#296 ‒ Foot health: preventing and treating common injuries, enhancing strength and mobility, picking footwear, and more | Courtney Conley, D.C.

Toe weakness is the single biggest predictor of falls when we age.” —Courtney Conley

Read Time 66 minutes

Courtney Conley is an internationally renowned foot and gait specialist. In this episode, Courtney delves into the intricate world of foot anatomy and functionality. She explores the complexities of the foot, discussing its anatomy, common injuries, and the importance of understanding its structure in preventing issues. She covers a range of foot ailments, factors contributing to them, treatment options, and prevention strategies. She delves into the significance of loading, balance, range of motion, and posture, emphasizing the crucial role of strength in preventing both injuries and falls. Additionally, she sheds light on the interconnectedness of the kinetic chain, from the leg muscles down to the foot, and how issues within this chain can cascade downstream, leading to various injuries and pathologies. Additionally, she provides a comprehensive overview of footwear, discussing suitable options for both adults and children to promote foot health and mitigate potential problems. 

In addition to this interview, Courtney also recorded a series of videos to better explain a number of the concepts discussed such as diagnostic tests that are used to determine mobility and strength and the exercises one should perform to improve the outcomes based on the diagnostics. The interview will be available to everyone while the videos from the gym will only be available to paid subscribers (found at the end of the show notes page). 


We discuss:

  • Why Courtney chose to specialize in the foot [3:30];
  • The vital role of foot strength, function, and health in human movement and well-being [6:15];
  • Anatomy of the rear foot and midfoot [10:15];
  • The development of flat feet, the impact of footwear, and the benefits of going barefoot [19:45];
  • Anatomy of the forefoot, common injuries, and why most injuries occur in the forefoot [23:15];
  • Foot musculature and its role in maintaining foot stability and preventing deformities like bunions and hammer toes [30:15];
  • The intrinsic musculature of the foot, plantar fasciitis, footwear, and more [39:00];
  • Plantar fasciitis: diagnosis, causes, and treatment [51:30];
  • Posterior leg muscles: strength assessment methods, role in ACL injuries, and more  [59:15];
  • Lateral and medial muscles: ankle stability, arch support, big toe stabilization, and exercises to strengthen and prevent injuries [1:04:15];
  • Importance of strength of lower leg muscles for gait and preventing shin splints, stress injuries, and more [1:08:15];
  • Tendinopathies and other common pathologies related to the anterior and lateral compartments of the foot [1:13:00];
  • The importance of midfoot integrity, ankle dorsiflexion, and a discussion of gait alterations [1:19:45];
  • Proximal stability and its implications for posture and movement patterns [1:27:00];
  • The age-related decline in foot sensation and strength [1:32:45];
  • Common toe injuries, treatment, and how to prevent further progression of the injury [1:36:30];
  • Preventing falls and managing arthritis with proactive foot care and exercises [1:46:45];
  • Footwear: advice for picking shoes that promote foot health [1:54:45];
  • Footwear for runners [2:05:30];
  • The importance of prioritizing footwear that promotes natural foot movement and strength while considering individual comfort and foot health needs [2:09:30]; and
  • More.


Why Courtney chose to specialize in the foot [3:30]

Where did your personal obsession with the foot begin? 

  • Courtney grew up as a ballet dancer and spent a lot of time in ballet pointe shoes
    • These shoes are very rigid, stiff, and you’re up on your toes
    • All through grade school and high school, she spent a lot of time on her feet
    • She always battled foot pain
  • She chose this career through self-exploration
  • She is a chiropractor by training, and she thought she was going to learn all of this stuff about the foot but that just didn’t happen
    • She really didn’t get a lot of education in regards to how the foot actually functions

Why did you choose chiropractor over say podiatry or something that was purely focused on the foot? 

  • She had this conversation with her father many times
  • First she was going to go down the physical therapy route
    • But she wanted to create her own treatment protocols
  • Her dad has always been a big fan of chiropractic
  • She has always been interested in exercise and movement, and it just seemed like a good fit
  • She had maybe half a semester in school on the foot, and she was fascinated
    • That’s more time than Peter would’ve guessed

The foot has always intrigued Courtney ‒ it’s a very complex part of the body 

  • With our education, the foot was always viewed as if something hurts in the foot, we’re either going to put an orthotic under it or refer them for some type of surgery
  • Courtney was blessed enough to have some really good mentors around that increased her appetite for learning about that, and that’s how it started

She ended up graduating from school and working in a couple of orthotic labs 

Courtney went straight from school directly into specializing in the foot 

Orthotic labs are presumably a place where people come and have custom orthotics made? 

