Click on NOTE CATEGORIES to browse by topic, read through the entire archives, or type a topic in the search box.Biomechanist Katy Bowman and biologist Jeannette Loram discuss Matters of the Heart. They cover the anatomy, tissues, and function of the cardiovascular system, highlighting key concepts of heart health that are underappreciated. They discuss the importance of the flexibility of red blood cells, arterial walls, and the heart muscle itself. They also explain the vital role of skeletal muscle contraction in healthy circulation. Muscle contraction during exercise not only assists the return of blood to the heart from the extremities, it is also the signal for blood vessels near working muscles to dilate or widen ‘pulling’ blood from arteries into the tissues.
Katy and Jeannette talk about a movement diet to support the cardiovascular system. They emphasize the importance of higher intensity activity for taking the heart and arteries through their full ranges of motion. Their discussion also offers up a much larger buffet of exercise options than you might have previously considered. Strength training, big body work, and stress-reducing movement all have complementary benefits for the cardiovascular system.
Also in this episode Katy interviews podiatrist Dr Ray McClanahan, founder of Correct Toes and one of our podcast sponsors. Correct Toes are a toe orthotic designed to return toes to their natural alignment as the widest part of the foot. Ray explains the functional benefits of aligned toes, including improved balance, circulation and strength. Katy and Ray chat about how and why Correct Toes came about and they also discuss the future, with an introduction to some of Correct Toes latest products.
Venn Design | Correct Toes | Movemate | Wildling | Peluva | Smart Playrooms
OVERVIEW
(time codes are approximate)
00:03:25 - How has the heart shown up in life recently? (Jump to section)
00:06:20 - The Dynamic Collective (Jump to section)
00:07:30 - Anatomy (Jump to section)
00:22:15 - Let’s talk about movement (Jump to section)
00:31:25 - The arteries and calf hearts (Jump to section)
00:43:25 - Glycogen, stress, strength training, and the movement buffet (Jump to section)
00:47:10 - Listener question sponsored by Smart Playrooms (Jump to section)
00:56:30 - Interview with Dr. Ray McClanahan of CorrectToes.com (Jump to section)
LINKS AND RESOURCES MENTIONED IN THE SHOW
Male vs Female Heart Attack Symptoms
The heart as a spiral in structure
Red Blood Cell Stiffness in Type Two Diabetes Mellitus
Effect of Exercise on Arterial Stiffness
Vasodilation and haemodynamics excerpt from Move Your DNA
Vasodilation induced by compression of contracting skeletal muscle
Episode #168 - Is Sitting Aging You Faster
Episode #172 - Is Standing the New Smoking
Calf Hearts in Rethink Your Position
Episode #139 - With Ray McClanahan
Podiatry practice of Ray McClanahan
Correct Toes influence on balance - summary
The Impact of a Foot-Toe Orthosis on Dynamic Balance
Correct Toes influence on balance- full study
Correct Toes influence on circulation
Simple Steps to Foot Pain Relief
Why Shoes Make Normal Gait Impossible
SPONSORS: THE DYNAMIC COLLECTIVE
This episode of The Move Your DNA podcast is brought to you by The Dynamic Collective, a group of six companies that create products and services helping you to move more. The Dynamic Collective is:
Correct Toes: Anatomic silicone toe spacers and other foot rehabilitation tools. Correct Toes are offering our listeners a $5 discount on all purchases with the code myd-toes5 valid until April 2025
Smart Playrooms: Design and products for active living indoors. Smart Playrooms is offering our listeners a 10% discount on monkey bars, rock wall panels, and rock wall holds with the code DNA10 valid until April 2025
Peluva: Five-toe minimalist shoes that are functional and stylish. Peluva are offering our listeners 15% off their purchase with the code NUTRITIOUSMOVEMENT valid until April 2025
Wildling: Minimal footwear handmade from natural materials for toddlers, kids, and adults. Wildling is offering our listeners free shipping on all purchases until April 2025 with the code KATYWILDLINGS
Movemate: World's first dynamic active standing board designed to make movement a natural part of your workday, without disrupting your workflow!
Venn Design: Functional furniture for a balanced life - sit still less and move more
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 my favorite "get my heart pumping" exercise is running stairs. And I'm Jeannette Loram, biologist, movement teacher, and I love swim training and also steep hills to get my heart moving. Every body is welcome here. Let's get started.
(Music fade)
KATY: Ok. Today we're going to talk about matters of the heart. Happy February.
JEANNETTE: Yeah, indeed.
KATY: In England is February also a heart-healthy awareness, cardiovascular function month like it is here in the United States?
JEANNETTE: That's an interesting question. I haven't noticed it specifically, but I bet on social media that time is used. But I would say I haven't noticed it really being a big thing.
KATY: It was a big thing even before social media here. I definitely think it was maybe an American Heart Association thing.
JEANNETTE: Interesting.
KATY: We're big on months - hallmarks.
JEANNETTE: I've noticed that.
KATY: We're sort of a hallmark country. Celebrate things and dates in that way. But I do think cardiovascular awareness is very important. And I want to drop a little line, too, that I found really helpful which is that those classic heart attack symptoms that are listed are different in men than they are in women.
JEANNETTE: That's right. Yes.
KATY: And I just wanted to drop that in. We're not going to be talking any more about that. We're definitely going to get into the mechanics of the cardiovascular system. But just to let everybody know out there - go look up the difference in symptoms so you're not caught unawares. And women will be more often caught unaware because they might not interpret the early sign2 of a heart attack because they aren't those classic symptoms always. Sometimes they are. But they seem to have different symptoms.
JEANNETTE: Yeah. That's very good advice.
KATY: All right. So that's the end of the podcast episode. Thanks everybody. And also, I am interviewing Dr. Ray McClanahan. He is the founder of Correct Toes which is one of our Dynamic Collective. And the thing that I like about the Dynamic Collective versus just having straight up advertising on this show is these are companies that I've known for a really long time. And I know some of their backstory but I think it's really helpful to understand how people come to create things. What leads you down the path of what seems to be pretty tricky, as far as I'm concerned, which is creating a product and bringing a product to marketplace. That's not my skill set.
JEANNETTE: No. Mine neither. And it's always interesting because there must be some kind of personal story behind why it was this product at this time.
KATY: And probably for all of us.
KATY: All right. So how has the heart shown up in your life recently - cardiovascular system?
JEANNETTE: Well this is an interesting one. Last Monday, so a week ago today or 7 days ago, my eldest son fractured his tibia.
KATY: Oh!
JEANNETTE: Yeah, doing a flying side tackle in football - soccer. And unsurprisingly he went off. He has now a very large cast, mid-thigh to just below the toes. A full leg cast to prevent any rotation about the knee. But the interesting thing for me was that he also came back - his dad had taken him while I was looking after everyone else - he came back with a set of 35 days worth of anticoagulant medicine that I was to inject into his abdomen daily. And that's because with a cast that's immobilizing the leg for at least 4 weeks in his case, there is a risk of DVT: deep vein thrombosis or even pulmonary embolism if that clot shifted. So that's a really great way to illustrate how the health of your cardiovascular system is really intimately connected with movement. Particularly of your lower legs.
KATY: And we know that, right? If you've taken a flight.
JEANNETTE: Yes.
KATY: Right there in your manual often times, they really don't have inflight magazines anymore but for the ones when they did, they would often have sections about mobilizing your feet, and your ankles, and your legs while you're sitting there because there's a direct risk between the movement of the lower, I'll say the lower body. I think that when we think of it, it's often calves. But it's really the whole leg.
JEANNETTE: Yeah. And even pelvis.
KATY: We have to keep those parts moving. So it's a bit of, I want to call it hyperbole or an outlier. When you look at a condition like immobilizing your leg because of a cast. But many people move to the same degree that someone in a cast would move.
JEANNETTE: Indeed.
KATY: Just out of habit. They don't have that physical structure preventing them but they've got more of a structure of habit. When I think of the heart, I'm always thinking about movement. And my intention with this episode is to really have people reframe their understanding of how the cardiovascular system works to show how it is very much dependent on movement and mobility. It's not that different than your hip joint. You can think of your heart and your lungs in the same way that you can think of your hip joint when it comes to movement. That's what I'd like to call out today.
