Episode 264: The Most Important Barefoot Study Ever Done

Some of the most important research about this whole natural movement or bare-f walking bare-f walking, minimalist shoes, whatever you want to think of it. Some of the most important research that has ever been done has come out recently. If it doesn't affect you now, it will and it definitely affects people that you know. We're going to talk about it on today's episode of the movement movement, the podcast for people who want to know the truth about what it takes to have a happy, healthy, strong body.

Starting feet first, you know those things at the end of your legs where we also break down the propaganda, the mythology and sometimes the flat-out lies you've been told about what it takes to run, walk, hike, or yoga, crossfit, whatever you like to do and to do it effectively, and enjoy it. If it's not enjoyable, you're not going to keep up with it anyway. Make sure you're having a good time if you're not. Find something that makes it so you can have a good time.

I can't talk because I just came back from vacation just a few hours ago. I have a serious case of vacation brain. I'm Stephen Sashan, the host of the movement movement podcast, any co-founder and chief barefoot officer here at Zero Shoes. By the way, what we're doing here is creating a movement- movement, hence the name of the podcast.

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You'll find previous episodes of the podcast. All the ways you're going to engage with us and other ways to have more fun. Let's get started. Erin, do you want to introduce yourself and tell people who you are and what you're doing here?

Yes, my name is Erin Futrell. I am a physical therapist first and foremost. I'm also an associate professor of physical therapy at Springfield College in Springfield, Massachusetts. And you are the reason that we're talking about this amazing piece of research because you were the one who spearheaded it.

Let's do the TLDR version and just tell people what you found and then we'll get into the details of how this plays out what's happening after this and how this affects more and more people as we get more and more research. Here's the really quick elevator story of the study. We got a bunch of older adults. That means they're 65 or older.

We tested the pause right there. I'm turning 64 in a couple of weeks. And the idea that you just use older adults in a way is very disturbing to me. But I'll deal with my psychological issues while you can tell.

That is the scientific community refers to people over 65 as older adults. It's not supposed to be pejorative in any way. And the age cutoff tends to be 65. Some studies capture 60 and older.

And then also, you know, this is a caveat, like not all older adults are created equal. So you can be, you know, a young older adult. You can be an older adult. Like if you're in your 90s.

So remember that it's just as diverse as adults or teenagers or kids, right? It's still a really large body of people. But we tend to group all these people over 65 and particularly for my interest as a physical therapist is we want to try to prevent false. False.

False or big problem in this community. They can really be life altering. So we got a bunch of older adults to volunteer for a study. We tested them in order to be in the study.

They had to already have a fall risk. So we captured that. And then we divvied them up into different groups. And one of the groups was they were going to transition from whatever footwear they had to minimal footwear.

And we used a zero aptos in that we had two other groups. There was a control group that was doing what we called a sham exercise program or they were seated doing some arm and leg motions. Nothing really involving the feet. And then we had a group that was doing toel yoga, just specific toe exercises.

And the paper that that we're talking about today, we looked at the data of what happened to the people who wore the minimal shoes compared to the control group. And our big variable that we were looking at was their fall risk. Did we could we improve their balance and prevent future falls? And you know, long story short is yeah, the minimal footwear did that very well.

And it did it. If you like to read research and you love statistics, I don't, but people get hung up on statistical significance. But in reality, that doesn't always mean anything. And so what we have in this paper is real, real change, like meaningful change that you could see and feel and observe in a person over time.

So yeah, so the movement that we got these folks to have better balance just by changing what's on their feet. And this is near and dear to my heart. I say this, I'll say this in advance. Some people get upset when I say this is cavalierism about to, but my father's one of these people who tripped fell broke a step and was dead a few days later.

And I say it's only cavalier because it's been 12 years and so, but this is one of the things that has been top of mind for me since we started zero shoes. And then my mother actually, she's one of these people. She also tripped fell broke her hip, but then live for another 12 years completely oblivious because my mother was just a machine. So I would ask her how she's doing.

She's fine. Why? As she couldn't walk. Not a thing.

So this is huge, obviously. And what thoughts do you have? Or what I don't know where to begin. When you assess someone's fall risk beginning and after, how do you do that?

I'm just really curious. So there are lots of different tests out there. One that's really, really common. And you'll see it if you Google like how to test because you can do it at home.

There's one called the timed up and go test called the tug. It really depends on your age, like it should be kind of divided into age, but it's sort of this umbrella cutoff score is if it's if you get up from a chair, walk out in front of you a certain distance and come back and sit down and you time that. If it takes you 12 seconds or longer, you're at a higher risk for falls. Now, that's a really broad quick and dirty.

It takes, you know, really quick test. Wait, I know people are going to do it. So what's the distance? Yeah.

Oh, God. I don't know off the top of my head. It's probably like, it's probably like three meters, I don't know, like 10 or 20 feet out there. So that is a quick one.

It's really easy to do on your own, but it doesn't really capture everything. So in this, so that's a quick one to just kind of assess for fall risk. And that was one of the ways we quickly assess people's fall risk in this study was we did a tug. There's another test you don't have to do anything physical.

There's something called the three key questions. And it's, do you feel unsteady when you walk? And I love it because a lot of elder adults will say, no, I don't feel unsteady when I walk, but you can watch them walk and they like hold on to things while they walk. And like, what if you weren't holding on?

They go, oh, yeah, I need to hold on. So that's one of the questions. Do you have a fear of falling? There's another question.

And then did you fall in the past year? So if you answer yes to any of those three, you're an automatic higher risk and that test has been sort of validated in multiple countries. It's a really good, quick and easy one. But then the balance test that we used for this study to really measure fall risk and to really kind of put it on a continuous scale.

