After 40, Your Feet Predict How Long You’ll Live — Fix This Before It’s Too Late | Courtney Conley

In this podcast episode, host and guest Courtney Conley explore the critical role that walking and foot health play in overall human wellbeing, especially as we age. The discussion covers walking as a physiological necessity akin to breathing and sleeping, the impact of modern footwear on foot function, the importance of foot strength and mobility, practical advice on footwear selection, essential foot exercises, and the increasing significance of foot health after the age of 40. Throughout, Courtney shares insights from her clinical experience, personal journey, and scientific research to illuminate why attentive care to our feet is indispensable for longevity and quality of life.

Walking as a Physiological Necessity

Courtney makes a bold assertion that walking is not just exercise but a physiological necessity essential for survival, comparable in importance to breathing and sleeping. Human biology, as a species of bipedal locomotion, is fundamentally structured around rhythmic, low-intensity movement such as walking. Walking integrates and facilitates the function of numerous bodily systems—musculoskeletal, nervous, lymphatic, and endocrine—working in symbiosis with breathing and sleeping. Disruptions in any of these areas negatively affect the others, influencing stress hormone levels and fatigue, which then impact motivation and physical activity levels. Framing walking as "Vitamin W," Courtney emphasizes that insufficient walking is less about risk reduction and more about addressing an evolutionary mismatch that leads to widespread health problems like cancer, dementia, and chronic pain. Recognizing walking as an essential nutrient encourages a proactive approach to movement rather than reactive management of disease.

The Foot: The Overlooked Foundation of Movement

The foot is the primary interface for locomotion, acting as the foundation for every movement and mobility-related function in the body. Despite this, feet are among the most neglected areas when it comes to strength, rehabilitation, and overall care. Courtney draws a parallel with back pain management—where improving strength, stability, and mobility is routine—and contrasts it with foot care, which traditionally relies on orthotics or cushioned shoes that often inhibit natural function rather than enhance it. The rise in foot pain, particularly after the age of 45, is alarming, with estimates suggesting one in three adults suffer foot pain at some point. She attributes much of this to inappropriate footwear and a lack of awareness surrounding intrinsic foot muscle function, joint mobility, and the foot's sensory capacity. The evolutionary design of the foot equips it to handle loads multiple times body weight, especially during walking, but modern footwear disrupts this natural capability.

Modern Footwear and Its Impact on Foot Health

Modern footwear's design largely prioritizes fashion or superficial comfort over foot anatomy and functional integrity. Courtney highlights that many shoe designers lack knowledge of foot mechanics, which contributes to shoes that often deform or inhibit natural foot motion. Ill-fitting shoes with elevated heels, narrow toe boxes, and excessive cushioning lead to muscle atrophy, joint stiffening, and loss of sensory feedback from the sole of the foot. She uses the analogy of training a jet engine on paper airplane feet to illustrate the disparity between the strength of the body's upper components and the underdeveloped strength of the feet. Cushioned or "rocker" shoes may provide temporary relief or assist those with specific pathologies but can cause long-term weakening by doing the work that the foot should naturally perform. This gradual loss weakens the foot's ability to provide balance, power, and propulsion, which are critical across all stages of life.

Footprint of Childhood Footwear and the Importance of Early Care

The developing foot in childhood represents the biggest opportunity for lifelong foot health. Courtney emphasizes barefoot experiences for children, allowing them to gather sensory input, stimulate motor development, and build muscular strength. Shoes for children should have a wide toe box, thin and flexible soles, and no heel elevation to respect the evolving anatomy. Restrictive footwear before or during this critical period leads to deformities such as bunions, hammer toes, and reduced toe splay—the widest part of the foot should naturally be at the toes. She also points out that flat feet are common in children due to ongoing development and are often mistakenly pathologized, leading to unnecessary bracing or orthotic use instead of stimulating natural function. Parents should strive to keep kids barefoot inside and opt for functional footwear with appropriate design when they need shoes.

Footwear Choices for Adults: Minimal versus Functional

For adults, footwear falls on a spectrum between minimal and functional. Minimal shoes meet three non-negotiables: a wide toe box, zero drop (heel and toes on the same plane), and thin, flexible soles that allow natural foot movement. Functional footwear shares the wide toe box but allows a small heel-to-toe drop (up to 6 mm) and some cushioning, serving as a transitional option for those whose feet are weakened by years of inappropriate footwear. Courtney advises a gradual transition to minimal shoes, akin to progressive overload in strength training, because sudden shifts can lead to injury. Functional footwear brands like Topo Athletic, Altra, and Vivobarefoot occupy this middle ground, offering healthier biomechanical alternatives without overwhelming those new to barefoot-style shoes. Proper footwear should avoid deforming the toes or overly elevating the heel, two common features of fashion shoes and many running sneakers that disrupt foot mechanics and sensory input.

Foot Health Assessment and Therapeutic Exercises

Courtney underscores the significance of simple foot assessments that also double as therapeutic exercises. Lifting the big toe while keeping other toes down evaluates toe strength and neural control; many individuals cannot isolate this movement, often compensating by lifting other toes or rocking onto their heels. Toe splay, or spreading all toes apart, assesses muscular balance and foot posture. These movements stimulate neural pathways, improve foot dexterity, and contribute to strength gains. Single-leg calf raises are used both as a test and strength-building exercise; quality matters as much as quantity. Correct form involves a straight leg, landing on the ball of the foot without ankle instability or knee bending and performing at a controlled cadence. Most people—including elite athletes—fall below the expected norms for their age, indicating widespread foot weakness. Assessment of walking gait can reveal compensations such as unilateral arm swing or altered heel strike, which reflect underlying neuromuscular issues.

