Kim (00:01.424)
Hi, Dr. Emily, welcome back. You are my first repeat guest.
Dr Emily (00:06.349)
I'm so honored. Thank you for having me back.
Kim (00:10.343)
Thank you for agreeing to be back. Yeah, I was looking back and you know that it's been now a little over a year and a half of doing podcasts. And yeah, there's definitely a couple people that were popular and that I would love to have back to explore deeper and the foot is something that is, you know, it's not talked a lot about in your world it is but in my world or pelvic health has not talked about a lot and I this thing is such an important topic. So thank you for coming back to explore it deeper with me. Yeah.
Dr Emily (00:38.202)
course.
Kim (00:39.495)
So those of you who are listening, can go back and re-listen to the initial episode and I'll tag that in the notes, but just quick highlight, who are you, what do you do and what got you so passionate about feet?
Dr Emily (00:51.426)
Yeah, so Dr. Emily, functional podiatrist versus traditional podiatrist. So I take a very integrated approach with the foot, with the rest of the body, specifically with the deep core pelvic floor, because I'm very much into human movement. I also have a master's in human movement. My passion is in gait assessment and really optimizing gait for movement longevity and a big part of how we control movement, i.e. walking.
is to have a very powerful connection between our feet, which is the only contact point between the body and the ground, and then our center of gravity or our center of mass, which is going to be part of the deep core. And how they communicate with each other is just so pivotal to how we control movement. And then last little piece is that...
Also a big part of my practice is that I focus on neurosensory stimulation or the sensory side of the foot and sensory side of movement in the body, which has led me to develop Noboso, which is a sensory based product line. And I'm the CEO and founder of that company. And I kind of balance both of those hats of being a clinician and a CEO.
Kim (02:00.666)
Mm hmm. And a mom. So why would you just you you touched on a couple of points there, but why are feet so important? You said they're the first contact point with the ground. And I mean, we think of even back to we were just talking about our children. So, you know, putting them into shoes at an early age and after having done studies with or not studies courses with different people.
Dr Emily (02:02.254)
in a month.
Kim (02:27.696)
recognize and I probably would have made different choices had I known different information at the time about footwear and myself having transitioned to the minimal footwear and you know all that sort of stuff. So why are feet so important? And then if you can tie that into why they are so important from a pelvic health and posture perspective.
Dr Emily (02:51.248)
Yeah, so feet are obviously extremely important, but what I would put even more so is movement is what's important. And as a human movement specialist or someone who's very passionate around movement longevity, is I truly believe that our ability to move well, to move the right way, to have the appropriate quality of movement is necessary for a healthy, happy...
long life. And part of the movement story is then, okay, well, what's happening as far as how our foot relates to the ground, how our foot senses the ground, what happens from a sensory perspective every time your foot contacts the surface. So there is a very important biomechanical story behind the foot. So mechanically, it is our body's foundation. If your foundation is not stable, the rest of your structure above cannot or will not be stable.
just mechanically, but there's a very important fascial, fascial muscular pathway that occurs between our feet and our deep core. So foot strength and foot awareness is very important to these fascial lines and how we stabilize our center of mass, which is what I had referenced earlier. And then also from a sensory perspective. So we were designed to move while
reading and adjusting to every step that we're taking. And there has to be that dynamic, live interaction with the surfaces that we're moving on so that your body can correct and adjust to every step that we're taking. Because a big part of movement that I focus on is movement accuracy. We want to be moving accurately so we don't get hurt, we don't fall. Or if you focus on athletics, it focuses on performance.
Kim (04:44.328)
Yeah, yeah. And I'm also looking at my youngest son who is a high level soccer player and how much time he spends in soccer cleats. And I have him in the splays, the neboso toe splay spacers whenever he's not in his shoes because I'm seeing the casting effect of our shoes. so if I think about how you're talking about movement accuracy and I think of it also like efficiency.
and how the foot will translate up the chain. And when there is foot pain or when there are foot issues, the compensations that then can influence the rest of the body. also then how we are pardon me. I've got a angry cat in the room here if you can hear her. But but how we are interpreting and as you say, feeling the ground and the movement that we're making through space. But the other piece about footwear. So I've kind of
alluded to the way that a lot of shoes are cramping our toes. They're very padded. They often have a higher heel, so a positive heel. What should we be looking for from a footwear perspective that would allow us to better feel the ground and move more accurately or more efficiently?
Dr Emily (06:08.226)
Yes, so for most people, this will be a majority of people, you will want a shoe that allows as much sensory stimulation as possible, which means we have to get away from the cushion. Cushion is essentially damping or taking away all of that information. It's being muffled and we need that information. So minimal cushion, ideal. Our foot is designed to naturally spread, engage, contract, twist.