KATY: But before we get started I want to thank our Dynamic Collective. The Dynamic Collective are a group of companies that make wonderful products helping you move more and they support this podcast. The Dynamic Collective is Movemate: dynamic active standing boards that invite movement and play into your work day without disrupting your work flow. Smart Playrooms: design and products to keep your kids engaged and active at home. And it doesn't have to be kids.
JEANNETTE: No.
KATY: You know what I mean. If you've got a monkey bar hanging around there's nothing that says that it's only for kids. They can carry adult weight. Correct Toes: soft silicone toe spacers that can be worn barefoot or in shoes. Wildling: minimal footwear for kids and adults made from natural materials. Venn Design: beautiful floor cushions and ball seats that keep you moving at home or at the office. And Peluva: 5-toe minimalist sport shoes ideal for higher impact activities. And now to the heart.
JEANNETTE: Ok. So where do we want to start?
JEANNETTE: Yeah, let's do that.
KATY: It paints the picture.
JEANNETTE: So the heart. I always think traditionally you just put three things in the cardiovascular system. You put heart, blood vessels, and the blood itself.
KATY: Which is a connective tissue, everybody.
JEANNETTE: Right.
KATY: I don't think people file it that way but when we talk about connective tissue, blood is in there.
JEANNETTE: It's interesting isn't it? Because we just think about this as fluid. So the heart actually looks nothing like ...
KATY: Valentine's day heart.
JEANNETTE: ...the emoji heart. It's much more like, I would say, an upside-down pear. It has these four chambers. Two atria which receive blood from the body and from the lungs, and then you've got two ventricles that take the blood away to the lungs or to the body. But the heart is actually very cool. You had sent me this most amazing video of someone with ... I don't know if it was a model or if it was a dissected out...
KATY: I think it was an actual heart.
JEANNETTE: So the heart actually is a spiral in structure. And part of its mechanism when it beats is a twist. But it twists one way at the apex and one way at the base. I'm sorry, the opposite way at the base. So you've got this wringing action, like wringing out a sponge.
KATY: And let's link to that video in the show notes.
JEANNETTE: We will.
KATY: If you're intrigued, I mean...
JEANNETTE: It's amazing.
KATY: Listening to people describe things, we're doing things with our hands right now. Just go see the video.
JEANNETTE: Yeah. And the key thing with that wringing action is that it enables the heart to expel much more blood on contraction than if it was just based on the length of the muscle fibers contracting. Which is, I think, why a bit of damage can make such a difference to heart function. Because you've got this very complex action going on.
KATY: And I just want to jump in and say that the heart is a muscle. It's cardio muscle. Which is different than skeletal muscle. But it is still contractile tissue.
JEANNETTE: And it's more similar to skeletal muscle than say smooth muscle. It's got that same...
KATY: I agree. I'm sure.
JEANNETTE: And the interesting thing about the muscle cells, a big difference in the heart, is that they are all coupled - electrically coupled. So when they contract it's synchronous. So that's why it can act as a pump.
KATY: Hopefully. Hopefully synchronized. And when it's not synchronized...
JEANNETTE: You run into trouble.
KATY: ...you run into trouble.
JEANNETTE: So that's the heart. Then we have the blood vessels. And the blood vessels are a bit like, I'm sure you've probably described it this way as well, a road network where you have big highways that start off and then it branches.
KATY: In Move Your DNA, you can think of main highways that carry many cars across and then you've got things that are more akin to city surfaced streets which fewer cars can fit across. And then you've got driveways, where you're just pulling into something small. And eventually you have an end destination. And we can talk about that when we get to capillaries. The end destination for the red blood cell itself. We describe the cardiovascular system like highways but we forget that that whole structure is about the cars that are driving it; and those are the red blood cells.
JEANNETTE: That's it. Getting the red blood cells to the tissues that need it. And those are in, like you mentioned, the capillary which are tiny and are usually smaller, actually, than the diameter of a red blood cell, quite often.
KATY: And I wonder if we have the highway analogy, but let's think of a river for a second. You've got a main river which is a large volume and then you've got branching off into smaller streams or the river can just dwindle and then when it reaches its end you get these thinner, sort of trickles at the end.
JEANNETTE: Rivulets, yes.
KATY: But they're widespread. Capillaries are like ... you said rivulets?
JEANNETTE: Yes.
KATY: I didn't know that word.
JEANNETTE: I hope I'm using it correctly. I'm not a linguist.
KATY: Nor am I, my friend. Nor am I.
JEANNETTE: But someone can tell us if that's right.
KATY: That's right. So these tiny little fingers of water that have a very slow flow. Capillaries have much lower pressure than the arteries. And the arterials which are the big and the medium. And capillaries don't actually have any contractile capability.
JEANNETTE: That's right.
KATY: So they are unlike arteries and arterioles. And I explain all that in Move Your DNA. So if you wanted to dive into some of the structure you can enjoy it in that cardiovascular/heart chapter. And it's that capillary place in the heart where that red blood cell diffusion is happening.
JEANNETTE: Yes. That's right. You have a very high surface area to volume there. So diffusion...
KATY: Hopefully.
JEANNETTE: ...hopefully...
KATY: Hopefully you have a high surface area because the capillaries are the part that adjust to exercise. So when you exercise you grow more capillaries to increase the area over which those red blood cells on the highway can get into the neighborhood.
JEANNETTE: Right.
KATY: The driveways of all the neighborhoods. So when you talk about adaptation to exercise, one of the things, if you first start out with, we'll talk about cardiovascular exercise whatever that is, and you're struggling at first, a lot of times it's because you do not have the anatomy to deliver the oxygen to the tissues that are working. Because the amount of capillaries you have is sort of dependent on how active you are cardiovascularly. So you kinda have to wait a while. You have to be uncomfortable for a while and struggle because that struggle exercises sort of microdamage and these loads that you're not suited for and then your body is like, "Oh wait, we're gonna have to grow more capillaries." So you will grow more blood vessels but the blood vessels you're growing are these rivulets which allow more of the cars to escape the highways and park into the garages.
JEANNETTE: Right.
KATY: Like urban sprawl.
JEANNETTE: And again this might be jumping ahead a little bit, but there can also be some what they call collateralization where you've actually got coronary arteries - there is kind of these backup routes that are sort of there as redundancy. But exercise actually can build more of those to your heart. So that's another place that you can get this. And that's particularly important in people who do have cardiovascular disease and why exercise is so important. Because you can develop those alternative routes. So, yeah.
KATY: Routes. R O U T E S - pathways. But they kind of look like roots, tendrils at the same. You're increasing your river system...
JEANNETTE: That's right.
KATY: ... in this way. We feel about ourselves that we are so static.
JEANNETTE: We're just born with this anatomy that doesn't shift.
KATY: Yeah, but our anatomy - we are shaped shifters. Again, going back to Move Your DNA to really grasp this, that you are much more malleable than you believe you are. And the cardiovascular system is a really great place to see some of that.
JEANNETTE: So we've not covered everything. Blood which we've mentioned. Blood obviously has several functions. It's the delivery of oxygen to red blood cells. It's also nutrients. It's removing waste. But the red blood cells are quite...
KATY: They're worker bees.
JEANNETTE: They look a little bit like kind of donuts in shape. But they have an indentation.
KATY: They don't have a hole.
JEANNETTE: They don't have a hole but they have an indent. And that allows...
KATY: Surely there's a baked good that is donut-like but is just thin in the middle.
JEANNETTE: I have no idea what. I'm sure there must be something.
KATY: But their morphology, their shape, is important to their function.
JEANNETTE: It is. Because it allows them a lot of flexibility. They can actually kind of almost fold to get through because of that shape.
KATY: And so the capillaries, you had mentioned this before, but maybe squeaked by without people hearing it, capillaries are smaller, thinner than the red blood cells themselves. So in order for the blood cells to get out to do the work that they need to do, they have to fit. They have to flex and fit and get through and out into the tissue.
JEANNETTE: That's right.
KATY: So mobility of red blood cells is quite important. And I don't think we hear very much about red blood cell flexibility.
JEANNETTE: No. I don't actually hear much about flexibility at all. I think when you look at the scientific literature it's there. But I don't think in the messaging that's getting out to the media, there is really discussion about stiffness, flexibility, in the heart health sphere.
KATY: No.
JEANNETTE: I think the assumption is that exercise strengthens the heart. But I don't think the conversation about compliance or flexibility is really front and center.
