health and um cognitive side. So I would say that's one of my really big takeaways. Um, the second would be the conversation about bony health and muscular, musculoskeletal um support. And when we think about the number of people on GLP1 drugs, all the drugs that are causing dramatic weight loss, those folks aren't just losing fat, they're losing muscle as well. And so I do think that it is absolutely a um call to action for our profession that when we're working with patients who are taking those types of drugs, um, we absolutely must be recommending weight bearing activity. And walking is the simplest way to do that. Some people can't do a squat, they can't do a lunge, they are scared of lifting weights, whatever it may be. This is the absolute entry-level, super inclusive conversation for folks that are on those types of medications. So I would say if we're going to distill down two really small bites of the message, it's the mental health benefits. And then if we've got patients that are using that type of um medication, that we really need to be advocating walking.

SPEAKER_01 13:01

Along with that, too, you touched upon athletes and how we, as athletes, may overlook walking and replace it with the uh spinning and the high-level stuff and how walking, because of what it does, is so important. Uh, can you touch on that a little bit when we look at our higher level patients uh that um basketball players coming back from an ACL repair or reconstruction or whatever that is?

SPEAKER_02 13:21

Yeah, I think that when we consider athletes, and they're so heavily scheduled, whether they're high school, college, all the way up to pros, walking becomes something that your body we need to reframe it. Your body physiologically needs to walk just like it needs to sleep and just like it needs to breathe. And when we put walking into that same echelon as breathing and sleeping, as critical to our function and our homeostasis, you position that with an athlete like, look, you've gotta recover. You're doing all this work in the weight room, you're doing all this work with your teammates, you're doing all this work individually, you've gotta have some downtime. But that downtime is not Netflix and chill, it's not horizontal on your couch, it's not playing, you know, Call of Duty. If you're going to be as optimized as possible as an athlete, regardless of that level they're competing at, this can be something that gets woven into recovery day from a physiological recovery standpoint and that cognitive recovery standpoint.

SPEAKER_01 14:18

That's huge. Could you talk? So I'm sure a lot of people are listening right now. I know I need to do this, but how can I? I don't have time. I got this, this, this, and this, and then I have to do this and this and this. How do we get that in?

SPEAKER_02 14:27

Yeah.

Making Time With Stack Switch Squeeze

SPEAKER_02 14:28

So my co-author and I are both moms, we're both business owners, we're both practicing. Like we're in the same boat, right? We're busy. I trained for a 50K a year ago. I mean, we've just got a lot on our plate. And I finished, which was great. Very nice. Uninjured, which was with a goal, absolutely. There was no time goal. It was get across the finish line without an injury. Um, but with that, you know, we're we live that, right? And so we have an entire chapter that's dedicated to time. Because I think the biggest pushback we get when we start talking to patients or just, you know, general consumers about starting a walking program. I have pain. What do I do? What shoes do I wear? How do I carve out the time? And so we dedicated an entire chapter. Adam Grant is one of our endorsers of this project project, right? One of the most like incredible scientists who talks about optimizing, carving out time, prioritization, right? So we really leaned into a lot of cognitive behavioral theory, we leaned into reality, we leaned into leveraging technology. How do you carve out the time? And what we came up with was this really fun framework, which is is there an you take a time inventory? So, and you, and given, you know, most of us are over 25, you kind of need to do that real time because I can't tell you what I ate for breakfast yesterday. Um, but what you do is you take a time inventory and you say, all right, in 30-minute increments, this is what I do today. I got up, I had a podcast, I have another podcast, and I'm going, you know, we're at a trade show right now at a the American College of Sports Medicines uh no wait, we're at the APTA conference, we're at the American Physical Therapy Conferences, yeah, CSM meeting, and I've got a lot to do today, right? So if I listed out what I was doing today, it would be pretty complicated. But could I go in and look at that calendar and say, is there an activity I could swap for a walk? Am I gonna go do something mindless, like scroll through social media or, you know, do something that doesn't necessarily serve me, it doesn't move the ball forward. Could I swap that activity for a walk? Could I stack an activity with a walk? So I've really started advocating walk and talk meetings. So instead of sitting behind your computer on Zoom, you know, are you having a conversation that isn't confidential to where you could do it walking with your AirPods in, right? And your colleague could do that too. And the two of you can get some movement stacking walk on top of that activity. Um, we also have the concept of squeeze. So any parents out there, those of you who are busy, those of you who are dropping somebody off at soccer and sitting in the car for 10 minutes, could you take a five-minute walk in that window? You certainly can squeeze it in. Um, and so those are really some of the strategies we've talked about with time. And we've gotten incredible feedback because those are frameworks that Courtney and I have always both used in our practices as we're trying to encourage people to do their home exercise programs or work on their breathing exercises or mobilize their cervical spine or whatever it may be. And so the stack, the switch, and the swap have been uh really positive frameworks that we've created. Stack, switch is swap.