Right? So the foot actually has a spiral that exists between the front of the foot and the back of the foot. And that means that your shoe has to allow that same freedom of movement if you want to unlock that freedom of movement in the foot. And so when I assess a shoe, of course, there's none around me, is it's not just about folding a shoe in half. Oftentimes people say, look how flexible the shoe is in the folded in half like a
like a sandwich or a wallet, right? Instead, you wanna take a shoe and twist it like a rag. And then when you twist a shoe, that is really showing the ability for the shoe to allow the spiraling that occurs between the front of the foot and the back of the foot. And when your foot spirals, there's this fascinating rotation that's actually created in your legs all the way into your hips. And that's how you achieve
glute power and glute strength or hip strength is from the spiral that comes from your foot translates all the way into the hip. So very important to be looking at footwear that allows that natural movement, that natural coupling that occurs if you're truly looking to harness as much strength in your hips. Athletics, they usually do. Unfortunately, shoes like cleats are very rigid. So they're taken away that function of the foot.
which in my opinion does contribute to lot of injuries that we see in soccer and football and certain certain cleated sports.
Kim (08:10.238)
Yeah, yeah. You mentioned the glutes and the glutes are also really important from a pelvic floor perspective. But I want to talk specifically in it's I think your answer is going to be somewhat about this spiral motion, but the big toe connection to the glutes and why we want to have mobility in that big toe and how that how that connects with the glute. What's the relationship there?
Dr Emily (08:35.15)
Yeah, so there's actually several. So your big toe, when you push it down into the floor, actually all your digits, but we'll focus specifically on the big toe, when it anchors or pulls down into the ground, technically it's activating long flexors in the foot, and these long flexors run up your lower leg, into your inner thigh, into your deep hip, into your pelvic floor. So there's a fascial connection between the big toe and your posterior pelvic floor.
and then your posterior pelvic floor blends into the deep sacral fibers of your glute max. So you have this continuity of stabilization, it's a muscular continuity that is very important to how you achieve power in your hips. That's the first one. Second one is that you can go more into movement and mechanics, meaning that part of walking, which that's what I focus on, that's your foundational functional movement pattern is walking. You have to be able to take a long
steps to walk the right way. Actually to walk fast enough you have to take long steps. And part of taking a long step is you have to get your leg behind you. So that's hip extension. And then you need to be able to get over your big toe. So for the listeners, can almost picture someone in a step length, like a stride pattern. And the leg that's behind you, see it? A beautifully extended toe, which is called dorsiflexion. A plantar flexed ankle. A knee that is straight.
and a hip that is extended, right? And you're essentially hitting all of these extensions. If you don't have range of motion in your big toe because you have a bunion, you have arthritis, talus limitus, rigidus, whatever it is, then you can't take that long step. You have to essentially shorten your step, which then starts to affect the degree of hip extension you move through. And now you stop extending your hip because you can't get over your big toe.
and therefore you become anteriorly dominant in your hips, in your pelvis, and you can actually reciprocally inhibit the glutes. So that's another one of how you could connect it. Or people may turn their feet out, which is another one that I see. So instead of just shortening your step, you turn your feet out and you kind of go around your big toe because you don't have the range of motion, so you're going to cheat a little bit. When we turn our feet out and we walk like a duck, essentially,
Dr Emily (11:01.388)
and you externally rotate your pelvis, you have essentially locked your SI joints. So now you are kind of waddling in a sense, which creates other inhibitions into the pelvic floor and then up the rest of the chain. So from a stability toe activation, which was kind of that toe strength to post your pelvic floor, that's a very important mechanism. And then you have the range of motion of the big toe.
which connects into how we go into our glutes. Very powerful, both of them.
Kim (11:32.513)
And as you were talking, so I'm standing, I'm my standing desk and that where I'm standing right now. And as you were talking about pushing your big toe into the ground, I'm doing that. And you can feel this activation in through the inner thighs. And you know, the way that I feel, definitely feel it mostly in the inner thighs, a little bit up into the pelvic floor, a little bit in the outside parts of the hips as well, just by the position and the,
the force with your big toe. So I think it's so cool to look at just minute movements and how everything is connected. It's so fascinating to me. So you talk about the foot core connection and you do a lot of foot sort of activation exercises that are helping. I mean, stimulate the bottom of the foot, stimulate up the chain. Can you talk about what the foot core connection is and what what are some of the
ways like the exercises that somebody might do to help with that.