KATY: And with flexibility of the red blood cells - we need to have a discussion about the impact of whole body movement on the flexibility of blood cells. As far as there are diseases that can make the red blood cells stiffer; they lose their cytoskeleton. I want to say stiffens and oxidizes.
JEANNETTE: I think the lipid bilayer as well, the lipid bilayer which is very fluid in the red blood cell, it's almost like it gets a rough edge.
KATY: And so sickle cell is prone to...
JEANNETTE: Which changes the whole shape of the red blood cell too.
KATY: And, what's the...
JEANNETTE: Malaria.
KATY: And Malaria which is viral. But then also high blood sugar. They're looking at the relationship between... the impact of diabetes mellitus on the stiffness here. And so when people lose blood circulation to the feet, there's just inflexibility of these tissues. Now, if we exercise with regularity, got more movement, would that change our blood sugar level? So that would, in tern, create the stiffness of the red blood cells. To me that's the relationship. I don't think there's a mechanical thing about changing the shape of the body that would impact the blood cells like it impacts the arterial walls.
JEANNETTE: No I don't think so. It's such a different level. I think it's the chemistry that's going on and the shape changes. And I do wonder whether some, because if the blood cells are not moving so well, there's more chance that they can clot as well. So perhaps the more you could keep moving, at least you might be dealing with that slow flow issue. But you're never going to - the disease, whether it's type 2 diabetes or it's malaria, you can't really do anything about the fact that you're dealing with these changes in morphology of the actual cells.
KATY: Well, and you're talking about slower flowing blood. I remember when I was in high school learning about blood alcohol. And we hear that term, blood alcohol, but I'll just talk about myself, I didn't realize that there was alcohol in the blood.
JEANNETTE: Right.
KATY: That part of the blood volume was now alcohol. Even though we call it that, it just didn't occur to me that part of what's flowing through your veins now, flowing through your arteries now is alcohol. And the same goes for blood sugar. When your blood sugar is high, the sugar is in your bloodstream and that makes your blood more viscous.
JEANNETTE: There is that too.
KATY: So viscosity is - imagine water flowing versus the rate of honey flowing.
JEANNETTE: That's right.
KATY: So the more syrupy your blood is, now you're messing with the movement capability of the blood itself. So to your point, I think what you are saying is, if you've got blood with higher viscosity, if you've got more honey in your veins than water in your veins, then movement is very essential...
JEANNETTE: Yes.
KATY: ...to help mobilize this honey. It's kind of like instead of just pouring over the honey, being able to squeeze the container of honey to agitate it to help it move along faster. Because we don't want slow moving blood.
JEANNETTE: That's right. And I think that's why exercise is so important. It's the first line - Type 2 diabetes - that's why it's so profoundly helpful.
KATY: There's so many benefits to it. But this episode is really about teasing out ways that the mechanics, so the movement of the body, is related in the smaller level that we hadn't really thought about. Because, again, blood sugar is just a word.
JEANNETTE: Right.
KATY: It's not honey in your veins.
JEANNETTE: No. You're not thinking about the chemistry of it.
KATY: Or the mechanics.
KATY: So let's talk about movement.
JEANNETTE: Yeah. Let's talk about movement. Movement. I think it's unfortunate because we have this catchword called cardio. And I think that that's what we assume is the only - that's what you have to do. It's the only thing that really helps with cardiovascular health. And I don't think that's true. It's amazing and we can explain why it's amazing. But I think there are other movement modalities and factors that are important other than just the ones that get your heart pumping.
KATY: Not just to your body but also to your cardiovascular system.
JEANNETTE: That's what I mean. Exactly. So should we talk about cardio in terms of, we might want to reframe it as moderate vigorous physical activity. And you have talked about this in My Perfect Movement Plan. And it's this balloon model which I wonder if you could talk about now and explain your balloon model and why it's so important for the heart.
KATY: Yeah. So where to start... Where to begin? I'm trying to not talk about movement in so many seemingly separate ways when it comes to the body. So in My Perfect Movement Plan what I'm trying to do is normalize this concept of movement which is; we're trying to change the shape of our tissues. And there's a lot of different tissues and whether we're talking about changing the shape of bone, changing the shape of or the loads to skin. And then, of course, muscles, joints. We're already fairly fluent in that. And then we've got this thing called the heart. We have maybe this concept of our heart - I need to get my heart rate up.
JEANNETTE: Yes.
KATY: Well getting your heart rate up, what we're doing is we're changing the shape of the heart muscle. Just like we're changing the shape of the bicep muscle or changing the shape of the hip joint. It has a range of motion and we want to take it through the ranges of motion with regularity because by doing so, you're able to continue to take your heart through those ranges of motion. We don't really think about things like heart attacks as affecting our future ranges of motion. But they can quite literally, if you die from one, there's no more changing your range of motion for you. But you start to get stiffening of these different parts. And so much of what our cardiovascular disease is is stiffening. It's a reduction in the ability for the muscles that are involved in the cardiovascular system, which would be the cardiac muscle itself, and also the smooth muscle in the arteries. I think that's a good one.
JEANNETTE: Yes.
KATY: We talked about that in our podcast episode of standing versus sitting versus lots of different sitting rest positions. Because in mobilizing your limbs, there's a ... and just by changing your intensity of movement which is the easy way for you to measure. You know when you're moving lightly. You know when you're moving in a way that is challenging you to the next level. And then you know when you're working really hard. So intensity is just this concept that allows you to self observe. You could also use your smart watch or whatever else you're using. But it used to be just the perceived rate of exertion.
JEANNETTE: Right.
KATY: You would just look at a wall chart and be like, yeah I'm about an 8. Or you would use your fingers to take your heart rate and use rudimentary measurements. And that's a skill set.
JEANNETTE: Yeah. And I think they're very valuable.
KATY: Absolutely.
JEANNETTE: They're always there. And sometimes they're just as accurate, I think.
KATY: It's a pretty simple measure that you're taking. You might be a couple of beats off. I was involved in a research project that I'll be talking about more as time passes. But one of the lessons that I had in there for the people in the study was how to take their own heart rates. It was related to cardiovascular movement and it's all the same stuff that we've done. Just classic cardiovascular and exercise science. And many of the people involved in the set up of the study said, "Well they have heart rate monitors. They'll be able to see." And I said, "This is actually a skill." I recognize the value of the number, and the number is important, but there's something about self-observation and just to know where you can take your own heart rate.
JEANNETTE: Right.
KATY: You should know where the spots are and how to do that on your own so you're not dependent on a watch.
JEANNETTE: Something with batteries. Yeah.
KATY: Maybe it's more accurate, sometimes, but the numbers have gotten us by pretty closely. And I haven't seen big debate around people's self heart rate assessment being off or problematic. So if you're walking, what if you don't have a smart watch? What if you just want to get a sense of what your heart rate is, or your breath rate.
JEANNETTE: Right.
KATY: It's a way of self observation. So in My Perfect Movement Plan the image that you're talking about is; how do we think of this pear shaped, twisted muscle in the same way that we think of our hip joint needing a range of motion. You can see what your bicep range of motion is. You can see what your shoulder range of motion is. What is your heart range of motion? So in the balloon model in My Perfect Movement Plan was set up for the lungs. The lungs will start small but as you put more air in them they grow and they change shape. The chambers themselves are expanding and contracting. And you can think of a balloon as a lung but you can think of your cardiovascular, your heart, let's just say your heart is a four ballooned chamber. And each one of those is having to go through expanding and also contracting. So there's these movements that are happening in a coordinated fashion around your heart. And when you move at greater intensities, you increase the sheer number of movements that those parts get. You also change how hard those parts are working. Which is going to translate into sometimes shape, but probably more accurate for the heart versus the lung is effort. You get a stronger force. When you have to do something with volume of liquid faster, then you have to eject it faster in order to keep up with the pumping system. So that is what your heart is doing. You're increasing the repetitions, we'll say reps, of your heart. And then you are also, when you're going harder, you're adding resistance. So it's like lifting a heavier weight. So the muscle of the heart has to perform harder. It has to contract more so than it does when it's not having to go as fast or hard.