SPEAKER_01 17:18

One thing I'll add to that, I love one of the studies uh regarding a mom walking with her daughter. My I texted, I took a picture of that and sent it to my wife because she just started walking with our 16-year-old daughter. So this is a very impressionable time. Real time. Real time. And just the she had seen the benefits, like you said, in the study where they were able to have more heart-to-hearts and to help the relationship, help this daughter that's in those fun teenage years, and it's gone a long way.

SPEAKER_02 17:43

Yeah,

Relationship Walks That Improve Connection

SPEAKER_02 17:44

there's there's three types of what we call relationship walks that we highlight in the book. One is with your partner. Take that spouse, go for a walk. Um, there's great data that talks about improving communication, clarity, empathy, understanding. Uh, we have one that's called the grandma walk, which is taking an elder for a walk, which has so many wonderful benefits of sharing intergenerational support, um, helping individuals who may be widowed or widowers, living alone, maybe have gotten a little bit isolated. There's phenomenal data that talks about um really supporting our elder community. And then, yes, we call it the Krabby Teenage Daughter Walk. And so uh Dr. Conley and I both have daughters. Mine has graduated from her teenage years, but Dr. Conley's lovely, beautiful daughter is a freshman in high school right now. And as we know, those are some, those are can be some trying times. And so what was interesting about that study you're referencing is they had moms and daughters do an outdoor walk, an indoor walk, like a treadmill walk, and then nothing. And what was very exciting about it is the outdoor walk actually produced the best outcomes from understanding, empathy, communication, um, and an enhanced mood. So it has a lot of other parts to play in it of being outdoors and being in nature and getting vitamin D and sunlight and everything else. So yeah, I I'm glad that that's working in your family.

SPEAKER_01 19:02

Very much so. So thank you. You told us it before we even knew it, in a way. But um, if we can touch on one more thing, I think is really important. So we

Progression After Injury Plus Shoe Fit

SPEAKER_01 19:11

the one thing I really loved um with both you and Dr. Conley is talking about how to progress our people. Because, first of all, uh, you're talking about people that had were active and something happened where they were injured, they couldn't do certain things, and so major depression, anxiety set in. So it was this nice progression of okay, you don't have to go back and walk your 10,000 steps, whatever. Let's start with this building up. And then if you can also transition that into footwork, because that blew my mind. Um, I guess the one thing I want to go for sure is was it one-third or two-thirds of kids' shoes do not fit them right?

SPEAKER_02 19:42

Yes. Yeah, those statistics are kind of scary. Let's hit on that first. So it's over 60% of adults are wearing the wrong size shoe. So that's a study from 2018 that is utterly shocking to adults, right? And especially like for those of us who are clinicians and sort of think we're doing the right things, you know, and we have a lot of knowledge about the body. And so, do you know the name of the device that they use to measure your feet in a foot foot store?

SPEAKER_01 20:08

Oh measuring device that tells you.

SPEAKER_02 20:12

It's called a Brannock device. It was uh made in the United States in New York a hundred years ago. It has not changed size, shape, or conformation in a hundred years. That is the gold standard for foot measuring. Uh low-tech, of course, you could have some sort of a scam, but 60% of us are wearing the wrong length of shoe. You have any guesses why that is?