Dr Emily (12:34.894)
Yeah. So the way that your foot connects to your deep core, you could think of your, the muscles in the bottom of the foot. let me go back. My apologies. So the muscles on the back of the foot or the bottom of the foot, are called intrinsic. So they're deep muscles. I want the listeners to almost think of that as like the foot's core, the foot's pelvic floor in a sense. These muscles are part of how we connect into the pelvic floor.
myofascial connection lies within these deep 26 muscles. The order in which muscles contract is also very important. This is for the pelvis, but also for the foot. And you want to have these deep muscles contracting first compared to the powerhouse muscles, right? You want your pelvic floor, then your glutes, not the other way around, because then you start to get transfer stress and compensation and things like that.
Similar in the foot, you want the muscles in the bottom of the foot to contract before the muscles of the lower leg, like your calf. You need to the foot contract, then the calf contract. And that just ensures that you have sufficient stability. Now the deep muscles of the foot, similar to the pelvic floor, they're very isometric based or tension based in a sense. And that further feeds into this myofascial connection that exists.
That fascial line is called the deep front fascial line that runs from the tips of the toes, bottom of the foot, lower leg, already went through it, inner thigh, deep rotator, pelvic floor, diaphragm, up the neck to the tongue. So I will often reference foot to core stability or toe to tongue, because technically it goes all the way up. Now a couple ways that I will initially start to introduce it. You could just push the toes down as we had kind of played around with with the big toe.
Or I actually like to do what's called a forward lean. And a forward lean, you would stand with your feet shoulder width apart. You would find your tripod, spread your toes, find a little bit more of a neutral arch if you can. And then you would stand nice and tall. Imagine that you're stiff as a board, stay stiff as a board. And then you're going to lean forward slightly, kind of like a ski jumper would go into a ski jump. Or Michael Jackson, whatever now do you want. So you're doing a slight lean.
Dr Emily (14:58.148)
And then after you lean forward, you want to come back to a vertical position. And we're just doing it a couple times, right? Subtle sway, then you bring it back, subtle sway. And what I want people to feel and connect to is that as you subtly sway forward or lean, your toes reflexively anchor into the ground. And it's actually a postural reflex that is built with interior nervous system so that you don't fall flat on your face. So we're just activating a reflex.
I have people then understand what that feels like. Right? So, okay, I feel what this anchoring of my digits feels like. Awesome. Keep that awareness. Now, can you anchor your digits without leaning your body forward? Yes. Awesome. Great. Okay. That's, that's ground one that we have to be able to achieve that. Then to get a little bit further into short foot, which is essentially the same mechanism.
We then have to understand how to coordinate when the toes go down, I want you to lift your levator anion. And as you do that, I want you to exhale at the same time. So it's a anchor the digits with a lift of the pelvic floor and an exhale of a breath to lift the diaphragm. Or you could switch it and you could do tongue to pellet if you want, depending on the actual exercise you might integrate this into, right?
Kim (16:22.283)
Mm-hmm.
Dr Emily (16:23.364)
But that is essentially the stack that we're trying to do. So that's another way that we can teach it. A final way that we can kind of talk about with it is that I will lead this integration through the breath. So taking a deep breath, diaphragmatic breathing, so into the belly, and then you're going to start to exhale. And as you are exhaling, the entire time you are exhaling, that is where you are going to be connecting to the pelvic floor and connecting to anchoring the digits.
but your breath has to move the entire time. Then you would relax, inhale into your belly, and then essentially start it all over. But I'm trying to teach people that it is the breath that is driving the integration. So your breath has to be moving the entire time. If someone cannot exhale for eight to 10 seconds and they can only do it five seconds, well then that's where the exercise stops and you have to inhale again.
I don't want people holding their breath and just pushing their toes down and lifting their pelvic floor because it's not, that doesn't transfer as much into this gravitational wave of how we move dynamically.
Kim (17:33.11)
Right. You mentioned levator and I, and for those listeners who aren't familiar with that term, that's, if you think about it from a Latin language perspective, lift the anus, it's part of the pelvic floor. It's a, it's a group of muscles that form the levator. And I, it's more like if many people think of, they, if they are familiar with that terminology, it's more anal driven. So posteriorly driven, would you say that it is more important to have the activation coming from the.
anus as opposed to the front part of the pelvic floor like would you say posterior is more important than the anterior portion?
Dr Emily (18:12.11)
I would and the reason why is that cadaver studies and research studies have shown that the connection between the toe flexors is actually blending more so into the posterior pelvic floor. it makes sense logically or anatomically functionally because that's really where your glutes are then connecting and it's the glute that is activated or
co-contracted at the time that your flexors would be pushing down, which is when your leg is behind you and you're about to push off and take a step. That's really where you're essentially setting the connection between the foot and the pelvis so that your glutes can activate. It makes sense functionally or biomechanically as well.