Like, can you see people getting better or worse was something called the mini best test. So it's called the mini balance evaluation test. And it's a really thorough test. And it kind of captures lots of different things about your balance.

So your vision, your vestibular system, your somatosensory, which is like the sensors in your joints that kind of tell where you are. And also there's a mental task. So what tends to be like, if you're doing something really mentally taxing, your physical abilities might kind of go downhill. And so it captures that too.

So it has people count backwards by like threes or sevens or something like that from a hundred while they're doing a physical task. And so anytime how that goes. So that's what we use in a study the mini best test and to kind of capture all of those systems. And we look at the total score and how it got better or worse over time.

And it got better or time. It got significantly better and it got it got meaningfully better. So there's something called the mini best test is kind of a fantastic test because it combines all these other balance tests that are commonly used out there in the research world, but it puts them all into one test. And it's probably like 10 minutes to do it.

And so it's more thorough than the longer. So sometimes people don't like that aspect of it. But it's very thorough and it kind of captures all these other tests in one. And it's also been studied enough in lots of different older adult populations that there are all these like norms for ages and there's also something called the minimal detectable change.

So how much would your score have to change for it to really mean something that you're balanced out better. And so we included that in this paper we kind of use that cut off score has to get three and a half points or more better for it to really matter. And that happens in the group with the footwear with a minimal. So one of these things where I said at the opening this if it doesn't affect you now will at some point or you'll know someone who does this does affect now.

How would you recommend or talk about you mentioned that there was a transition program so this is something that we're very very diligent about or as much as we can be to say look this is not just about putting on a pair of shoes and the way you go. Some people do that. Some people suffer through that and I don't mean suffer hardly but some people will experience calf pain which I say is totally optional. We're various other things if they don't have a clear idea of how to make a transition.

So what was the transition plan that you had these people go through. So it's funny when I was developing this at the time back when I was developing a study I was like okay you know my background knowledge and in the literature older don't have a lot of problems which is one of the contributors to false is all these different problems you can have. And so taking somebody who's used to like orthopedic shoes or they've been you know prescribed some sort of type of footwear and taking all that support away it's not indifferent like if somebody always wore a back brace or a neck brace and you suddenly took it away. They wouldn't have the capacity to like hold themselves upright those muscles haven't been challenged in that way.

So I was really nervous and I reached out to a mentor mine I mean Davis. I used to study runners and like different footwear and runners so that's my background and I know transitioning runners to minimal footwear we were careful you know about how we did it and I remember the time looking up several different footwear companies what they suggest and nobody gives any like concrete anything at the time I don't know I haven't looked recently but nobody gives you any concrete advice of like what's the timeline how should I do this. So I just tapped into okay exercise physiology principles you know my knowledge as a physical therapist like how do we gradually introduce load to both bones and to your contract I'll tissues your muscles and your tendons. And also keep in mind that these folks might have pre-existing foot problems and so I made up a really conservative schedule and I ran it by Irene and she was like no this is too conservative you need to do it bigger stronger faster and I just was like I just disagree I just went against you know what young Skywalker said no Yoda I'm not I just I don't want to hurt people right.

People are going to be in the study for a year I really needed them to be in it and to you know invest in it and so I made a really conservative plan I can share it on my screen if you want like. It's in it's available in the article and articles freely available on yeah I'm going to put the article and I'll put the article in the show notes so people can download it. So I can sell send you like it's available like is supplementary material in the article but I'll send you a document but we over 16 weeks we like really gradually actually pull it up for myself so I can look at it. We really gradually so the first two weeks I told people I want you to wear these for just three separate 10 minute times right I just want you to walk around.

And do that for five days a week and do that for two weeks right and then so we kind of increased it a little bit every two weeks. You said where you didn't say what they had to do in them. I told them at first I said try to walk in them now we're talking about like people who had they weren't excluded from the study if they had like if they used a walker or a cane or if they were if they had trouble with mobility and that's sometimes a problem like people are at risk for falls or if they have fallen. They're kind of scared to get up and move and so they don't want to go for like long walks or they don't have the stamina so you know we said you can break it up you don't have to do it all at once.

But try to take like three separate 10 minute walk so you're in the shoes for 30 minutes by days we for the first two weeks and we very gradually increase it the next two weeks. Take a 10 minute walk in a 20 minute walk so that you're like walking around but then also just wear them for an hour. So the total time for those two weeks was like hour and a half the next two weeks. Alright keep walking 30 minutes a day and I'm on purpose you know and then wearing for two hours and so we kind of just kept doing that.

And after that the first six weeks I was really cautious with people and then after that I just increased it by an hour every week like per day you're wearing you know so like week seven. They're walking around for 30 minutes and then they're wearing them for three hours a day. 30 minutes and four hours a day week nine. So we went all the way up until I think by the time yeah by week 11 right a couple months they were wearing them like all day.

And then intentionally trying to get some like walking in so 30 minutes and that was one of the criticisms of reviewers of this article they were like oh how do you know the walking didn't just improve their balance and it's been studied out the wazoo that walking alone doesn't improve balance. And so there's a lot of substantial evidence about that and we weren't really that's not what we were really going after we didn't want these people to just walk more we wanted them to. Yeah not a whole new regimen. Yeah.

And we did count we gave everybody in the study of pedometer and we counted their walking and there's been studies about that by itself you get people pedometer they suddenly walk more right. And so the group. You know there's one group for whom that doesn't work. Kids.