JEANNETTE: And to go back to our earlier discussion about flexibility or compliance, you could also think about this as stretching and maintaining the flexibility of those parts. I mean, we know that cardio/endurance type exercise does actually increase the diameter of your arteries, for instance. The walls are more pliant. The space is bigger. And that's important for blood pressure. So if listeners know their blood pressure. You usually have 2 numbers. It's something over something. 120/80. The first one, if you have stiffer arteries, that first one is going to be higher.
KATY: The top one. The systolic.
JEANNETTE: Yes, the top. The systolic will be higher. So I just think that's often not something we realize - that it's about compliance and space.
KATY: Well, and in the balloon model, I was talking specifically about the heart and their chambers. But now we've also got this concept of what's happening in your blood vessels themselves? Let's talk specifically about the arteries. You're taking deeper breaths. You're pulling in more oxygen. You need to move more red blood cells. You need to your highways to get bigger. Imagine if you lived in southern California and during high traffic time the freeways could widen to accommodate many more cars. And then when they don't need to accommodate cars, they would go down to a 2 lane highway or a 4 lane highway instead of a 12 lane highway or whatever you've got going on now. So with biomechanics, the reason they're different is, in biology many of our ... well our tissues are pliant. They're sensitive, meaning they take in sensory information and can change their shape in the moment, many of them. And then there's also the ability to adapt.
JEANNETTE: Right.
KATY: That's what sets us apart from machinery, at least machinery now, where the materials are fixed. Their mass is fixed. You're not going to build pipes for water that sense the flow of water and take up less space when there's less flow and grow when there's more flow. So they can control. And part of that ability to get bigger and smaller is about efficiency. Right? Not having to do so much work. But if you don't have a lot of demand for oxygen because you're pretty stationary most of the time, there's no reason to have a permanently big highway.
JEANNETTE: That's right.
KATY: So you get the smaller highway. And then if you don't engage in movement with regularity, to open up to the bigger highway which our genetics have the ability to do, but maybe not individual bodies over time, you are not opening and closing that artery very often. So it's the same thing. If you don't spend a lot of time opening and closing your hip what happens? When you get out of the chair it's like, "eh!" That hip is not going to open all the way because how often do you need an open hip?
JEANNETTE: Right.
KATY: 15 minutes a day? A thousand steps, two thousand steps a day? It's just not going to maintain that. It would be inefficient to maintain all this muscle mass for something that you barely do. And your cardiovascular system is the same. The blood vessels themselves say, "eh if you're just going to barely exercise and it's easier for me to try to shove all these blood cells not open as much" and "You don't have that many capillaries. You're not going to be able to perform as well, but you'll get by." And then you have to really push against that system if you want it to change.
JEANNETTE: Right.
KATY: You have to show that system your intentions. And it's sensory equipment. Your intentions are communicated by the movements that you do. And if you want more flexible walls, you have to take your heart, your cardiovascular system, through a broader range of motion more frequently than you are right now.
JEANNETTE: Right.
KATY: And that's how you keep those pieces flexible. And taking your heart through its range of motion on one hand, and I think we're good at this right now, it's about the intensities that you hit.
JEANNETTE: Yeah.
KATY: But there's a secondary geometry piece.
JEANNETTE: Right.
KATY: Which is you also, you're not just tubes floating in space. These tubes are living inside of things that hinge and bend. And when you use repetitive positioning or even repetitive movements...
JEANNETTE: Yes.
KATY: ... you decrease the full range of motion. You're still not getting the full range of motion of a body part. And that can also end up influencing, I think, how stiff arteries get.
JEANNETTE: Yes. And it would be worth, we did in our standing episode, there's a little bit more about that. Which if you're interested in the position, repetitive positioning and blood vessels it would be worth listening to that episode. I just want to bring in one thing that's related to what we talked about, the immobilization of the lower leg. Is that the health of your cardiovascular system, it's not just the heart as a pump. We have other pumps. And you have, I think, before, on Valentine's day, about calf hearts.
KATY: Yes.
JEANNETTE: The heart is what ejects your blood out to the body. But that blood has to get back. And that's where our whole body movement comes in. You need to be contracting your muscles to pump them through the veins which do not have a pump other than the skeletal muscles to get them back up to the heart.
KATY: So we're talking about the function of the heart. So part of the heart is sending fresh oxygenated blood to the body, and then other parts of the heart are taking the blood that came back, that doesn't have any oxygen left in it, and it's sending that blood specifically to the lungs...
JEANNETTE: That's right.
KATY: ...to be reoxygenated. So, your heart's doing two different things. In kind of two different directions. Like I love fluid dynamics, hemodynamics is amazing. So the model is, for the cardiovascular system, that the heart is busy doing all the work to circulate. But a big part of it is musculoskeletal contractions, yes to return it, but also musculoskeletal contractions are required for it to even get out. So I think that that's under-appreciated. So yes, of course, calf hearts. Let's talk about calf hearts. Calf hearts is this concept of all your blood has to return back to your heart. But the part that's farthest away is the blood that had to get down to your legs.
JEANNETTE: Right. And gravity is already helping take it down there and keep it there.
KATY: That's right. And so that's why you get swollen ankles if you've been sitting down for a long period of time. Because it is these contractions of the muscles in the lower limbs that are part of the walking it back up. They support the movement back up. But they can only do that if you yourself are moving. It's not the muscles that do it, it's movement that uses the muscle that does it.
JEANNETTE: Right.
KATY: Because you think, "I have the muscles. Why aren't they doing anything." It's like putting a book beneath your pillow and hoping that the information makes it into your head.
JEANNETTE: Absorb it.
KATY: Yeah. It's not like that. You've got to use that. But also when we talk about circulation, this is not about venous return, but this is just about getting to the end point. For a long time in exercise physiology the model was you would initiate movement, let's say moderate to vigorous movement. And that would create a cascade of chemistry that would then vasodilate.
JEANNETTE: Right.
KATY: Open up everything to allow better flow.
JEANNETTE: Yes.
KATY: But once, which the help for nanotechnology, it's the muscular compression around an area that signals parts to open. Which then creates that pressure gradient that it's more of a pull.
JEANNETTE: Right.
KATY: It's more of a pull. It's helpful. If you're trying to move a heavy box you want someone pushing it on one side and having someone pull it on the other side makes it go more easily. And we want that as far as our cardiovascular system as well. We want a push of our heart and a pull of the muscles which really brings the pressure on the system down.
JEANNETTE: Right.
KATY: As opposed to having a high-pressure system where you're just sitting there and your heart is saying, "Ok, I'm going to move this heavy refrigerator around and you just keep sitting there watching me." And you're making it so all of the work. And we describe it as doing all the work.
JEANNETTE: Cardiovascular health is so heart-centric.
KATY: It is.
JEANNETTE: And I think that's because it's not only simple, and that's the model that we've been presented. But I think also because the experience.
KATY: It's a tissue.
JEANNETTE: It's a tissue that, when your cardiovascular system is not healthy, experiences the issues. Although you can have peripheral issues too. But it's the dramatic ones are to do with the heart.
KATY: And our systems are really shaped, I would say, by the appearance. By tissue type. We sort by tissue type. So if you've got skeletal muscle over here, it's easily separatable. It's discrete. The cardiovascular system is discrete and it has its own tissue type. So it's easy. It's just classified as "these are the cardiovascular tissues." Yes. But that's like saying electricity isn't part of my television set.
JEANNETTE: Right.
KATY: Because we're not looking at things that interact. Where the television set has no function without the electricity. And the outlet for that matter. And all the wiring in my house. And also the station over here. So just keep in mind that with discrete systems of the body, they're not really about function. We do sort by clumping similarly looking things together.
JEANNETTE: Yeah. That's right.
KATY: With a lot of biology. And fair enough. But you need to move. Movement is a key player. It's like the electricity that helps the heart circulate. So yeah, if you're sitting there and you're worrying about your heart, just get moving. Just change your body geometry. And then also take yourself through intensities. You don't have to do all high intensity, but high intensity is something that you want to visit for just the stretch of it.
JEANNETTE: That's right.
KATY: Just the stretch of it. But you don't go into the biggest stretch without doing little stretches all around. You can get injured if you sit all day and then try to put your right leg over your shoulder - do some crazy big stretch. And the same goes for jumping right from sitting all day to doing something that's an outlying high intensity. And that's where a lot of cardiovascular episodes happen is when you have an unexpected high intensity change and the system, because it's so stiff - you know if you try to open something that's really stiff - you break.