Kim (18:50.497)
Mm-hmm. Mm-hmm.
Kim (18:55.906)
Got it. Okay. People who have flat feet. some people, my understanding is that there are some people who may be born with flatter feet. Are they destined to have flat feet for the rest of their life? And if they, like you talked about how the arch of the foot is almost like the pelvic floor, that's the core of our foot. And I've also, like in my mind, I've often thought that if somebody had a flatter,
foot less of that arch in the arch, sorry, the, well in the arch of the foot, could that potentially increase the likelihood of pelvic floor challenges? Cause the arch provides a little bit of dampening and, and support during impact activities or that type of thing. So can you talk a little bit about flat feet and what we could do? Like, it reversible and would they potentially be more at risk of pelvic floor dysfunction?
Dr Emily (19:53.604)
Yeah, such a great question. And one where a lot of people, there's unfortunately a lot of misinformation on the internet about that fee. Not possible, I know. Everyone is a credible source. Is that there is this belief in part of the internet that all feet are, all flat feet are reversible. That's one side of the school I thought here.
Kim (20:02.611)
No.
Dr Emily (20:23.416)
And then you have more the traditional panayatry one that is like, my gosh, every flat foot must be in an orthotic. These are really two extremes of what it is. And the way that I try to bring an awareness to the space of flat feet is that there's different types. And we have to first really understand what are we presenting with. And I start my flat foot explanation or flow chart.
By first classifying, is your foot flexible or is it rigid? And you can easily determine this by sitting on a chair and looking at your foot, no weight bearing, so open chain, right? And you're just looking and do you have an arch? If you have an arch when you're not standing on it, no gravity, okay, take that in. But then when you stand up and you're in gravity and your body weight, if your foot goes boom, right? Which means you had an arch and then the arch fell.
as soon as you introduce body weight gravity. that's what's considered flexible. That's what a majority of people are going to fall under. Rigid, just so that the listeners know, when a rigid flat foot is sitting in a chair, no body weight, you can tell that that foot is flat from across the room. Totally different animal. Okay, that's gonna be less of what the listeners will be presenting with. So let's focus on flexible, right? So you're like, I know I have the arch potential, because I have an arch right there. What's happening as soon as I stand up and boom.
I drop down. Two main reasons. First one is muscle weakness. And that's where most people think it is. Almost everyone thinks that their feet are just weak. That is not the only reason. The other reason that I see a little bit more in my office because they thought that it was muscle weakness and it's not, is the ligament laxity. Ligament laxity, there's over hundred ligaments in the human foot.
If you just have body weight and gravity and your connective tissue is just a little bit looser than it should be, just because of the unique design of the foot, you're essentially going to bottom out that foot and you're going to drop into those ligaments and you're going to pronate and you pronate typically into the middle of the foot. So the way that you can start to differentiate it is the flatter foot that's based off of muscle weakness.
Dr Emily (22:47.034)
presents more in the rear foot. And I hope that this helps. It's in the heel where a flat foot that is ligament laxity is in the middle of the foot. It's like the whole foot spilled into the midline of the body. So you can see this if you take photos, put your phone, record it, and just stand in front of your phone. And if it looks like the inside of your foot is just spilling towards the midline and you have kind of this strong curvature towards the inside, that is oftentimes
Ligament laxity contributed. So those ones, let's just focus on that one for a moment. A ligament laxity that you were born with, it's structural, it would be the genetic side of flat feet that people will talk about because your connective tissue integrity is genetic. It's not necessarily the flat feet or the bunions. It's the connective tissue integrity. That foot weight bearing is always going to be planus or flat, unlocked. It's in its...
unlocked position just to start. Okay? So when we walk and move and load and unload energy, kind of like the pelvic floor that you were talking about, here's the pelvic floor, you don't have the play of the arch like a trampoline in a sense. Now going into an orthotic or an arch support is going to put that foot into a more locked position, neutral,
Kim (23:56.407)
Mm-hmm.