So the way I can say this there's a I don't want to throw people into the bus too much but I will throw some people into the bus. The people who came up with a couple who came up with jibbit so those things you put in the holes of crocs. Their next business what they did with the money they got from crocs was I blanked on the name of the company but it was a gamified pedometer for kids like let's get kids out moving more so they have this pedometer. And they move more they win points that they can then spend in our online store.

And I said and I'm thinking if I was a kid I would take the pedometer and just like shake it all day and in fact in their promo video there's like a quick shot of a kid doing that. And it's one of these things where you know the parents love this idea and the kids are like yeah not gonna happen and they spent a.k.a. lost many many many millions of dollars not understanding. So.

No. Well our groups the three groups that were in the study they all walked a quickly they know and it's funny I had to go back and look up the kind of what's that where the 10,000 steps come from everybody does this whole like I had to get 10,000. It's kind of yeah it's kind of made up and there is some cool evidence out there about like also why is that the universal number for like everybody right and so I looked it up specifically for older adults and it you know it's recommended for them. Don't try to get 10,000 steps per day but try to like think about how many steps are getting for a week because sometimes you might take it you did a lot one day you might need to take it easy another day.

But our groups they all they walked equivalently it wasn't like the footwear group was walking more because we did tell him spend time in the shoes but it was mostly just make sure they weren't like putting them on and sitting down and reading a book all day you know. And so that's the point of that. So after the 16 weeks what was happening after that. Yeah so they were in the study for a year so after 16 and the magic number why 16 weeks why do we make them do them for that long tends to be that if you start doing any sort of muscle strengthening exercises.

It can take anywhere from basically about six weeks maybe is the minimum where you might start seeing changes in your muscle or you might actually see them hypertrophy and get bigger and then for older adults it's probably going to take them longer so you know typical for younger adults probably six to eight weeks and so we just doubled that so you're going to capture it something's going to happen to their muscles if anything's going to happen in that time period where we're having to do it like most days a week five days a week. And then after that we told them they could cut they continue to do it as much as they want but do it at least two days a week still spend like all day in your minimal footwear and that was the physio exercise physiology principle is once you've built up your muscular strength and endurance in a with an exercise program you can maintain it by doing something as a little as two days a week. And were you collecting actually back up the giant step so I have not I have been very deliberate about not putting out a very specific plan because of the idiosyncratic nature of what it takes for someone to transition and some of this I mean I'm not going to get into it but I have a whole neurological idea about you know different people need different things to make the transition. The short version is some people literally can't tell if something hurts or not feels good some people just have which is the biggest group is this group that has bad proprio septus skills they don't know what their bodies actually doing so they'll think that they're doing something but videotape shows they're doing something different.

They're pretty fast or they can tell if something hurts they're you know they kind of know where their body is and they just need some cues that can speed up the process of learning and then the last group their natural and their problem is they have so much fun once they get out of shoes that squeeze their feet together they do too much too soon and revert to one of those previous levels temporarily and many of them will go I got a blister seat is bullshit. And it's like no no you just went out and just switched your shoes and still and just did your normal 10 mile run without noticing that this is about form not footwear but footwear informs the form and of course in this case footwear informs everything else as well. I will tell you this like I admit I'm right there with Dr Davis who said it was too conservative I know it was very conservative this plan that I made because I didn't want anybody to get hurt and to drop out prematurely or to just you know not want to wear the shoes to only two people had any sort of adverse effect those two people when I asked them my first question was like, where are you following the schedule both of them and I'm going to throw you under the bus they were both men they said what schedule after we like after we spent so much time going over with them making sure they understood it and checking back in with them and both of those guys like they just didn't follow it all just put shoes on a went and they both would complain that their caps hurt really bad right and never feet and so everybody that followed the schedule it was fine no adverse effects they dropped out one guy did and one guy didn't once one guy had to he was just like his he just did way too much too soon and his he just couldn't he couldn't adhere to like walking around he just needed to rest his caps he had really really really damaged him so he had to drop out the other guy once we got back on the rails and following the schedule he was fine. Yeah, again, like I said before calf pain is optional it's an indication that you're doing one of three things wrong either you're over striding and flexing point of your toes or you're eccentrically loading your calf or you're pushing off as your foot's coming out the ground you're pushing off too much actually is there even a third one those are the two biggies that people tend to do and I know that I think they're actually a third that I can't think of but you bring up an interesting point like I wonder if this is the third I don't know and this is something I commented on in the paper there was this there was another paper I read that said oh in the short term study like they put older adults in minimal footwear and they found one of the things that happened was their stride got shorter and so they said oh they feel uncomfortable a lot of times balance studies do this if you're not moving as much outside of the range that means you have worse balance and so this other author he attributed I think it was he attributed this shorter stride length to this person feeling off balance in the shoe and I'm actually disagreeing I'm just completely my running brain right comes back in because I know when you transition from a thick cushion shoe to a minimal shoe you're straight shortens right because you don't want to hit your foot on the ground as much a lot of times especially if you're a heel striker well what I say is your stride shortens if you're maintaining the same speed of movement your cadence has to increase and the only way your cadence can increase is if you're trying to short because you can I had an email volley with someone just the other day about this and she was saying you know just my stride gets shorter I said well depends stride length has to do with how fast you're choosing to move and whether you know how to actually use your glutes and hamstrings to push you forward and so it's like if you look at Olympic level not all of them but most Olympic level runners their stride is no shorter when they're not heel striking over striding because they are pushing and stride length is you know in effect not a cause so anyway that's all other it is well and this is my observation and runners when we switched them from one to the other it's a very like common phenomenon that changes at a constant speed but we interviewed the folks in the study in all the groups we kind of asked them because we were kind of studying our study at the same time that's a different paper but it's we asked them their opinions about this whole thing and opinions about the shoes and this and that and I remember a few of them said well I feel like I take smaller steps because I don't want to hit my foot on the ground is hard and I was like oh that made sense to me like because it the same thing happens when people switch when they're running like so that might be the third thing you're thinking about like if people don't naturally do that they're kind of hitting their if they're heavy footed and they're hitting their foot on the ground just as hard as they do in cushion shoes that might be a and they do and they do and they do and they do that.