JEANNETTE: Right. Yeah. That's a great way of putting it. You need to progressively train always. I think, I just want to make a nod to, you know we do want those higher intensity. But we tend to compartmentalize strength training outside of cardio. Or relaxation outside of cardiovascular health. And those two things are also valuable for your cardiovascular system's strength. Muscle mass is very very important. It's a very, when we go back to that red blood cell ... to make your blood less viscous, you want lots of very glucose hungry tissue, which is muscle.
KATY: That's why there's glycogen. It has to be able to put the blood sugar somewhere. Your skeletal muscle stores blood sugar in the form of glycogen chains. And so if you don't have a lot then it's like well, we'll just keep it in your blood or it can go to fat. That's another way of storing it.
JEANNETTE: Right. And skeletal muscle also secretes hormone-like substances which are also very health promoting for your cardiovascular system. And then, you know, relaxation for stress is a big cardiovascular disease risks.
KATY: Right. And pressure. That's another way of changing your pressure. Your muscle tension.
JEANNETTE: That's right. So I am not able to speak about stress. My expertise does not lie in that. But I just want to make a nod to that - that actually using movement to relax is also a very valuable thing for your cardiovascular system.
KATY: Well, and you went to a different place with that than I would have. And I loved everything that you just said. So maybe I'll just say back to you what I heard. You were saying that instead of thinking about cardiovascular exercise as the sole type of exercise that your cardiovascular system needs, strength training, and then also any sort of movement that you find relaxing, would also be part of a complete plan.
JEANNETTE: That's exactly what I meant.
KATY: Ok great. I get an A. Which, you know, for my personality type makes me happy. But, I think when we think of what the heart needs as far as cardiovascular exercise, when people hear that, they're gonna go to high intensity, repetitive type movement. And I think that that's also problematic. Because I wouldn't necessarily take strength training outside of something that could take your heart and its blood vessels through their full range of motion. That you can get to high intensity by shoveling snow.
JEANNETTE: Oh absolutely.
KATY: And you can get to high intensity by lifting weights. And so, in addition to those three things that you had mentioned not being the complete heart healthy movement diet, I would further it by saying and you probably have a much broader buffet of movements to choose from that will get you that (air quote) "cardiovascular" exercise. And cardiovascular and strength training can happen at the same time. Which is efficient and time consuming. I call that "big body work" in My Perfect Movement Plan. If you want a different model of actually looking at what the buffet of exercises are: movement types, physical activity, everything. If you want to look at the movement buffet and look at your physical needs by tissue, and not just tissue by what you find meaningful, My Perfect Movement Plan is that book where you're going, "What do I need in my body? Where are my holes? Where are my overindulgences?" And then you look at the buffet and you start to realize that maybe there's a more efficient, pleasurable, feel-better way to get the movements that you need.
JEANNETTE: That's perfect. The buffet is what I was meaning but I said it in a far less beautiful way.
KATY: Oh I love the way you said it.
JEANNETTE: I love that. A movement buffet is exactly it.
KATY: Ok, let's pause. We're close to the end. Let's do a listener question.
JEANNETTE: Ok.
KATY: This question is brought to you by Smart Playrooms. If you want to get your kids' heart pumping a bit more, and I want to say also the adults in the house, check out Smart Playrooms. They offer custom playroom design services to enable you to create a playroom that is movement rich, engaging, and stylish. They also offer products for any indoor playroom from slides to monkey bars to foam pits. I love their monkey bars. We gave away a set of monkey bars at the launch party for Grow Wild. And that winner was super stoked. You order them individually. So if you have enough space for 3, 2, 7, you just order them individually and can install them.
JEANNETTE: Oh that's brilliant.
KATY: Yeah, it's very modifiable for our spaces. Because all our home spaces are radically different from each other. So I like that you can customize it. Smart Playrooms is offering our listeners a 10% discount on monkey bars, rock wall panels, and rock wall holds with the code: DNA10. Valid through April 2025. And you can find that code again in the show notes for this episode. Ok. So what is the question?
JEANNETTE: The question is from Kelsie. And it's a nice, short question: Are any movements unnatural and to be avoided or done minimally? For example, handstands or ??
KATY: Ugh. I hate the word unnatural. Because it's so tricky. I feel like I know exactly what someone means when they're asking this question. But it's very tricky. So I would say if the nature of your body allows you to get into a position, it's not unnatural for you. And it doesn't damage anything. You know, I can get my leg over my shoulder, but you'd be breaking some things in order for it to go there.
JEANNETTE: Right.
KATY: But I think the spirit of the question is more akin to looking at foods. Are there foods that we could eat that are unnatural? We would say if they're completely human made...
JEANNETTE: Yeah. I would say that that's unnatural.
KATY: But that's not even what we ... if I make acorn flour, I've converted something into something edible. So what do I mean by that?
JEANNETTE: I think synthesized by a chemical process and doesn't occur. I think for like a trans fat. You're creating something that has never existed in nature. You've completely changed. You've added something. So I think that that would be defined as - it's completely generated in a laboratory. Whereas I think modifying a food by cooking is a long history. Or grinding. There's a long history of modifying their food in that way.
KATY: So there's just a line. There's a line that we're making. And I think there's push back on the line. I mean, especially right now. I took Instagram off my phone as the biggest gift that I could give myself. I'm a whole different person. And I can see there's a lot of push back. And I really like whole foods that are minimally processed. That works well for my body. I can tell, physically, when I'm not eating foods that work well for my body.
JEANNETTE: Right.
KATY: But to movement, I think the spirit of the question is sort of the same thing. Are there synthetic movements? And they listed a handstand. A handstand is not a synthetic movement.
JEANNETTE: No. I wouldn't say that. Kids seem to spontaneously do that kind of movement. It struck me as something that would, in many cultures, would appear as a natural expression of play or gymnastics or dance.
KATY: But then we could take a bicycle. Cycling. That's something that - you don't get that movement. That whole configuration would not occur if that technology, that machinery, had not been made. But, people have been riding bicycles for a very long time. And is there any indication that riding a bicycle is problematic? I would say perhaps sometimes. We've looked at research on people who exclusively ride bicycles and we can see that it affects bone density.
JEANNETTE: Right.
KATY: So this is a great question to refer people to My Perfect Movement Plan, because that's essentially what we're talking about - is dose. That there are movements that you need that serve purpose beyond physical fitness. We spent this whole podcast session talking about the role of basically walking movements in returning blood back upward. Movement isn't just to serve your physicality. A lot of philological/biological processes depend on specific movements. Just like you can eat a whole bunch of food. There's no bad food. Let's go with there's no bad food. But you could find a couple of foods that are high in calories that have no nutritive benefit and you'll be malnourished even though your caloric need is being met. I think of movements in a similar way. And I just have one example. There was a... I think it was a dolphin. I don't think it was a whale. It was a dolphin. And it had lost a fin. There's a movie that was made out of it. A kids' movie. And it had lost a fin. And it had come up with a different way of swimming by instead of pumping its flukes up and down to propel, it had created almost a spiral motion.
JEANNETTE: Wow.
KATY: Just like any animal that loses a limb, you still have to move. And whether you're human or you're a dog or a cat, you come up with a new propulsion system with what you've got. That's very natural for us to do for living things to be able to do. But in the x-ray of this dolphin, because it had adopted this way of swimming, the muscle mass that it had built from using its muscles in this way, was breaking down its spine.
JEANNETTE: Oh right.
KATY: I don't know exactly what it was. Because I remember when I had seen it 10 or 15 years ago, I was like, "Exactly." This is what I'm talking about for people, too. It had created a propulsion system but the anatomy could not work long term with muscle being laid down in a way that would close off these blood vessels. Something was pushing on the spinal cord and it would be paralyzed in a short time. And so they had to create a prosthetic.
JEANNETTE: Right.
KATY: So I think there are a lot of movements like that. When we say that something is unnatural, I mean, this accommodation was natural. It was a natural accommodation. But it didn't fit the needs of the anatomy. That we have that limitation of we're not machines but we have to have some laws of mechanics that when you don't follow them...
JEANNETTE: Have consequences.
KATY: ...have consequences to them. And so when I say something is natural or unnatural, that's what I'm thinking about. It's dose related. It's not just dose but time related too. What are we looking at over a three-year or a ten-year or a twenty-year situation? And that's the perspective I'm always taking on everything. So I would say in the spirit of the question; yea, probably there are some ones that you want ... it's not so much that you want to avoid them, it's that you want to be, just like foods. Any food in a context of a pretty nourishing diet regardless is nothing.