Dr Emily (24:15.948)
so that it can have a little bit more play. The way that I design orthotics is that I don't use very, very rigid materials. And every podiatrist has the ability to dial in the rigidity of the orthotic to what they feel appropriate. I want some support, but I want the play so we can still be a quote unquote trampoline in the arch like the pelvic floor. If you do not use arch supports and you stay
Planus or unlocked you essentially created this energy leak or disconnect with the rest of how your body controls energy transfer So yes, you will see an effect from it. It may be something that They're dealing with a symptom proximal or upper low back pain SI joints deep hip groin whatever it is, right and they're seeing a therapist and they
are getting better, but then they kind of slide back. So they're continuously like one step forward, half a step back. And they're like stuck in this thing until someone looks at the whole system and how the feet influence the pelvis, both structurally, fascially, sensorally, then they may never get out of that one step forward, half a step back. So that's where I do think it is important to understand feet. It is important to understand foot.
Kim (25:37.101)
Mm-hmm.
Dr Emily (25:43.12)
types, what type of flat foot so that you also don't want to be spinning your wheels and strengthening a flat foot that's actually ligament lacks, but you thought it was muscle weakness and just muscle weakness, right?
Kim (25:58.029)
So if I understand just to summarize, if somebody had the ligament laxity potentially in a non-rigid orthotic, would that be forever and ever more or for a period of time? And then the people who have more of the muscle weakness, not the orthotic working on the foot strengthening piece. Is that accurate?
Dr Emily (26:18.5)
Yeah, so muscle weakness, would want to focus on muscle exercises, foot to core exercises. You could use arch supports based off of activity. Let's say you're a nurse working on your feet, long hours on concrete. Yes, I would probably tell you to be in an arch support because that's just for that specific activity, right? With the ligament laxity, it is something that to some degree they may always need a little bit of support.
And what I tell them is, and that's okay, because we are incorporating exercises on top of every orthotic. I've never prescribed just an orthotic and said, this is a magic insert. I mean, this is the most, this is a magic insert, but if it was a custom orthotic, say, this is your magic insert, slide this in your shoes, all your problems and go away. Give me my money, have a good life. Like I don't, that's not the transaction of what I have.
Kim (27:16.567)
Yeah. Right.
Dr Emily (27:17.134)
because that's not true and that's obviously not the story. That's why we're here. Some people do think that all that they need is something in their shoe like an orthotic and then everything goes away. You correct the skeletal stacking. So an orthotic will skeletally stack you. But if you still have certain muscle inhibitions and your pelvic floor is inhibited or whatever it is,
you will still present with some degree of that inhibition until you address that as well.
Kim (27:50.795)
Right. Would the exercises for both of those people be the same?
Dr Emily (27:58.704)
Theoretically, yes. Yes. Now, I do have some chronic feet who present in a certain way who cannot do certain exercises. So there is slight modification in it. And then I do make sure that the individual has a very clear understanding of what the outcome is. I'm literally just on a podcast talking about this with someone else who was, they were so focused.
Kim (27:59.927)
Yeah, yeah.
Dr Emily (28:27.916)
on a change in what the foot looks like visually. They're like, success is when my foot is like this. And I'm like, that's not what we're going by. We are going by how you feel and your function. That is always what we should be going after with our body, especially as you get older, because it's very hard to reverse skeletal positioning. But if you can...
Kim (28:47.757)
Mm-hmm.
Dr Emily (28:53.444)
decompress, create just a little bit facial stabilization, get a little bit more coordinated into the pelvic floor. You essentially just take enough stress off of the system that you are, you're a happy little camper. And you're like, I don't need to be skeletal like the anatomical textbook because I don't believe that that is achievable. Yeah.
Kim (29:10.157)
Right.
Yeah, yeah. This is a sidebar and I didn't prepare you for this question, but it's my mind is going there. Are you familiar with some of the peptides like BPC 157 that is that is for not necessarily laxity, at least to my understanding, it would be more for people that may have a ligament tear or something like that. Are you familiar with that? And would that play a role in a person who might be dealing with something like that?
Dr Emily (29:40.88)
Great question. I'm familiar with prolotherapy, which is similar in here for ligament laxity. I do regenerative injections in my office. So I do Wharton's jelly. Of course, there's PRP. There used to be some amniotic-based ones that's similar. And then you have peptides. I personally do not do peptides, but I have patients that when I do the regenerative injections, they will piggyback it with peptides. So I start to see that more and more. Prolotherapy in this side just on
Kim (30:05.828)
Mm-hmm.
Dr Emily (30:08.92)
on the case of ligament laxity where I think you're going with this is that they will sometimes be recommended or will associate ligament laxity. You could do prolotherapy to tighten the ligament and then you don't need the orthotic anymore. Is that kind where your mind was going? Okay, so research around prolotherapy is very good around the pelvis, ligament laxity and scarring down some...
Kim (30:24.632)
Got it. Yeah, yeah, yeah, yeah, yeah.