And they do it too soon. I can see that being a cause of pain. Well it could be I mean the biggie is simply just you know any sort of overuse thing and the only way you're going to over use your calves is if you're you're pushing harder or decelerating and those are the two biggest there were some backing up to the transition thing. The thing I say to people is I mean I give them a couple of pointers and say you know the only you want to start stupidly small like if you're if you're walking for a minute maybe five minutes if you're standing all day just you know for half an hour if you're running 20 seconds and see how you feel the next day and it feels like you know you just little too much of the gym you want to think about relaxing more not just getting stronger you will get stronger but that's not going to be a little bit more.

If you feel like you did something bad then a for both situations you want to rest to be better and try again but if you feel like something really went off then you definitely need to pay attention to some big form issue. If it just feels like you know did too much of the gym not a big deal if you feel like you did something crazy which almost never happens then you know you got to pay attention to the form and the forms pretty straightforward. Don't reach out and put your heel in front of your ankle when you land. I mean that's it and then for runners in particular but walking to go instead of pushing off the ground which if you have it you know I say that if you've got a shoe that's super stiff with all this toast rings so it's basically constantly pulling your toes up towards your knees and door and then you got used to pushing in a certain way that now you're doing more of that you don't need to you want to think about lifting your foot off the ground like you're you know like you step on a beat on push harder you lift by flexing your hip or if you're going to need a soccer ball in front of you you know you lift to make that happen.

Yeah. Those are the two big cues and people you know then they get into a tizzy about walking or running slower like a speed is just stride like times cadence times how much steps from minute. So if you want to go faster just make it like one of those I mean not a big deal anyway but back or moving forward or moving in some direction. So I'm curious when you were checking into people what was the check and like were you hearing any spontaneous comments from oh sorry wait I want to tell this story that's what it was.

There's a doctor that I know who works with a very small group of patients they all work together they all work in a factory on country floors all day and he had such a great he doesn't work just with them he works with their families too. He had such a great experience switching like their high school cross country team to minimal shoes where their injury rates went to next to nothing and this tiny little school won like a state championship partly as a result of that that he switched everyone in the factory wearing minimal shoes. And the way when he presents this in public says 97% of them stuck with the minimal shoes and the number of lower extremity injuries that I treat went down to almost nothing. And he says privately the 3% that dropped out because they were having experience then started seeing how everyone else was having a great experience so they tried it again.

And now we have 100% at once we're looking for adoption rate but I can't say that because people wouldn't believe me if I said that. So the fact that you know that one person kind of stuck with it and came back the other one yeah if he had rested more and tried it the way you described or some variation or I imagine it would have been somewhere. So I probably also unfortunately as we get older it takes us longer to heal right and so like tell me that. And it was already he was already too far in by that point where we couldn't really start him over them yeah I got it yes the longer to heal or get over the workout that I had this morning.

I was working with a personal trainer and I said to him a while ago I only worked out three days a week Monday through Wednesday and then I recovered and I basically feel okay by Saturday afternoon. And I say is this the rest of my life that I'm going to have 72 hours of not being sore somewhere he goes yeah what do you expect. So I know you're alive Steven. No I got to tell you it actually does the fact that I feel sore in places means something is happening which I needed this point because it's not like when I was 17 through 30 where I would grow muscular muscular.

That's not the word I'm looking for. I have a hyper traffic response hyper traffic response very easily or I could lose body fat easily at 64 it doesn't happen that fast and and it's so having the soreness kind of keeps me going because I know something is happening and it's not so bad that I actually I've had times where I had to walk downstairs backwards it was the only way I could get downstairs or slide on my butt I've had that to occur yeah it's not that bad now but it is you know I need to use the handrails to get on and off the toilet there's definitely that. So I and my wife asked me early on she said you're having fun oh my god more than I've had decades so it's a good time anyway so I'm curious and I asked this only because of the times that we hear from people spontaneously did you have an opportunity to hear from people spontaneously. During the study about what their experience was or are you asking them that anecdotal stuff along the way.

Well I asked them so at a certain point it was at the 16 week point I asked them questions about their experience and they were trying they were attempting to be like open ended not leading and we asked the exact same questions to all three of the different groups and some of it was based on other research in this area which was like you know did you are you any more aware of your feet or something around the sensory there's like a question asking about their sensory I don't have the exact wording in my head but you know do you feel like you're more aware of your feet or like how do you feel about your foot sensation that type of stuff and people were like oh yeah I can feel everything through these shoes some people like that and some people didn't. They were like I can feel everything and that a lot of times we end up in an answer in a positive way that I can feel the ground better I can correct myself if I feel like I'm about to lose my balance there were things like that being said. And then we asked them about previous pre-existing injuries or aches and pains anywhere in the lower extremities all the way up to the back and many of them said yeah that they were like actually they thought about that yeah hasn't been bothering me. And that comes from that question was kind of stemmed from there's a paper that's written about women over 60 with me arthritis right who wore basically like aquasox like those types of shoes I think they made them wear them for a few months.