  • Yes
  • She would work in the front offices and there’d be grinders in the back where they made the orthotics
  • They would see patients who had foot pain, and they would cast them for orthotics and make the orthotics
  • When she came out of school, her knowledge and practice was largely still based on the conventional way of putting support under the foot, hoping for the best 

Courtney has evolved leaps and bounds ahead of that to where she is today 


The vital role of foot strength, function, and health in human movement and well-being [6:15]

The complexity of the foot:

  • One of our superpowers is that we’re a biped
  • We have so many cutaneous receptors, muscle spindles, joint proprioceptors on and in our feet that communicate with our vestibular system so we can become upright and bipedal
  • When you take away those functions, it really alters how you’re moving, how you’re interacting with your environment
  • It’s always so wild because when we think about it from a rehabilitation perspective, we are very good at rehabbing the low backs
    • We do a lot of core strength, we do a lot of glute strength, we do a lot of hip strength
  • But you don’t hear many people saying, “I’m doing a lot of foot strength,” and it’s literally our first interface with the ground
    • That’s how everything starts

When we take that [foot strength] away, you’re really making it much more challenging for yourself, and I think it really can alter our survival as well as decrease our quality of life.”‒ Courtney Conley 

Using race cars an an analogy 

  • Peter is obsessed with race cars, and there are 4 things that determine the speed of a car: the engine, the chassis (the aerodynamics, the stiffness), the driver’s capabilities (what they can do in the car), and the tires
  • The analogy is clearly that the tires are the feet and you can have the greatest car in the world, the most powerful engine, the most remarkable chassis, and the best driver, and if the tires are shot, none of it matters
    • Without them, you simply can’t get the power to the ground and back 
  • He thinks there’s a lot to be said for how it is imperative

Peter would even go one step further: feet are even a more important part of the human body than tires are to the car 

{end of show notes preview}

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Courtney Conley, D.C.

Courtney Conley holds a B.A. in Kinesiology, B.A. in Human Biology, and a Doctorate in Chiropractic Medicine. Dr. Courtney Conley is the founder of Gait Happens. She is pursuing her dream: helping as many people as possible reclaim their foot function. 

In addition to Gait Happens, Dr. Conley is the head of patient care at Total Health Solutions and Total Health Performance, based in colorful Colorado. She is also a founding member of the Healthy Feet Alliance, an international team of practitioners who focus on the promotion of natural footwear to prevent unnecessary surgical procedures. 

Dr. Conley is an internationally renowned foot and gait specialist who teaches globally on topics related to foot function, gait mechanics and strategies to combat foot and ankle pain. She is an author, educator, and lecturer, offering credentialed courses to medical professionals all over the world. She has written numerous professional education courses, contributed to textbooks, developed foot and gait protocols and created learning communities for health professionals and “human soles” alike. [Gait Happens

Instagram: @gaithappens

Website (with curated offers for The Drive listeners): Gait Happens

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.


  1. Finally…I’ve been waiting and suggesting this guest for so long! I’ve had online appointments with one of Courtney’s Colleagues and their approach is so good. Very quickly I saw positive changes in my feet, posture and gait.

  2. Can we talk about how in the US it’s normal to wear shoes indoors, whereas somewhere like Canada they don’t? Any impact?

    • Depends. This is a generalization.

      I’m from a small country (<10 million). In my house, I prefer people take off their shoes. In other places I've been, I'm not asked to, but I take them off.

      I don't need to go barefoot, may not be practical (cold floor), so I can wear slippers. But no shoes inside. Why would I want to bring outside germs to other people's places or my own?

  3. Best podcast yet! One of Dr. Conley’s associates helped me greatly. Now that I’m wearing minimal zero-drop shoes all the time, I’ve found that the best option for me when I want to wear really stylish shoes is driving loafers. Gucci, Ferragamo, Tods, etc scratch that luxury itch while still giving a pretty minimal moccasin-like shoe.