Dr Emily (30:38.672)
pelvis ligaments where those ligaments are under a completely different load, gravitational load and force load than the foot ligaments. So I've never seen any research. I've had patients ask me for it to do prolotherapy to tighten, let's say their spring ligament, which is the one that actually holds the arch of and there's no good research behind it that I, I
Kim (31:01.604)
Mm-hmm. Mm-hmm.
Dr Emily (31:07.97)
I don't feel proper guinea pigging with the patient and taking their money for it. So yeah, I would say.
Kim (31:12.036)
Yeah.
Yeah, can you, yeah, for the people that don't know what prolotherapy is, can you just elaborate a little bit on that?
Dr Emily (31:21.196)
Sure. So prolo therapy is essentially sugar water and you are injecting it's dextrose. So you are injecting it into the ligament to create an irritation, an irritation response, right? Loosely we'll call it scar tissue is really kind of inflammatory response, which is irritating. Then it's a little chaotic. And then that tightens the ligament in that way. That's why it works really good for like SI joint ligaments and other ligaments sitting around the pelvis. A lot of
Osteopaths will do this technique. That's where I was first introduced to it in New York City was through osteopathic medicine. And then it kind of branches out into other specialties, but that would be prolotherapy. Because of the unique loads to the foot and the ankle, there's not a lot of strong research behind prolotherapy in the foot itself. Maybe the top of the foot, because those ligaments are a little bit different. The dynamic ligament structure on the inside arch is just a little bit different.
Kim (32:19.973)
And then PRP. So I've PRP is for those aren't familiar platelet rich plasma. This is now being used in a lot of different regenerative medicine in skincare. It's even I've had a therapy from a vaginal health perspective, pelvic health perspective. So how would that be? Obviously one's plasma from our blood. The other is, as you say, sugar water.
Dr Emily (32:46.436)
Mm-hmm.
Kim (32:46.606)
how would they be working differently and how would you use PRP for foot health?
Dr Emily (32:51.332)
Yeah, so PRP and other regenerative injections. So, prolotherapy, I don't consider regenerative injection. PRP, and I do Wharton's jelly in my office, that's umbilical cord matrix. Those are, and then there used to be placental-based ones here in the US, the FDA kinda came down on those ones, but they are essentially growth factors. So, you are injecting growth factors, which is stimulating the building block
Kim (33:03.236)
Hmm, I haven't heard of that.
Dr Emily (33:20.624)
to the tissue in the case of, let's say, ligament tear. I do them a lot in plantar fascial tears. So if you have a partial tear or thickening and degeneration in a tendon or your plantar fascia and you inject growth factors, you stimulate the fibroblast, which creates the collagen to create increased integrity to the connective tissue. So it's a little bit different, right? So one's kind of a scar response through
irritation in a sense. The regenerative injections is more growth factor collagen stimulating. That's why they do like the vampire facials because they know that it's a growth factor, stimulates fibroblasts, collagen. That's really the mechanism that they're taking advantage of. Photobiomodulation, which is red light therapy, is something that I always stack when I do regenerative injections. I'm a huge fan of red light therapy and I'm sure there's modalities of that for pelvic health also with red light.
Kim (33:50.917)
Mm-hmm.
Dr Emily (34:19.053)
because that's very supportive of supporting natural tissue repair.
Kim (34:24.388)
Yeah, yeah, I'm a huge fan of red light therapy. Before we kind of I want to, you know, talk more about kind of the neurosensory and foot health. But because we're in this ligament piece right now, this is my own personal question. I have a plantar plate tear and I am not a foot expert, but I had never heard of the plantar plate until I was diagnosed with a plantar plate tear. And so my question would be, could
Prolotherapy or PRP? Obviously it's not going to fix a complete tear. Could that be helpful? And would surgery be something that would be necessary for somebody who had a plantar plate tear?
Dr Emily (35:07.216)
Some of my favorite injuries. I love talking about the plantar plate. So that's actually there's two injuries that I see primarily in my office and then I do regenerative injections for partial tears of the plantar fascia, partial tears of the plantar plate and your plantar plate for the listeners who are like what is happening is your plantar fascia which is on the bottom of the foot, it's a thick banded tissue.
Kim (35:28.132)
Yeah.