Six months yeah it's about sacros studies yeah they wore she was called it and it's still squeezes your toes together but otherwise it's a really inexpensive really lightweight really low ground. And so I wanted to kind of capture that phenomenon and I would say our group was in agreement with that most of them were like yeah like I haven't had any like people have plantar fasciitis or Achilles to not to an apathy like or knee pain or hip pain yeah it actually feels better. Or I haven't noticed it bothering me so you know I would have reviewed that to probably just like what's that go found is and their their's was speculative was we think the whole kinetic chain is affected. I mean this is one of these things how could it not be when suddenly you're at the very least not elevating your heel or putting you know developing a shoe especially if you got a flared soul is changing all that torque and women are effects of when you're landing I mean it's this is one of those things that's so screaming obvious to me and anyone who's been doing this.

So many people I think will tell you you know if they're used to wearing big pick cushions shoes right they feel like they're leaning backwards right they're not like pitch forward anymore. First they have that they have that sensation to go out I was really leaning forward a lot. That's a phenomenon with older adults who is their balance a lot of times they do lean forward they're looking down and they're sort of always trying to catch their balance. They're kind of continuously falling and trying to catch their balance and so putting them back their center gravity changes a little bit and gets more inside them that might be why they feel better balance.

It's something that my wife discovered before we started the company even when I was just making sandals for people and they were going out having a time she wore them for a few weeks and then she put on what she thought was just like a normal shoe that had a very small. Yeah I mean not even a very big heel lift and she's feeling when I fall in my face and so yeah it's it amazes me in both positive and negative ways how the brain is designed to acclimate to whatever you just give it on a continual basis whether it's good or bad. And then I love that it's like oh yeah that thing wasn't bothering me because we also don't notice those kinds of changes especially if it just kind of gradually goes away and then it becomes the new norm and somebody has to bring it to your attention until you go right unless it's one of these dramatic things which we've had that often as well. Somebody switches to our shoes and literally the next day we have a guy who's working with us now who was about to get his second hip replacement.

I send him a pair of shoes and four days later he said I don't need my hip replacement. All right well there you go. The actually hasn't changed but I'm not in pain so. One thing I noticed it's funny I teach goniometry which is like if you've ever been to physical therapy when they measure your joints with this little protractor type of pool and when we go to get to the ankle and we're talking about like college age people right there in their like early 20s.

We're measuring each other and so many of them lack any amount of dorsiflexion. It's because they're sitting in plant reflection all the time in their giant wedge teal shoes and most of them are wearing athletic shoes like around the gym basis with that thick heel and so they're always in plant reflection. Yeah and this is again another one of those things about your brain adapting it's like I watched this happen with runners in my neighborhood where they're big big shoes with a big heel lift and the good runners are not using the heel at all. Not even coming close to it but which means they're not stretching their kilies at all practically and then people say oh if I switch from then will shoot I get a kill his tendonitis like no no no no what happened is your brain got used to the fact you can only stretch your kilies you know a small amount and then you try to force it you had an argument with your brain.

When you switch shoes and your brain is going to try and win because you're working with a much more primitive part of your brain and that one's going to win if you taught it that was safe to stretch your kilies further and there's ways to do that almost instantly then you would have that problem and it's like when I got back into springing when you can't train your spikes or get a kill his tendonitis yeah because you're training in a big picture with a big heel lift and then you're switching to something that's the exact opposite but if you actually trained in the spikes you wouldn't have a problem in your spikes. And eventually also like if you've been if your tissues have adaptively shortened over time. Well this is the thing this way I'm going to let them look at a little. I wonder how much is actual tissue shortening which we can only tell from could ever studies really versus just literally your brain.

Yeah. Yeah. I remember there's one of the one of the people who brought much of felling Christ to America which his whole that whole body work system is all about telling your brain this is safe again and he tells a story of a woman who had a frozen shoulder where she couldn't lift her arm past parallel to the ground and he had her bend over so she was her torso is parallel to the ground and she was her arms high as she could and she lifted it and her arms parallel to the ground but he's standing up and she's pointing at ceiling she's like what the hell. Yeah.

Yeah. No I love that building Christ stuff like it is it's cool to do it this way with this change and people can suddenly do it. Well my favorite part about it is that the way you work is let's work on the good side first decide that isn't having a problem just lock in what it's doing and then we'll work on the quote bad side and it will have learned from the good side and the reason I love that is because that's how I got into this whole thing is I my first foot which is one that got injured more often. So the next week when I went for a run I just paid attention to the good leg and then nine minutes and 31 seconds later the bad leg figured out and everything.

Yeah. Brain like symmetry. Your legs like symmetry. So what else do anything else from the study striking you that we didn't bring up yet?

No I mean you know they're balanced got better. Did you measure strength as well? We didn't measure strength in this we did that we have future paper we did look at what we did it's hard to measure what we were specifically looking at our intrinsic foot muscles right those little ones in the foot they don't go into your calf they're just real small ones called the foot core which are also you know kind of highlighted when you do tell yoga exercises. So it's really hard to measure those with any sort of like strength measuring device that it's sounding so we use ultrasound to measure I gotta tell you they're tiny small muscles anyway and then measuring in people that are in their 60s 70s we had a guy in the study.

He was 96 he was the oldest one in the study. He was in the group he was in the fluid group. It's really hard to find it and some of these older adults somebody we get we measured five different muscles and transit put muscles on the plant our surface of the foot and so I don't know the jury still out I haven't looked at the muscle changes. I would say one of the things we ask people do they feel like they were stronger and I would say anecdotally like a lot of folks out there foot.