Common Foot Issues: Bunions and Big Toe Mobility

Bunions (hallux valgus) are a prevalent foot problem often misunderstood as purely genetic or cosmetic. Historical data shows that bunion prevalence increased notably with changes in footwear, such as the introduction of pointed medieval boots, challenging the notion that bunions are a modern female-only condition. Genetics and connective tissue laxity can predispose individuals but are not sole determinants; lifestyle and footwear remain pivotal modifiable factors. Early interventions focusing on strength, mobility, and footwear choice can stall or improve bunion progression; however, in severe cases, full reversal may not be realistic. Instead, pain relief and functional improvement are realistic goals. Big toe mobility is vital not only for foot health but for the biomechanics of the entire lower kinetic chain. Adequate extension (about 40-45 degrees for walking, with up to 65-70 degrees possible) is necessary for proper push-off during gait. Restricted big toe motion leads to compensations with repercussions on knees, hips, and back. Pinching or pain during big toe extension indicates problems that should not be ignored.

Foot Function and Athletic Performance

Courtney has worked with elite athletes, including NFL players, and observes a recurring pattern: outstanding strength and power above the knee but neglect of foot function, which limits overall performance and longevity. Feet require progressive loading and targeted training just as other body parts do. Strong, functional feet underpin efficient speed, power, and agility. For runners, early barefoot or minimal footwear exposure during development builds resilient, wide feet optimal for performance. Although high-tech running shoes with cushioning and carbon plates provide advantages in racing, they do not replace foundational foot strength gained through natural movement and training. For sports involving lateral movement, such as paddle or tennis, Courtney advocates training foot mobility and strength through all planes, including inversion and eversion, rather than relying solely on shoes with rigid lateral support. Foot function is key; supportive shoes have their place but should complement—not substitute—the trained foot.

Walking Speed and Its Predictive Value for Health

Walking speed is increasingly recognized as an essential "sixth vital sign," predictive of health outcomes including dementia risk, with research indicating that slow walking speed can foreshadow cognitive decline years in advance. A brisk cadence of approximately 120 to 130 steps per minute sustained for about 30 minutes daily correlates with lower risks of chronic diseases such as cancer, depression, and dementia. Walking speed reflects underlying muscle strength, neuromuscular function, balance, cognition, and overall vitality. Regular assessments, such as timing a familiar walking route or using a metronome to match footfalls, help monitor this parameter. Improvements in foot strength and function directly influence walking efficiency and speed, and conversely, intentional walking practice at increased pace serves as power training, which tends to decline faster with age than strength alone.

Sensory Decline with Aging and the Role of Walking

As people age into their 50s and beyond, sensory receptors on the soles of the feet lose sensitivity, requiring 20-25% more pressure to stimulate afferent nerve fibers. By 80 years old, this loss may reach 75%. This sensory decline contributes to impaired balance, increased risk of falls, and reduced gait stability. Exercising the feet through movement and targeted foot strengthening can improve circulation, promote nerve fiber branching, and partially restore sensation. For people with peripheral neuropathy—due to diabetes or other illnesses—exercise remains a foundational therapy to boost circulation and function alongside other treatments. Thus, maintaining foot health through proactive walking and rehabilitation is potent in preserving independence and reducing the risk of debilitating injury in later life.

The Psychological and Social Dimensions of Foot Health and Walking

Beyond physical benefits, walking and foot health exert profound effects on mental wellbeing. Courtney shares how inability to walk due to foot pain can precipitate anxiety and depression, spotlighting movement as therapeutic for mood and cognitive function. Furthermore, gait uniquely conveys emotional states; confident strides versus cautious or painful walks offer visible cues to observers, reflecting the nervous system's status. Reclaiming foot function can restore both physical independence and emotional confidence. Hosting these conversations publicly through digital media extends access and empowerment, as evidenced by listeners and followers who report resolving knee pain and improving mobility by applying accessible foot exercises.

Promoting Practical Foot Care and Accessibility

Courtney's clinic offers online services and a foot health kit designed to simplify daily foot care, including toe spacers to improve toe splay and structures that assist big toe mobility. She dispels myths that barefoot walking damages feet, highlighting the importance of skin and sensory interaction with ground surfaces. Her approach emphasizes incremental change—novel stimuli spark neuroplasticity even in advanced age—and gradual reintroduction to barefoot or minimal footwear to avoid injury. Five to ten minutes of foot-focused activities daily, including toe yoga, single-leg balance, and calf raises, confer meaningful improvements over time. The message is clear: it is never too late to begin, and consistent small steps lead to enhanced foot health and overall longevity.

Embracing a Lifecycle Approach to Foot Health

The conversation underscores the necessity of a lifecycle perspective—from infant foot development through adulthood and into old age—about the importance of foot health in optimizing lifespan and quality of life. Early childhood barefoot time, thoughtful shoe choices, and ongoing foot exercise build a foundation that reduces future pain and mobility limitations. For adults, particularly as they age past 40, the window remains open for rehabilitation and strengthening, which open pathways to improved walking speed, balance, and reduced disease risk. Walking, supported by functional feet, remains the cornerstone of sustained independence and vitality. The discussion wraps with a call for greater awareness, changing cultural expectations around footwear fashion, and rehabilitative priorities to restore foot function and, through it, transform health outcomes.