Dr Emily (35:34.594)
as it comes towards the ball of your foot, so you have this thick band tissue towards the ball of your foot, as it's coming towards the ball of the foot, it actually splits into five pieces, and then it's going to insert into the base of your toe, right? So as it splits into this piece, it's a ligament, even though it's your fascia, it's technically a ligament, and it's called a plantar plate. So your plantar plate is your plantar fascia, and the mechanism of the plantar plate, which is your plantar fascia,
at your toes is a douchour foot. It does that anchoring and pulling down of your toes into the ground to achieve stability. So that's an important mechanism. People who have a plantar plate injury, typically it's in the second, it's the most common one just because it's the midline of the body. It takes a very unique stress and load during dynamic movement. What starts to happen is that the second toe starts to float. That's usually what people will notice for outside of pain.
is that as the toe flows, that's called you lost purchase, touch, you lost purchase of the toe. And that's a sign of a stress to the plantar plate, ligament or the plantar fascia. So depending on how it presents, there's a little bit of minutiae in there, but a majority of plantar plate injuries are partial tears, not complete. They're partial, which means they are perfect candidates for regenerative injections. And I would do...
PRP or Wharton's jelly, I would not do prolotherapy. I would do something that is collagen stimulating and I have very high success doing it for those injuries.
Kim (37:12.143)
Hmm, very cool. Yeah, I so mine is a complete now. If I hadn't known enough and I don't even know how. I mean, I didn't have an injury and but as I guess, could you elaborate? Are these injuries? Because I'm hearing more and more of them actually. Is it footwear related? Is it? Is it the way we load our foot? Is it does it have to be an abrupt injury that happens? I I didn't I I don't think I had an abrupt injury, not that I can remember anyway. And it feels like
At one point when I had an MRI it was partial and then it went to a complete afterwards. So what are some of the contributing factors to plantar plate tears?
Dr Emily (37:50.42)
Yes, so again remember your planter plate's purpose is to keep your toes on the ground. That's his purpose. It is primarily stressed when you are in a push-off position, right? Because as we push off, this is super important, and part of how I train the foot is as we do a calf raise, which is how you take a step, at the same time as your heel is lifting, your toes have to be pushing down. This is how you achieve
peak power in the foot. Okay, so just having said that, that's an important mechanism of that ligament or that plantar plate. So if you are constantly in that position, you're wearing your stilettos, you are essentially, not that this is how you injured yours, but that is a very stereotypical way of how you stress the plantar plate is through chronic plantar flexion, high heels.
Kim (38:44.421)
Mm-hmm. Yeah.
Dr Emily (38:46.456)
Certain athletic sports, you could see it in like cleated sports, soccer, ballet, dance, things like that, just because they're repeated in this position. If you have a bunion, if you have a bunion that predisposes you to injuring your second, and it's because of transfer stress. So any issue in your big toe, your body's like, I'm going to dump that to the second, and the second's going to take all the work. But your second is already taking a majority of the force.
when we're moving through the foot, just because it's the midline of the foot. So you're dumping even more, and then honestly it becomes this like perfect storm. For anyone who has a long second digit, which is called a Morton's toe, you are predisposed to plantar plate tears. If you have a hammer toe or a contracture of your second, you are predisposed to plantar plate tears. So you can actually see there's these risk factors or things that like, check that, check, check, check.
Kim (39:20.004)
Mm-hmm.
Dr Emily (39:44.92)
right? And it's really just a lining up to then stress that ligament. So yes.
Kim (39:49.008)
Yeah, yeah. And if somebody, it's complete, would they need surgery or could you live without surgery?
Dr Emily (39:55.856)
So you could live without surgery. What typically happens is if you tear that ligament and you've lost the stability that keeps the toe down and it, say it's contracted. I don't know how yours is presenting. So I'm super quite curious and you can email me a photo later if you would like. Okay. It's not. Okay. So what can happen is that your toe can dislocate and then it'll be sitting higher on the foot.
Kim (40:13.252)
It's not contracted. It's not contracted. Yeah.
Dr Emily (40:25.082)
So if you actually just have place, so it's called a drawer sign. If anyone's familiar with how they assess the knee after like an ACL tear, what's called a drawer. Can you just pull the gate? Here, can you lift the toe? It's a toe drawer. And if you can lift the toe, it's dislocatable. And that's really where you would say, okay, right? If you're fine and you're like, no stress, high function, I just know it's torn, but here I'm super happy and I can do everything that I want. You don't have to do surgery.
Kim (40:34.128)
Yep. Yep.
Kim (40:53.863)
Yeah, yeah, and that's pretty much my mentality as it's been right now. And so just thinking about long term. Anyway, that was my own personal little question there, but foot health and like I, so we mentioned the splay, the toe spreaders that we have. So this is something that I wear around the house. I will sometimes wear in many of the shoes that I have. The socks that have the
sensory component, the neuro ball with the sensory. Can you talk a little bit more about the importance of the sensory, why it's important for us to keep that healthy or to stimulate the nerves within the foot?