Yeah my foot feels better stronger like I can feel with it which was expected for them to see that and I would say the people that did the exercises the so yoga and the people that were minimal where both reported that. Yeah the it's one of these things that I say as a scientifically minded person on the first one to say that anacos does not do not equal data but a preponderance of anecdotal data is a very critical data point and and especially when it's getting spontaneously. And when we say look on our reviews we didn't ask for those and that is what people reporting that's the big deal. Well it's also fun to compare their anecdotal data to the actual data so you ask people you feel like a better balance and we could really tell them if they really did have better balance or not and I would say a lot of people in the control group said yes I think I had better balance.

They did not have better balance. It's one of those things you know you're in a study about fall risk and so we did give them a sham intervention they weren't doing nothing so they but they were doing the control group was doing something that I would say is very commonly seen when you go to like a senior center or you want to see why I have CA of older adult. And you know you got to do what people are able to do and so a lot of for safety a lot of times older adults are told to sit in a chair and do their exercises. Yeah the exercises we gave people they didn't have any weights we didn't progress them in any way they were just doing like active stuff they were really common exercises that you'll see in those classes and there were actually two people in the control group that did get better balance and it might be because they were so bad off to start with.

Right that actually did help them because it is it might have been like significantly more activity for them. There's a problem where it shouldn't have helped them it really I wasn't expecting it to help people. I did some research when I was an undergrad cognitive psych research where without any of the details people thought they totally failed the exercise completely failed it and statistically they all did better and basically had to do with whether we have an innate perception of rhythm and the way the study protocol. We gave people we listened to like four bars of various drum rhythms in various levels of syncopation from no syncopation to like really simple two things that were crazy and the crazy syncopated ones were so unpleasant for people that they just hey and then so they listened to these various some number of them I don't know how many we did and then we wait for a few minutes and we play a number of rhythms back to them and just ask did you hear this one before or not.

And everyone thought they failed it and everyone hated because the syncopated rhythms were so annoying but statistically we found people did break down the way we thought and yes we do have an innate sense of rhythm and yes it doesn't matter if you're black or white. So that's what happens when you get to do a study in the south. That's cool. But there's another one that's interesting I have a friend who has a company called Nimble and why MBL and they're doing the cognitive stuff that you talked about.

So it's an app where people are mostly doing you know stand a sit and various very very simple exercises while getting some additional cognitive load and they're getting good results from that as well they won't use my shoes because they don't want that to be a confound they want to be all about their app to get money for the app not get money for our shoes which totally cool they wear our shoes. But they don't prescribe them because they're trying to prove the value of the app. But that's another one that I find very interesting especially since my undergraduate research was cognitive research was cognitive aspects of motor skill acquisition. So what's happening with in your brain while you're learning something and what happens if you're being distracted or not being distracted and so it's all fun.

So I won't say with this you just stimulated my brain. One of the things that we really wanted to look at so we were our main variable of this study was fall risk because that's easier to study with smaller groups. If you want to study big like epidemiology of falls you study fall incidents or you actually literally count how many falls someone have and you have to follow people for a minimum of a year to really get a good idea unless they're a very high risk population maybe could do it. Right.

But and then there's even ideas that you should do it for two years right you should follow somebody for two years to really capture if something's really changing fall incidents in a population but to do that you have to have huge numbers of people. It's the same with like running injuries if you want a running injury to occur. You got a prospective study with hundreds of people and it's the same here when we look so when we were looking to design the study. The funding agency wanted us to use fall incidents and I tried to my statistician and my co author Julia and I were like okay no problem and we looked at how many people we need to study.

We're going to need like 800 people. Yeah, maybe it depended depending on the equation was like 400 to 800 people and sometimes that was per group. So I have been like 1200 people if we had three groups right it was just kind of unattainable for little old me and my fun you know my little lab. And so that's kind of an inherent problem in falls research is that if you want to study falls incidents you have to have a ton of people.

If you want to look at fall risk you can do it with very few people like relatively in the study with you know it was like the whole study had about 100 people in it. Well it wouldn't be it wouldn't necessarily again back into statistical significance it might not reach that level but of course now you have these two groups and doing a sort of follow up could be interesting. Actually three groups and it would be interesting to see you know if there's any follow up this meaningful but even that you know cost time effort money. And this is the thing that I'm grateful for is that in the early days of the whole barefoot movement barefoot movement there was just no money involved and there was no one doing there was very few people doing any research.

And because what's the point the people had the money were not going to do the research because frankly those are the big shoe companies and they know what the results would be it would not be in their favor. And I say that because on the Nike website they have the results of study that they did and it proved that there's huge people at different rates and different shoe designs and different rates. So they didn't do that till six years ago or so that they did that study. But so yeah I mean something with these these three cohorts you have could be interesting there's a way to follow up but more importantly what's coming up.

So I was saying it's great seeing this research actually happening. At the same time it's not making a difference yet because the belief that cushioning is good more cushioning is better the super cushioning is even better even though there's a rant for hours about why that's not true for 99% of people. It's just so ingrained it's going to take quite a while till people start to really believe that or more accurately it's going to take quite a while till enough of the population has the experience of the benefits of getting out of their shoes that people will start to accept it as possible. And then another there'll be another inflection point where they go oh let me try it and another inflection point after they have the experience and have something similar to what we've been talking about.

And that's all you take time. I tried in this study so there were about 100 people in the study across all three groups and when everyone was done with the study as they ended and we told them their individual results we kind of told them what was the whole study about and then we gave them the option. We will give you a pair of these shoes if you want and a lot of them took that option. And so we provided the shoes because at the end of the day the shoes really helped right so I wanted to give all these people that had volunteered their time with me.

The opportunity to like to use those and so we gave them all free pairs of shoes and so yeah. And even the people that did the foot exercises we gave them the opportunity to have the shoes to and I would say the majority of the folks took it. There's another study that's like a short term study just about kind of the immediate effects of what happens in with older adults and minimal footwear. And they actually got their opinions on the aesthetics of the shoes and I would say that's a challenge right is like everybody all the time and I didn't really give people like color options or anything like that.