  4. This was one of the most educative podcasts yet from The Drive (at least, in my opinion!). Well worth the time to listen, read, and watch.

  5. I am age 80 with peripheral neuropathy – would acupuncture help? I walk daily in Hokas. great show!

    • You can find the link in the show notes under this section: Footwear: advice for picking shoes that promote foot health [1:54:45]

    • Patty and Nicole,
      You can find Conley’s list of shoes on her website, gaithappens.com/favorite-products/ .

  6. Hi Peter – great sessions with Courtney, thank you. I have a bone spur on my big toe knuckle, caused by arthritis. I wonder if Courtney has any specific exercises for helping with big toe arthritis, or whether her treatment would be the right shoes toe spacers and the exercises you and she have shared here. thanks, great programme! Jennifer

  7. I didn’t hear any discussions about socks, is there a recommendation for wearing/not wearing or maybe types of socks for avoid? Or is it fairly irrelevant?

  8. I have always been “geeked out” by the elegant natural engineering of the foot but that’s pale compared to the excitement Dr. Conley brings to it. Like Peter, I had a few “sad trombone” moments from the assessments; many in areas I once did wellat so this swells my enthusiasm for getting that stuff back.

    • Hi Dr. Atia,
      I thoroughly enjoyed your podcast! I had a quick question for you. I have hammer toes on both my feet, worse on the right and worse on the big toes. I have had it as far back as I can remember and every doctor that I have asked about it says that it is genetic and the only way to fix it is to break the bones and let them heal again. My father has it worse than me so it made sense that it would be genetic. In your podcast Dr. Conley says that it is caused by environmental factors ie bad foot habits. This is the first time I’ve heard this but it is exciting because I may be able to fix it. Are there genetic versions of hammer toe?

  9. Loved this podcast! I play a lot of tennis and was wondering if there are any tennis sneakers that have the wide toe box?

    • Surprised there was no mention of shoes like vibram 5 fingers that seem to best promote toe splay, any input on those type of shoes?

    • I looked on the Xero website and one of their new models is purported to be good for racket sports…I was thinking about using it for tennis myslelf.

  10. I’m a woman in my 70’s. I exercise, walk and play pickleball, but I have bunions (one surgically corrected), a hammer toe, and peripheral neuropathy (no pain!). My balance is also an issue. Would it be good to use zero drop shoes and toe separators, along with toe exercises?

  11. Great Podcast and the timing couldn’t have been better. I have recently developed Navicular stress fracture most likely due to rucking with heavy weight too fast with minimalist shoes. Would love to know which shoe Peter wears that he finds that comfortable while rucking.

  12. I loved the episode and I feel like I need to see Courtney. Do I have to go to Colorado to see her? Are there people who share her outlook and expertise in the New York area? Thank you.

  13. Very interesting…thanks for all the helpful info. Would have loved information on neuromas…treatment and causes…have tried everything including several shots from podiatrist which just made the ball of my foot numb without helping the neuroma!

  14. Can anyone comment on good shoes for racquet sports? I looked at the list from Courtney and saw running shoes from Topo but I don’t know if they would work for the rapid directional changes for things like Padel, Tennis, Racquetball, etc.

  15. Super informative episode. As someone with significant patellar tendinopathy at age 29, I suspect improving my foot/toe function might help a ton. Would love if the pod could host a similar convo with a knee tendon expert!

  16. Does toe strength really predict fall risk? Or is it just a marker for other physiologic factors that predict fall risk. Has anyone prospectively measured toe strength in say 60 years olds, and followed them for 10 years for falls? Would toe strengthening alone reduce fall risk if you don’t address balance, proprioception, lower extremity and core strength, foot speed, and so on?

  17. Thanks for a great podcast! When you have Dr Conley back on the show, please discuss metatarsalgia. It was mentioned a couple of times as a very common foot problem, but was not discussed in any detail. I have been in minimalist footwear for many years and still have an occasional bout of metatarsalgia. When it happens, the only thing I can do is wait it out. A puzzle I’ve been trying to solve for a very long time. Thanks again!

  18. I honestly think this is the best podcast AND best show notes to date! I practice physical therapy and I am so grateful for how this platform has made me a better clinician.

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