JEANNETTE: Right.
KATY: It's like, whatever. Just enjoy it. The same goes for movement. But a lot of times these highly processed movements are our exclusive movement.
JEANNETTE: Right.
KATY: And that's the issue. It's not so much that they're good or bad. It's about the context of it all together.
JEANNETTE: Brilliant. That was a great answer. Big question.
KATY: And I think it kind of fits with this episode actually. I wasn't thinking that it would initially. But it just kind of continued on.
JEANNETTE: It does.
KATY: Well done Kelsie thank you!
JEANNETTE: Yes. Thank you Kelsie.
KATY: Ok before we wrap up this episode, I want to take a little time to talk to Dr. Ray McClanahan about Correct Toes.
(Theme Music)
KATY: Hi Ray! Welcome to Move Your DNA podcast.
RAY: Hi Katy! Thanks for having me.
KATY: I guess I should say Dr. McClanahan.
RAY: No, Ray's fine.
KATY: Because we know each other, IRL, as the kids say "In Real Life".
RAY: Indeed. Yeah.
KATY: So I've had you on the podcast before and we've talked about your evolution, I would say, as a podiatrist going from conventional shoes to minimal shoes. We've had that conversation and I will put it in the show notes - a link back to that but today I want to talk to you about Correct Toes. You are the creator of Correct Toes.
RAY: Mm-hmm.
KATY: How do you describe Correct Toes if you're at a cocktail party - I don't know if anyone does those anymore - if you're at a coffee shop and talking about Correct Toes, how do you explain what they are?
RAY: Yeah. I basically tell people that this toe orthotic puts people's toes back into the natural alignment that nature had intended. That opens up the conversation. And it's kind of fascinating because it's brand new information for those people. I can't tell you how many middle aged or adult Americans have no idea that our feet are supposed to be widest at the tips of the toes.
KATY: Well it doesn't match the shoes.
RAY: Indeed. So that's what it's for. I show a baby's footprints when I talk about this conversation. I show people that if we didn't live in industrialized societies where we deform our feet with footwear our feet would still be baby shaped. So I tell them Correct Toes is a way of getting your adult deformed feet back to their natural, or their baby shaped construct. Because that's where the healthiest feet in the world exist - in that natural alignment.
KATY: There's looking at a shape and going this shape isn't right. But you're a podiatrist so I think - how does the function of someone's experience with their feet - how they feel and how they work - relate to that shape? Because it seems like more than just chasing a shape, we want to chase a function.
RAY: Absolutely.
KATY: So do you ever talk about them, Correct Toes, in response to how people's feet feel and work?
RAY: Absolutely. In fact we've done a bunch of studies which we can talk about. But in terms of function, what your audience should know is when feet are positioned naturally, meaning that the widest part of the foot is the tips of the toes, the heel is level with the front of the foot all spread out.... We've done some studies that have multiple other people to show circulation will be better. Nerve function will be better. Balance will be better. Foot strength, as you know, can increase by about 10% just by putting the feet back into natural alignment and stressing them. So as far as function is concerned, I'm surprised at how well we can function in conventional shoes until we break down. In fact not a day goes by where somebody middle aged, typically middle aged female says to me, "You know I've been an active person. I've kind of done whatever I want my whole life. I didn't hurt myself. I didn't sprain my ankle. And all of a sudden one of my feet won't work." And they're curious about that. And I share with them that the function of your feet has been compromised by your fashion athletic footwear. And that opens up the conversation to how do we pursue natural positioning. Which will then allow natural function and comfort and keep them out of the podiatry office.
KATY: Well it is interesting because I've written two books on feet. I know you're a podiatrist. It's an interesting topic to you. It's not really an interesting topic to a lot of people. But one of the reasons I did was not even so much about foot pain, I mean it's helpful to know that there are things to do that can fix your feet. But the real reason that I feel so compelled to help people with their feet is because feet are often the thing that keep people from moving their whole body. So the rest of this episode Jeannette and I are talking about cardiovascular function. And I don't think that a lot of people would associate the foot with the cardiovascular system. But a sore foot can take your whole body down. It makes it so you can't really walk.You can't go to the gym. There are workarounds, always, with injury. But in general I think that's a big reason why a lot of people aren't moving regularly is because their foot hurts.
RAY: It's so true. In fact it's fascinating to me to see how many people fully become aware of the value of their feet when they're feet start to hurt, and, like you say, the rest of their body, they can't use the rest of their body. And I'm no longer surprised by that and it's a very empowering journey to get them back on their paths to natural foot health. But you're right. You've probably heard the old term: When your feet hurt, you hurt all over. And it's so true. And when people experience neck pain, back pain, hip pain, knee pain, when their foot hurts, they kind of clue in to the value of fully functioning feet.
KATY: Mm-hmm. And I think the thing that confuses a lot of people is, "I've always done this. I've always worn these shoes. My feet have always looked like this." And you can kind of get by with anything when you're 20. It's kind of like drinking alcohol. What you can do when you're 20 is different than what you can do when you're 30 and it's different than what you can do when you're 40. And it just keeps going in that direction. And I think it's middle age that the feet really start to let you know that the way you've been using them is not their preference. We'll just say it that way.
RAY: Absolutely. And I like your alcohol analogy. I've been thinking a lot lately also about the food analogy. You know when we're young we can eat all kinds of horrible things - a lot of processed food. Even my children, my daughters are in their 20s and they don't get sick. They don't feel bad. And nor did I when I was 20. I didn't drink a lot when I was 20 but it's another good analogy. Right. I often times think about how miraculous our bodies are. How just fantastic they are. Incredible. They will let us do a lot of bad things for a long time, like you said. In terms of feet, a lot of people do bad things to their feet until they're 40 years old. And to your point, they get away with it. I ran marathons in fashion athletic shoes. I ran my best 5k in a size 9 Nike that was 3 sizes too small and it was a fashion shoe. But eventually it does catch up with us. And that's what I feel so passionate about our work is to get the message to people before they break. I want to prevent. I want to cure. I don't want to wait until that person gets to middle age and has made all the mistakes like I did. And then we're trying to back track. Right? Or trying to heal. Whereas if we were trying to prevent it then, we'd never got to that place.
KATY: It's like parenting though. You're like, "Learn from my mistakes!" And they're like, "I'm not going to. I have to learn on my own." So definitely prevention is really helpful. But I know that the greatest number of people come to my work and I wonder, you're a doctor, so I assume it's similar, once a problem has already showed up. But, you've created Correct Toes. So that's what I want to talk about next. Correct Toes to me seems to be a solution - a prehab. Not a rehab but a prehab. It's something that you can do now that's very simple. So I want to start with; How did you come to create a product? I mean I write a lot of books. I am not a lazy idle person. But I feel like bringing a product to market is just a hurdle that I couldn't jump over. What was that like? What was the story behind it? How did you come to decide to make an orthotic device?