Just like here. Yeah, everyone's got an opinion on that one. I mean, for everyone who says I don't like this shoe or this color I can find another person who has the exact opposite opinion. So there are so many more options now.

Well, yes or no, there are more options now but there are also many more options that are not truly minimalist footwear. They're either too much padding or a little heel lift or pointy toes. I mean, it's basically we're reliving what the early days were 16 years ago where the big companies came actually 15 years ago and the big companies came out with what they called barefoot shoes which were not. And now there's just more companies who are doing that who are smaller companies doing that the bigger companies aren't even doing it as much.

So it's the same kind of confusion in the market. I was at an event recently where somebody was wearing a quote competitor shoe that I knew was not a truly minimal shoe and he was raiding about them. I said, well, come over to our booth and try on ours and he puts on ours went, oh my God. These are different.

Yeah. So about keeping the shoes. I there was a very informal not even a study really but we gave some shoes to a physical therapy works with a lot of Parkinson's patients and again, not a real study but just kind of wondering what would happen over time. And there was some really cool again anecdotal info like one person kind of shuffled in and then put on our shoes started like jumping around and walk out fine and I bumped into her a year later.

And she said, by the way, everybody kept their shoes. They're still wearing them and they bought more. So and again, I'm not I'm happy about that obviously for the business but I'm more happy about that because as Lena my wife said early on just. Look, there's enough shoe companies in the world.

There's no reason to start another shoe company unless you're changing people's lives. And that's the thing that gets us up in the morning and deal with frankly all the significant challenges of running a growing business is that's what we hear all the time for people and from people and the more we can identify specific groups where we're showing a demonstrable benefit, the better and I know there's more research coming out that's going to allow us to talk about other specific ailments or injuries or issues and the more of that the better because that's it's going to help over time at the very least if somebody buys a pair of shoes and they see the research, it gets them some whatever that word is for not buyers or more. Yeah, well, at the very least, here's what I in the background research that I did and my team did. We looked at this huge report about there's this huge report that comes out called the US preventative task force does this like study about all the false literature.

And they look at everything they look at medication they look at vision they look at exercise but they find that exercise is like a good thing right it can moderately improve your balance. There's a lot of other reasons that people can fall but musculosciently neuromus yearly right we do what we can and so and I think they included like 70 studies about exercise in their report. And like two of them included anything about the feet. Well, and you know even the stuff that we really need to include the feet people that's the first contact with the earth.

Even more the thing that I find I wish I could say I find it perplexing I find it just too obvious to unsurprising is that the research that's like anti barefoot anti natural movement usually has two things in common almost always the first is we let people transition to a barefoot shoe by running for five minutes on a treadmill. I mean something as simple as I mean as stupid as that one and simplest that one and the other is they never pay attention to or measure gate because like I said this is about form not footwear it's a bit where it forms your form. And I mean I've had this argument with doctors for 16 years when they are getting more patients than ever thanks to this whole barefoot thing I go cool first of all you guys had the same thing in 1972 when running became a big thing and running shoes became a big deal. So get your story straight which is it and then secondly I go this is about form not footwear so when people came in did you ask them if they were actually running barefoot or in what people in the industry think of as a truly minimal shoe or not and they will know.

No I go did you look at their gate anyway did you do any gate analysis and you know what proper gate mechanics are no I don't really care about your story about getting more patients when more people start doing some activity when the pie gets bigger your proportional slice gets bigger too even though the proportions of same and by the way how many people in regular shoes are still getting injured at a very high rate. So it's like what's the math on how many people who are you know doing barefoot running especially correctly what's the math on how many of them are getting injured compared to the people who are wearing a regular running shoe again back to the Nike study their best selling shoe in a 12 week study injured 30.3% of the people wearing it. How do we compare that if I 100 30.3% of people wearing our shoes in a year I'd be in jail. So no I'm trying to avoid that although you know I could use the mental break at this point it could be vacation vacation again.

I'm cool being a lot of meditation I spent many many hours in a room just staring at breathing. So all right so what's the future for you want anyone else that you're hearing about or any wishes for the future in my country search. My wishes are to continue this work continue looking at how footwear effects feet how we can strengthen feet how that translates to function. I would love to continue just like kind of offshoots of what this study told us okay so we know this can help older adults with fall risk okay well let's let's have people wear the shoes while they're doing these like fall prevention exercise programs because they don't really like involve the feet and we need to involve the feet yes strengthen your quads strengthen your feet at the same time and that's a simple we know that you could do the targeted to yoga exercises and these older adults could do those but they're hard and they're frustrating even for young athletic people.

It's also anytime you're getting someone something that is a real noticeable change in your daily routine just yeah it's always low. If you can slap on a pair of shoes that we know can benefit you and get you stronger as long as you do it gradually right and let your body get used to it. Then it can just be part of your routine and part of your day and it can really make a meaningful change and so that's really what I want to continue doing and also kind of I'm trying to build right now a database of feet because as far as I know it doesn't exist. And so wait what are you measuring because we have we've got one.

You have a database feet. I'm measuring I so I look at just one muscle with ultrasound and look at the abductor halicis I ask people about their shoes what they wear for daily use as well as if they play different sports or if they're dancer or whatever their activity is we measure Alex valgus angle because that's easy to measure we do measure we try to measure strength of the abductor halicis with a little dynamometer kind of like the paper grip test like pulling out a card but we do with a little dynamometer and then we do the arch height index seated and standing which if you don't know what that is it's kind of like one of those foot measuring devices and shoe stores but on steroids and it's considered kind of a better way to measure your arch height. Because it takes into account foot length of with things like that. You know you just remind me the one study that I can think of that hasn't been done yet and this is coming from anecdotal data starting with me is I had ridiculously flat feet my whole life and there's some muscle I stick my foot on the camera and show you back to laser to do that right now.