SPEAKER_01 20:32

Well, actually, one thing I've experienced, my foot has gotten bigger over time.

SPEAKER_02 20:37

Why do you think it is? Why is it bigger?

SPEAKER_01 20:38

Uh, because I there's a uh episode in my life where I put on some weight and that weight probably squashed me down. And then just uh general wear and tear, things probably expand and stretch out a little bit.

SPEAKER_02 20:48

Yep. Those are um weight gain, weight loss are definitely two factors. Hormonal changers are a factor in your foot length changing. If you increase or decrease muscle tone. So the hypertrophy, so muscle growth or atrophy, muscle shrinkage in the bones and the internal parts of your foot, for those clinicians, we're talking intrinsics, that sort of thing, that changes your foot volume, which also impacts your length. And so, yeah, 60% of adults are typically wearing the wrong size shoe. Best practice there, clinicians who are listening, please tell your patients to get their foot measured in a shoe store at least once a year. And if someone has recently had injury surgery, giant weight loss, again, back to the GLP one, GLP ones, right? A Zempek and those sorts of drugs. Um, you know, if people are having significant weight changes, again, another opportunity to educate them about foot length. And so uh you could also buy a Brannock device, they sell them on Amazon, they're like a hundred bucks. Might be a nice thing to have in the clinic to provide that education and help direct them in the right uh shoe length. Um and with kids, yeah, we were actually uh Courtney and I were on another podcast this morning and we were talking. Uh, our host is about to have a baby this year, and he said, All right, I don't want to, I wanna do best practices as soon as possible. And uh one of our favorite sort of uh sound Bites from the book is babies aren't born with bunions. Um, and there's a whole story in there. And clinicians, I'm sure you guys get asked this all the time, you know, oh, I have this bunion, my grandma had one, my mom had one, it's genetic, it's uh, you know, due to my ethnicity, it's due to this, it's due to that. No, yeah, no baby has a bunion. So bunions are an adaptation. Some of us could be a touch more prone biomechanically, structurally, yes. Sure. Generally speaking, it is a stress and footwear-related adaptation. Um, you can drive some people back from that, and some people do need to have orthopedic intervention. But with that, as we talk about kids, um, there are some significant times when we see vertical growth and uh weight growth, and that's typically when foot size is changing. So if you are an orthopedic PT, generally treat an adult population, it's just good information to relate to the parents who come in and out of your office that if your kid has grown in height, their foot has probably changed. Um, if your kid is put on five or ten pounds, their foot has probably changed. Wow. There are some significant markers, you know, that um most babies are walking, you know, a year-ish to a year and a half is kind of a typical uh pediatric milestone right now. So really making sure at two we have a clear measurement, at three at four. So thinking about measuring on their birthday. But if they're having significant gross spurks, a six-month measurement is not a bad idea. Um and from a footwear perspective for kiddos, the more flexible the better. Um, there's some really interesting research studies right now that have video of babies crawling in stiff shoes versus flexible shoes. Um, and if you imagine being in like a Nike high top versus barefoot, you aren't gonna be able to go into as much planner flexion. And so it messes with their crawling mechanics if they're in cowboy boots or cute little Nike dunks or whatever, which they're cute. Are cute, but are not good for a lot of those functional myostats. Yeah. So barefoot's best as long as you can keep them uh in a safe environment and then flexible shoes for little kiddos um as long

Footwear Myths Cushioning Pronation Minimal Transition

SPEAKER_02 23:56

as possible.

SPEAKER_01 23:56

And then with adults, you you acknowledge that you stepped into a little controversial area with footwear. Um if you can just give us a quick summation of what to look for, because that kind of blew my mind, some of the things that we see just with general footwear everywhere.

SPEAKER_02 24:11

Yeah, it is tough. And you know, as we're sitting at a national convention with thousands and thousands of physical therapists and physical therapist students, um, I have to shun my eyes from some of the things I see walking by us.

SPEAKER_01 24:24

High heels, come on.