RAY: Yeah. In 1995 I was here in Portland doing a surgical residency and I was operating on a lot of people that had the condition that I had at that time which is bunion and hammer toes. So in other words, my second toe set up on top of my big toe. And a lot of people with that. A component of the operation is to cut the muscle of the inside of the big toe, the adductor hallucis. And I remember asking the doctors that were training me, "why are we cutting this muscle off of the bone?" And they said "well this problem is genetic and this is what we have to do to fix it." And I also at that time noticed that not everyone who gets bunion surgery recovers. Not everyone gets back to the activity that they want to do. And worse yet, a lot of people who have bunionectomies get it repeated 8-10 years later because the cause of it isn't fixed. So I was very curious at that time in my life and I was wondering if there was some other way to fix this problem without an operation. And then the greatest inspiration of my professional life was exposed to me through Podiatry Management Magazine, Dr. William Rossi, wrote an article that blew my mind and changed my life overnight: Why Shoes Make Normal Gait Impossible. And in podiatry school, I know your best friend passed unfortunately. Probably got the same training that I got which was; shoes are good. The more cushioning and the more support is good. Don't pay attention to shape. Take money from companies that make fashion athletic shoes. And that's podiatry. However, somehow Podiatry Management decided to publish Dr. William Rossi who was a natural podiatrist. He passed on about 10 years ago. But he got me thinking about many of the problems that we encounter may not necessarily be related to the reasons podiatrists are taught. We're taught biomechanics, genetics, overuse, etc, etc,. Very little emphasis is given to the fact that we deform our feet at age 3 in America. Dr. Rossi taught me that and I went home that night after reading that article and I realized if I was going to do good work I had to go back to the clinic the next day and change. I had to overhaul. I had to stop putting people on the treadmill, looking at their pronation, making orthotics thinking it would fix them because it didn't. It would temporarily help until their feet got weak and then they were on this constant quest for the right orthotic shoe combination because they were weak, deformed. They're dysfunctional. So Dr. Rossi got me thinking about changing my own shoes to begin with. Which I did. And he also got me thinking about the rehabilitation capacity of feet non-surgically. And non-orthotically. And nobody had ever expressed that to me. Although I lived in Africa growing up, I saw the capacity of bare feet to do some incredible things which I couldn't do with my feet. So I decided that I was going to try to experiment with my own body to see if what I was being taught was correct. So I started buying these little silicone spacers which you can see everywhere. They're in the drug store. We've got them on our website. And I started putting them between my first toe and second toe. And then between my fourth and fifth toe. And I noticed a difference. I noticed that when I took them out my toes were a little bit straighter. But I also noticed my body felt better - to your earlier point. I had chronic knee pain since age 17. I had low back pain so bad occasionally I took narcotics for it. And I noticed, wow, my whole body is feeling better as my toes are changing. So I started putting them between all of my toes. And at that time I was trying to make the olympics. So I'm doing a lot of running. And I'd get out on my run with these silicones between my toes and they wouldn't stay in place. As soon as I'd start sweating they'd move around. No runner wants to stop their run to squish their silicone between their toes. So I was out on a mountain bike ride with a friend who does silicone molding and I was telling him what I had in mind and I said, "Why can't we just take four of these pieces and put them together? That way it will stay in place." And then subsequent to that we thought, well what if we also make it adjustable for people like me who need to push their big toe out further as time goes by. And so we did that. And unfortunately we made a lot early mistakes. We made the product wrong. We made the durometer too hard. The hardness of the material. I ruptured my collateral ligament on my fourth toe by overstretching. So we made a lot of mistakes. And eventually through testing we got down to the right durometer. We streamlined the product. And early on, we launched it probably 20 some years ago. I thought podiatrists would be excited about this. I reached out. I used to belong to a lot of listservs and I reached out to 18000 podiatrists. "Do you guys want to try this? This can cure some things." And probably less than 10 people wanted to try it and the ones that did didn't understand it. "It doesn't fit in my shoe." And I was trying to encourage them to understand "That's the point."
KATY: Um-hmm. Neither does your foot.
RAY: Exactly. So we started that. I had the impression that I wanted to make it in America. So we did for a time. We made it in Redmond, Oregon. And found out it was cost prohibitive. We found out that the tools that we original made, they were not production tools. They were prototype tools. And to your earlier point, Katy, it is quite and obstacle to launch a product. You could definitely do it. Not everyone could do it but you could.
KATY: I don't think I could do it.
RAY: It has been a journey. And we're launching some new products as well. Which is we're back to the drawing board and back to that challenge. But that was my initial idea was to see if it would work in my own body. Then I started telling my patients. And it's become a cornerstone of my work.
KATY: And I feel like it was grass roots. You put it on a listserv in front of podiatrists thinking this will be the great way to increase uptake. People will see it and pass it on. But that probably wasn't the case if you only got 10 orders. So how did they spread, if you will?
RAY: Yeah. So we didn't even get 10 orders. I couldn't even get 10 podiatrists to be excited about it. So nobody ordered it. No podiatrist did. How it started to spread was a couple of ways. Some very significant influencers, people like Dr. Mark Cucazella who had surgery on both of his feet and unfortunately the surgeon bandaged him in deformity, so he healed deformed. And he tried to run again and he went back to the surgeon. And the surgeon said, "Well, Mark, you just have to stop running." And Mark said, "No, I can't stop running. It's what I get joy out of." So he found minimal shoes, he found Correct Toes, he found ChiRunning and various other movement patterns. And he was able to heal himself. Now he's got the second longest sub-three-hour marathon streak in the world. He's done 33 of them. So a guy like that, as tapped into the world as he is, and as well-spoken as he is, and as intelligent as he is, people take him seriously. So they're like, "Well if Mark found benefit in this, if Mark believes in this, we're going to try this." And so it was Mark, it was physical therapy, it was naturopathy. It was yoga. Because, obviously, when you are in yoga you are in your bare feet. Your yoga instructor tells you "spread your toes." And I tell people well, that's great, but if your yoga instructor wants you to spread your toes, why are you only doing that for an hour out of the day? Let's get you doing it all day. So it wasn't podiatry, ironically. However, in the last two or three years, podiatry is finally getting on board. Especially the younger people, which is gratifying to see. But it wasn't podiatry. In fact, I was all excited that they were going to embrace this and see it as a new innovation. But it took 20 years.
KATY: Yeah. There is no overnight, it's not so much overnight success, but to distribute information takes a long time. Every time I do anything I think, "This is going to be amazing!" And people will say, "Why didn't you tell me it was like this?" But it's really, I think, the people seeking for themselves who have looked under every stone who find you and then it works. And then it's just sort of a grass roots spreading. Do you think you're still grass roots at this point? I'm not sure what the pinnacle of toe spreading success looks like as far as a brand goes. But maybe when they're in drug stores. Just like the single spacers. Eventually will there be that point where this is just "oh yeah" or there's just no longer shoes that require people. How would you feel about that? When all the shoes are wide and Correct Toes are no longer necessary?
RAY: Yeah. I would feel fantastic about that. In fact, that truly is my goal. I sort of feel sad in some ways that even though the product is wonderful and helps people, I had to make my product because other people made bad products.
KATY: Right.
RAY: So in other words, that shoe designers didn't deform people's feet to begin with there would be no need for Correct Toes or any kind of toe spacers. And that really is the impetus for my continuing work is to get to people. Why don't we have the kids' feet checked at school like they check their eyes, and they check their ears? Why don't the pediatricians talk to mom and dad? So, yeah, the shoes are getting better all the time. My friend Anya from Anya's Reviews mentioned that she thinks there's somewhere over 200 brands worldwide. So people are getting the message. Toe spacers aren't such a weird thing anymore because there's tons of companies out there now. People would go to the trade shows years ago and go, "What's this?" Now I went to a running event a couple months ago and there's probably 6 different brands there. There's probably 40 brands now out there. So word is getting out. There's some good studies on them, as well. Which we've done. No question your balance is better. No question your circulation is better. No question your foot strength gets better. So if you're somebody who cares about your body and your feet, even if you're not in foot pain, that's the direction you want to go.
KATY: Are they considered an orthotic? What's the actual clinical definition of an orthotic?
RAY: Yeah, it's to make something straight.
KATY: Ok.
RAY: So it is an orthotic and I call it a toe orthotic and I differentiate it from arch orthotics which I used to make a lot of. I used to work for SuperFeet Northwest Podiatric Labs for about 5 years in my early career. Until I read Dr. Rossi and then I started putting people's feet on top of their Superfeet and I noticed that their toes were wider than the Superfeet. So if you can't spread your toes, you can't control your arch. And so the difference, Katy, is conventional arch supports, or orthotics, try to make a body part straight in an unnatural fashion. So we're not intended to have anything up under our arch. Correct Toes orthotics are making toes straight, which is natural. Which correspondingly then helps the arch to function the way it is intended to. So the goals are the same. The arch orthotic is expensive. It has weakening effects. It adds extra weight to the shoe. People keep going back to the doctor and getting them year after year after year. Versus, Correct Toes orthotics are a temporary natural orthotic to get your toes back into alignment. And once they're in alignment, throw it away. And then just don't wear pointed shoes anymore.
KATY: So I appreciate the definition of orthotic. I didn't know that it was to keep straight. But with Correct Toes, they're part of a journey to transition. Where an arch orthotic - it's not trying to get you anywhere. It's not trying to get you away from needing the orthotic. The orthotic becomes part of what your feet needs. Just like it needs a shoe. To the positive point, though, we're used to orthotics. As a culture, we're used to this idea that there's something that you can get that you can put in your shoe that makes your feet feel better. It's just changing what that orthotic is between the toes, perhaps underneath the arch. Do you have any patients that wear both? I'd imagine you're still recommending arch orthotics for some people as well, along with shoe changes.