That was like over developed as a result and once I started spending more time barefoot and specially running barefoot my arch developed and that's not anything massive that's predominantly genetic but there's an arch I mean when I step out of swimming pool it doesn't look like you know an egg with dots around it and egg with more eggs around it. There's actually a little curve in there and that muscle that was overworked is no longer protruding the way it was overworked. I have not seen or heard anyone wanting to do a study on changes in arch height with whether it has to be with you know wearing zero shoes or just doing foot exercises or whatever and that's one that I would like to see. Now I think you know what they have done is I can send it to you there is a study of like not that they did interventions but people who wear minimal shoes or people who don't they just look at different characteristics of their feet.

I'll send it to you and I want to say that there are noticeable differences. Interesting I mean I'm not going to be surprised but I'll be curious to see what they say by the way we don't have the database that you're looking to put together that would be a good one. But yeah I'm just trying to because really like there's no way to say what is an average or what is there's not such thing as normal right but like and the opportunity I have at Springfield college is we're very sporty school with a lot of athletes and so I'm trying to measure just starting with the easiest low hanging fruit students. And so they're all kind of a certain age but they all I can get a lot of feet per sport.

Yeah. On athletes or per dancers where I can start to look at oh and I've asked like what kind of where they wear so I can say and we were kind of in it with the athletic training department where they contract their injuries and so over time I can develop this usual database. And be like do certain foot types or certain footwear have relationships and do they end up leading to certain types of injuries in certain sports. Now it'd be interesting I realized now my story is a little not as good as I wish it were I just realized why I watched some video I don't remember who did it about foot strength and developing foot strength and talked about certain sports and you could do or certain things but then he mentioned by the way I mean you know gymnast and dancers foot strength is through the roof.

And I was a gymnast until I was 32 but then after I landed and twisted and heard that sound coming from my knee a gymnastic stop and I didn't I wasn't really doing anything that was very foot intensive for like the next 15 years. And so I think you know my foot strength came back more than just developing it from nothing is my suspicion I don't know it's the one regret that I have is that I didn't measure foot strength and arch height which I guess will be two regrets from the day that I started this until you know anytime there after. But I've measured since and you know it's off the charts for an almost older guy at 64. I'm just waiting I'm actually looking forward to 65 a I'm in a new age group for sprinters and be you know all the discounts I mean that's right everything's going to be cheaper right.

I know I'm very excited. I'm not excited about having had dinner at 4 30 but you know that's okay. I know I do you again you know 65. I do you it's going to be it's going to be an assault.

Yeah I haven't really thought about that until now and depressed. So I'm actually looking forward to getting the point there's a story that I heard a blackjack card counter was at a table and there was like some old like old guy like he was 80 years old sitting at the table just half asleep and would play a few hands and then kind of go back to sleep and then play a few hands and go back to sleep and finally the guy who was a card counter noticed that this guy was also a card counter. And he was only playing the hands where the advantage was like way in his favor and but no one paid attention to him because he was just like random old dude and he walked away with 40 grand. Yeah with age comes wisdom and that guy and a certain level of anonymity if you play it right.

Yeah. There you go. Things to look forward to. I it's all very interesting.

I can say that anyway Aaron if anybody wants to get in touch with you for any reason including like you know if they are inspired to help a funding in some way what's a way that they can do that. They can email me do you want me to send it to you so you can post on your website. Well you can also tell them. You trail at springfolkcollege.edu last name is spelled F is in Frank UT or ELL and I also have a little small research lab at spring folk college we call it the fit lab stands for I'm not even going to know it but intrinsic testing and training lab.

So the fit lab at spring folk college you can also search for that and I'm on there. Awesome well thank you thank you and I mean I thank you for this of course and thank you for the research which I know when you told me about it I couldn't have been more excited and I had expectation about what happened and those were exceeded so it's just been really a treat and I'm looking for lack of a term taking advantage of that exploiting that to help more people who are currently at risk for falls where we can help do something about that because it's surprisingly an untapped area of research and an untapped I think business market to really get it all compiled. And it's an 80 billion dollar insurance problem right now so this seems like a pretty simple solution. You one would think.

The study that I did was funded by the CDC they also think that before all the funding was taken away they also thought that this was a worthwhile thing to look at because it is a simple and affordable way to make a difference people's lives. Very very happy here. Well for everybody else thank you so much for being part of the conversation and just a reminder that a if you like what you heard and want to hear more spread the word give us a thumbs up or like or five star rating or hit the bell icon on YouTube. Well you're here about future episodes you want to find previous episodes go to www.join the movement movement calm but most importantly no matter oh by the way if you have any recommendations requests people who think should be on the show especially if you think there's someone who has who thinks I have a case of cranial orientation syndrome then I want to hear about them I've been for years wanting to get someone who thinks I'm completely full of it to talk to me but they don't want to I've had one where I got really close but then he realized it would be public and he was like oh no I don't want people to hear what I'm thinking but I would love to have that conversation I'm open to it.

I'm literally open to if I'm wrong about something there's nothing I like better as a marketer I like finding that out to then figure out what I need to know more of or better of or whatever would be an English sentence anyway. Anyway drop me an email move m-o-v-e at join the movement movement calm and more importantly no matter what you're doing between now and whatever we do next go out have fun and live life feet first.