SPEAKER_02 24:25

There, yeah, there are definitely some sins going on here, if we can call it that. I see some high heels, I see stiletto, I see pointy toe boxes, I see rigid.

SPEAKER_01 24:33

I mean, look at that uh heel to toe drop, am I right?

SPEAKER_02 24:36

Right. I mean, come on up. Uh excessive cushion, excessive stability features. So here's what's challenging, Mitch. Um, guess who has the biggest marketing budgets?

SPEAKER_01 24:48

The big shoe.

SPEAKER_02 24:49

Companies who are putting out, we call them the big shoe, big shoes, right? It's like big food, big pharma. And the marketing budgets um and the places that they have stores, you know, you'll see some of the big cushion players in an airport. You can go through a major international airport. There will be, and I will not name names, but you guys all know who we're talking about, um, major but next to the Louis Vuitton store in London Heathrow, you will find footwear that is heavily cushioned. And what was challenging about the footwear chapter is this most of us come from a traditional footwear background. So we're wearing running shoes that have cushioned, you know. Think of all the brands that have that Nike, Audi, Brooks, Hoka, Awn. Everybody is in this sort of race to be more pillowy, more cushioned, you know, bigger, you know, heel-to-toe, drop, rocker, all of these features that can be construed as creating um different types of performance benefit potentially. However, when you take um a person and you take their foot and you put three-quarters of an inch of cushion between the surface they're standing on and their foot, that information is getting dampened to their brain. Your foot has, and most of you guys on this uh listening to this probably know, you know, we have hundreds of thousands of receptors in the bottom of our feet. They're one of our areas of the body that gathers information, pressure, temperature, rough, um, fuzzy, soft, like we have so many different types of receptors in the bottom of our feet, and they're feeding that information to the brain, right? And the brain interprets it and it the brain acts upon it. So if we're blunting that information to the brain, things can go awry, right? And if someone is using heavily cushioned footwear year over year over year over year, not spending much time letting those receptors interact with the ground, get the information to the brain without that blunting, things change, right? Our our neuroperception, our neuromuscular activation changes. And it's its own little pandemic. I mean, I'm gonna call a spade a spade, and uh this is an unpopular opinion and ruffles some feathers every time I see it. But we definitely have um a misunderstanding of time and place of cushioned shoes. And when we see individuals wearing cushioned shoes all day long, and then some of them go home and put on an indoor pair of cushioned shoes, all we're doing is contributing to problems. So we talk about cushioned footwear in the book. We also talk about uh stability features and excessive rigidity in shoes. And again, this sort of pandemic of over-engineering of footwear is simply disallowing our foot to act in its best biomechanical patterns. So if you are someone who's wearing a pronation control shoe because somehow you think pronation is not good for you, DM me on Instagram and let's have a conversation. Uh, because if we go back to any biomechanical, uh, you know, science-based biomechanical education, we need pronation because we need to get the big toe to the ground. We need to be able to roll the tibia over the ankle. Um and so pronation is normal and pronation helps us, and the sort of demonization of pronation in the last 15 years um has really become a part of the misinformation we're trying to break down in the book.

SPEAKER_01 28:10

Which is big. Like you said, you're going against the big boys.

SPEAKER_02 28:13

We are. You know, there are a lot of footwear companies who create non-traditional footwear. So when I talk about traditional shoes, I'm talking about, you know, anybody that has a lot of cushion, a high heel-to-toe drop, maybe more rigid features in the shoe. Yeah. Um, typically also a tapered toe box. And when we start talking about the different categories of footwear that we recommend, there is the category of functional shoes and the category of minimal shoes. And there needs to be a progression if you are going from a traditional footwear to a functional footwear to a minimal footwear. Because what happens if you jump? What happens if you go from traditional to minimal?

SPEAKER_01 28:50

That's gotta kill the foot. It's so weak. Right. Intrinsics are down to nothing.

SPEAKER_02 28:53

Absolutely. And you don't have the tolerance built up, right? So if I'm asking you to go from a Hoka to a brand like a Zero or a Vivo, which are minimal shoes, minimal cushions, super flexible, what's gonna happen? Heel pain, Achilles pain.