RAY: For sure. I would say a small percentage, maybe 5% of my patient population truly has a structural problem or a biomechanical deformity. It truly does happen. I could give some examples and we could go into some detail. But yes, people do use both. I have a test in my clinic that I do to try to figure out who needs just to spread their toes to get stronger, wear better shoes, who needs to spread their toes, get strong and some help at the arch. And typically for me in my patient population it's going to be people who are hypermobile.
KATY: Yeah, right.
RAY: The test that I do, I call it the hallux adduction test. You know I've got some videos on the website. Essentially I have the patient stand in front of me and most of their big toes are kind of close to the second toe. If not, a slight bunion. For most everybody that I see except in little children which I don't see that many of them. And I ask them to pronate their arch with their toe in that deformed position. And we both observe how much pronation they're doing. Then I have them supinate their foot. I pull their big toe into natural alignment, where it's supposed to be, where Correct Toes will put it. About 90-95% of people when I ask them now to pronate, will pronate to what I would call neutral. Meaning their leg is over the top of the middle of their foot. They don't go into over pronation, they basically go to neutral. And this is astounding to some people. In fact, I'm going to tangent off and tell you I was at a chiropractic symposium in Florida probably about 3 or 4 months ago and it was sponsored by Foot Levelers, the chiropractic orthotic company. And it was the premier sponsor of this seminar. And some young chiropractic students had gone to their booth and walked on their force plate and pathologized as being flat footed and you're going to have to wear this orthotic for the rest of your life. Well they came by our booth and we were talking to them and they said, "Yeah, well we have to wear these orthotics." And I said, "Well, let's check a couple of things. Let's look." So I had this young chiropractic student and I did the hallux adduction test. And when I got her great toe into natural alignment, she was perfect and normal. Her arch was normal. And her girlfriends are standing there looking and she's just like, "What's happening? How come my arch won't go down when my toe is in alignment?" And so overwhelmingly people don't need any kind of orthotic if we get to them early. But later on in life when they start to have problems they have the choice of doing the two of these. But to answer your question; the people that need both are people that do not stay in natural alignment when you spread their toes. Or occasionally, not to confuse your audience or get too detailed, but you're familiar with valgus and varus. And occasionally I'll meet somebody who has a valgus or varus deformity that doesn't compensate when they're walking or when they're standing. I vividly remember a lady that I still see about every 6 or 7 years, she comes in and gets her new orthotic because it helps her. In her case, I won't call it a cure. In her case it's what she needs because she kept rupturing her peroneal tendons and having surgery because she had a rigid forefoot valgus. So for your audience, the front of her foot was like this in relationship to the back of her foot that was neutral.
KATY: For the people who are listening mostly on audio. The front of the foot sort of angled in but the back of the foot stays in place.
RAY: Yeah. So as soon as she started walking forward on her heels, she's finding her foot still neutral. But as soon as she loads her forefoot, because it's down and rigid, she has to supinate massively rapidly. And the peroneal muscles or tendons on the outside of the foot are, as you know, are prontators. So if that rapid supination is occuring, the peroneals basically are going to try to fight that until they break down. So she kept getting tendinosis. She kept tearing. She kept getting surgery. And after the third surgery somebody said, "You might have a structural problem. You should probably go have a look at this." And she came and she saw us. And she only had it on one foot which was weird. But this is probably one of my favorite orthotic success stories. We made her a beautiful orthotic with what I call a four foot post. And this is where podiatry shines where people need it. However I think podiatry overuses orthotics. In fact we have a class in podiatry school where we classify each others' feet with the mindset that no matter what kind of foot time you have, there is a kind of orthotic for your foot type.
KATY: Interesting.
RAY: I no longer believe in and I no longer correspond to that thinking. The other thinking, too, is that you always wear your orthotics for the rest of your life. And when I was first making orthotics, I would send a postcard to the patients every year, much like the eye doctor would, or the dentist, it's like "it's your time to come in and get your new orthotic" and I didn't do any more work, I just signed a prescription for them and sent it off and made another big chunk of money. So there's some economics behind it which is needing to be challenged. And like I said, I think there's an overutilization. But sometimes people need them. And when they need them, podiatry is the place to go. But like I said, too often they're overused. And unfortunately we don't cure people if you keep people in orthotics.
KATY: Yeah I like that clarity. And it's interesting, I was thinking while you were talking that orthotics probably were a natural solution at a time. Right? The idea of "oh you don't need a surgery. You just need this easy, natural support. It was a less invasive solution. And positive for so many reasons. And maybe it got you away from a pharmaceutical or surgical solution. And then that becomes a standard. And then now it just seems like as we know more and consider broader perspectives, we're starting to whittle away and say it's not so much the fixed structure. I think of it in terms of it's a strength and an alignment. It's an alignment and a resulting strength that you get that provides some of that support naturally. Which is not to say that we don't need pharmaceuticals and surgical interventions when we do. Or orthotic interventions. It's just maybe not the first place that you look, that you have the full picture in mind.
RAY: Yes. Agree.
KATY: Well, ok, you mentioned new products as we're winding up. What is Correct Toes' future? What are some new things that you have coming up?
RAY: Yeah. So we have had a lot of competition in the last couple of years. In fact we have had people directly copy us and sell for less money.
KATY: That's how you know you've made it, by the way.
RAY: Well thank you. I hope so. I appreciate you saying that. So we're coming up with two new products. We're coming up with a product that will be for people that may not need the full Correct Toes. It's going to be just for the big toe. It's going to be adjustable. We're going to be able to put material in there. For people who maybe only their big toe needs help, or maybe they've got footwear that might not allow for that full spread.
KATY: Love it.
RAY: We've also got what we're going to call Correct Toes Sport. It is a prehab device.
KATY: Ok.
RAY: We want to get to people before they need correction. So it's just going to guide peoples' feet into that natural alignment. The original Correct Toes was a corrective medical orthotic meant to correct deformity. So now that there's more awareness out in the community, we're hoping that this concept will be more readily accepted. So we want to be available with a product at a lower price point to help people achieve what they want to achieve.
KATY: That's wonderful. I think those are excellent additions to the market.
RAY: Thank you.
KATY: They're refined and they accommodate a broader range of people who maybe don't need all toe spacers. I got to see, for those who are listening on audio, I got to see what the - What do you call the first one, not the sport one?
RAY: Stable Toe
KATY: Stable Toe. That's a really great addition. I'm excited to see that on the market.
RAY: Thank you, Katy.
KATY: I just want to say thank you for the work that you do. It takes a lot to swim upstream a little bit. You know. And also I just wanted to say thank you for supporting the podcast. I really appreciate you doing that as well.
RAY: You're welcome. Thank you, Katy.
KATY: All right. Thanks for coming on.
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JEANNETTE: Thank you. That was a really interesting conversation. Thank you to Ray and Katy. And also thank you, listeners, for joining us on this episode which has been brought to you by our Dynamic Collective of Venn Design, Peluva, Wildling, Correct Toes, Movemate, and Smart Playrooms. To make sure you don't miss an episode and to keep up to date with what is coming up, be sure to follow or subscribe to our podcast wherever you like to listen to audio. And if you have any questions for us, or even topics that you would like addressed, please send them to me at podcast@nutritiousmovement.com.
KATY: All right. Well, thanks everyone for listening and happy February.
JEANNETTE: Yeah.
KATY: Whether you are celebrating your heart for emotional connection reasons, because you love to love, or because you are just really grateful for the fact that that big ole muscle in your chest is pushing all that blood around for you so that you that you get to love...
JEANNETTE: Right.
KATY: ...frankly. And walk. And do so many other things! Yeah, take good care of it everybody.
JEANNETTE: See you next time!
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Olá! My name is Laura Houston, originally from Seattle, Washington, but now in Portugal. This has been Move Your DNA with Katy Bowman and Jeannette Loram, a podcast about movement. We hope 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. This podcast is edited by Chris McLaren, transcribed by Annette Yen, and our theme music is performed by Dan MacCormack. Make sure to subscribe to this podcast wherever you listen to audio. And find out more about Katy, her books, and her movement programs at NutritiousMovement.com.
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