SPEAKER_01 29:08

Talk about that in your book.

SPEAKER_02 29:09

Absolutely. There's all sorts of things that your tissue just isn't ready for. And in to use an example that's really familiar to those of us in the rehab community, would you give somebody a 37-pound dumbbell to do a bicep curl with? No. You start them with a 10, a 12, a 20, you know, and and work their way up to that heavier weight. And so the same idea is true here. Like we're we're looking at progression from traditional to functional to that, we have a few brands that we definitely recommend in the book. Um, and we make those recommendations based on foot health. Does it have a wide toe box? We tend to say that's a non-negotiable. And so for those of you who are treating a back pain population, a hip pain population, a total joint population, a foot pain population, if you have individuals with orthopedic issues and they're in a tapered toe box, that's super low-hanging fruit you can help advise them. The second feature is is the sole flexible? Twist the shoe kind of like you're wringing out a wet towel. Um, that's a more advanced feature. And then the feature that's sort of in the middle is going to be less heel-to-toe drop. Trying to bring the foot to a more even plane to optimize our ability to go through great toe extension and propulsion.

SPEAKER_01 30:19

Thank you.

SPEAKER_02 30:20

Yeah.

What The Book Project Changed

SPEAKER_01 30:21

Um, I want to take a quick left turn to finish up here.

SPEAKER_02 30:23

Okay, let's do it. Okay, so zombies and college friends.

SPEAKER_01 30:26

Oh, you wish. Uh with the uh thank you for bringing that up. I'll talk more about that later, everybody. Uh looking at stress-free PT Nation, what we're trying to do is help reduce stress, burnout in our physical therapists that do so much.

SPEAKER_02 30:39

So much.

SPEAKER_01 30:40

One thing I've endorsed is doing hard things.

SPEAKER_02 30:42

Yeah.

SPEAKER_01 30:42

Doing things that aim us towards our passion that are hard. And it's like we talked about just with walking, the knee reaction is I don't have time for this. Well, you're not, you're not facing those things that you love doing. What did this passion project, what did this project do for you personally?

SPEAKER_02 30:58

Gosh. Writing a book with your best friend is a uh it's a journey because you have to, Courtney is an incredible expert. She flies around on she gets flown around by professional teams. She could, she can't tell you, but of the A-list celebrities who have foot and ankle pain, uh, many of them are her clients. I know. So she she's a she's an international expert, and she's one of my dearest personal friends and a very respected colleague. And so for me, this was a huge undertaking. And it was also a place where I learned a ton of new skills. Because when you're working with somebody who is an absolute like tip of the spear expert, this is her like 20-year life's work, right? She's been talking about getting people out of orthotics. She's been talking about avoiding surgery, she's been talking about wide toe boxes for 20 years. And because this is such an interwoven part of her fabric, being the second author in a project that has this magnitude and potentially this type of impact was definitely challenging because Courtney wanted to write, and Courtney, I love you if you're listening to this. Uh, she wanted to write an entire chapter, chapter, 7,000 words on evolution. And we did it. We wrote an 8,000-word chapter on evolution, and we talked about all of the ancestors who have had these different progressions to get us to where we are primarily bipedal, we have a wider pelvis, we've got forward-facing kneecaps, we've got you know tendon attachments of the feet, we've got all this leverage that we've created over, you know, these years and years, mil four million years of adaptation. We talked about every ancestor, all the findings. Yeah, guess what happened? The editor came in and went and gave this haircut. And they're nice, are probably like four or five pages about evolution. And so the what I really learned was being a great collaborator, also being a voice of reason. Um, we always had that check and balance. Our mom's gonna understand what we're writing right now, is the accountant, the second grade teacher, the the painter who's our patient. Do they are they gonna be able to go through this book without us having to help them? Um, and so I really learned a great um, a lot of partnership and communication skills. I also learned that she and I have very different skills. So, as you said, we have 300 research articles in there. That was a Melissa job, and I loved it. I'm a spreadsheet gal. I was like, you give, give those to me. I will get them organized, I will get them all dialed in, we'll make a strength. Yeah, it was one of my strengths. Um, I wasn't going to write the chapter or the sections on evolution. That's not my passion, that's not my background knowledge. And so I really learned very technical collaboration and project management skills that I never would have had before we did this. Um, and I also learned a lot of empathy and a lot of um really just like taking time to listen, especially with the parts that she wanted to emphasize. Um, because the challenge became we could have written two books, three books. There's a lot of information out there. Um, and that for me was a really great learning moment at this stage of my career. You know, I've been a PT for over 20 years, I've gone to practice, I've had a bunch of emergent acquisitions, I'm now working for a giant corporate entity, which is an amazing opportunity. So I really picked up some new skills I wasn't expecting. Um, and I got a deeper appreciation for how foot health impacts your overall health. Because as you know, and all the therapists who are listening, and anybody who's maybe even not a therapist who's had foot pain who's listening, because one in three adults have foot pain in the US, um, it impacts every aspect of your life. You can have a broken arm and still function. If you have a bunion or you've got heel pain or plantar fasciopathy or an Achilles injury, it impacts walking to the bathroom. You can walk to the bathroom with a broken arm, right?

SPEAKER_01 34:46

Well, you even talked about the research shows like low back pain. It's very good for low back pain. I know that's the general inclination of our patients. Oh, I have back pain, I can't get up and move. No, actually, it decreases pain.

SPEAKER_02 34:57

Yep. Yep. And one of the maybe parting comments that could be really valuable for the therapist listening, um, we have a lot of we have movement snacks throughout the book. And the movement snacks are really designed to be sort of this like self-care journey of learning these little bits and pieces that you can take away and practice. Yeah. There's some breathing exercises, there's mobility, there's stability, there's strength, there's awareness. And so with that, I think we really have created, it's almost like a cookbook, right? Where you can go in and be like, oh, I want to make a salad today. Okay, great. I'm gonna go to the salad recipes. If you're somebody who's got pain, if you've got, you know, as time is your challenge, if finding someone to go do it with is your challenge, we've really tried to hit on these elements in this book to make it so there's really something in it to help everyone walk a little bit more.

SPEAKER_01 35:46

Exactly. Thank you. Okay, last two questions. Are you

Favorite Walks And Final Recommendations

SPEAKER_01 35:49

ready for this? Speed round. When I think about this first question, my family, we went to the east coast of Maine for vacation. Beautiful. Best walk I've ever had. We walked along the shore amongst the houses. It was this walkway. It was beautiful. Tell me first your uh that's not being number one, but your one of your top favorite walks.

SPEAKER_02 36:07

Favorite walks. So my family lives in Maui, and there is a beautiful walk along the west coast of Maui that I do most every morning when I'm there. And it allows you to see the Haleakala crater, you can see the island of Luna'i, you can see the West Maui Mountains. And it is, if you've never been to Maui or Hawaii in general, it is like something out of a fairy tale movie. So that's one of my favorite walks. Walking in Maui by my parents' house.

SPEAKER_01 36:31

Okay, great. Number two, if you could walk with anyone, alive or dead, take a walk with them, have that talk, who would it be?

SPEAKER_02 36:38

Uh, it's between Michelle Obama and Snoop Dogg. Um, let's see. I'm gonna have them both. I'm gonna pick Michelle Obama because I'm getting a lot of Snoop Dogg right now because the Olympics are happening currently. Um I would love to go for a walk with Michelle Obama. I love her advocacy work. I love how she promoted health when she was the first lady. She is a glamorous babe. I would love to hear some of the stories about raising her girls and her relationship with Barack. So, Michelle Obama for the win.

SPEAKER_01 37:01

Yeah, there's gotta be some crazy stories there. Well, thank you very much for meeting with us today. Again, we have Melissa McDowell with Walk. Get this book. It is amazing. It'll change your life personally. It's great for your patients. Just again, things I never knew and overlooked that are just so beneficial that change our mindset or health. So thank you very much. Thank you very much. You can find it on Amazon. There we go.