Dr Emily (41:34.512)
Absolutely, so our foot is not just very biomechanically important, it's very important sensorially and the nerves that we're talking about from a sensory perspective of the foot are on the skin and the bottom of the foot, similar to the hands. So these are touch nerves, called mechanoceptors or touch nerves, and they are reading the ground and the surface as we stand and as we walk. So we want them to be sensitive and stimulated.
Now these different nerves are sensitive to very specific stimuli. And one of those stimuli that your foot is sensitive to is texture. It's actually not texture. It's actually two point discrimination, but we refer to it as texture. So, noboso, this is half of a neural ball. Here's both of the pieces, but it splits into two. So the neural ball has the texture and the texture for those on the video, there's little tiny pyramids across the dome or half of a ball.
And then for those on the camera, I'm pushing on it and then I'm showing my thumb, there's these little indents. So little tiny indents on my thumb that make me think of like braille, right? An ATM and look at braille and like push on braille and look at it be like, there's little indents, right? Your brain reads braille by sensing the points. So it's feeling the different points and then it's sensing the distance and it's like,
Kim (42:42.342)
Mm-hmm. Mm-hmm.
Kim (42:48.412)
Yeah.
Dr Emily (42:59.054)
Yeah, that's two points, that's not a big blob, right? So this discrimination is very important to how we control foot awareness, our center of mass, obviously in your hands, so it's manipulation of objects. So two point discrimination, texture, braille, neboso, is stimulating a very specific nerve. When you stimulate that nerve, it communicates with your
Kim (43:01.959)
Hmm.
Dr Emily (43:26.692)
brain, the part of the brain that controls movement. Happens to be called the somatosensory cortex, but it's just how we control movement. Now, sensory in equals motor out, right? So sensory controls movement. If I want to control movement, I have to have sensory in. So what I will often tell people is if you want awesome movement, accurate,
efficient, for a long time, whatever characteristics of movement, you just don't want to fall, right? You want to move effortlessly. That type of movement you should be saying, okay, what is the quality and quantity of sensory information coming in? Light, sound, joints, touch, do I feel my body? Do I feel the ground? Am I wearing thick cushioned shoes? Well, I can't feel my feet, so my movement is not going to be
as efficient in this big old pillow because I can't feel the sensory, the sensory is decreased, right? So quality, quantity, sensory, better movement output.
Kim (44:38.608)
I love that. Before we wrap up, just as you're talking there, I often look at the shoes that the elderly population would be in. And they to me look like the absolute worst possible shoe of all time. And even before I knew all the things I know about twisting our shoes and crunching our shoes and all and flat, no, no, cushing all that they, they often are very, very thick sole very rigid.
very narrow, they look like especially somebody who has poor balance, it looks like they could roll an ankle very easily. So from an aging population, I'm becoming a lot more also concerned with concern, but just I want to promote this in my population of balance and bone health, like thinking of the osteoporosis. So all the things you're talking about. Also, I feel like can
If we are not paying attention to our feet, if we are not providing the sensory input, if we are not paying attention to the length relationships and the movement of the big toes and all that can ultimately influence the bones like all the way up the chain as well. And then we are not going to have the most optimal balance we're going to be at risk of falling like all of these things. It's all
interconnected and I don't really have a question on that I'm just making an observation.
Dr Emily (46:04.435)
Yeah, no, no, no, 100%. So a big focus of where I'm at. So I'm in my forties and I'm now more than ever thinking of like, wow, I've got to be like, girl, get your muscle on and keep that muscle. Like I'm obsessed with like muscle because I know that it's going to be harder in my fifties and even harder in my sixties. So there's something about this, like forties and fifties. Let's just say.
that this is your time to dial in your strength, your movement awareness, your breath, your pelvic floor, your foot strength, your facial health, like all components of whatever encompasses healthy movement and movement longevity. You've got to like really hit that habit and lifestyle and peak in a sense in your 40s and 50s.
where I feel like a lot of people don't prioritize that until they're in their 60s or 70s. And it is gonna be hella harder to try to do that then because you just don't have the same amino acids that create the muscle. The nervous system is higher, the risk of comorbidity is the inflammation goes up. There's lots of other things, right? So very much yes. For the bone health, what is really, really important, especially for women and bone health is
Kim (47:14.899)
The hormones, yeah.
Dr Emily (47:28.1)
Dynamic movement, sensorally stimulated dynamic movement is rich in vibration, vibration, ground reaction forces. Get the cushion out of your shoes, because you need to feel the vibration because vibration stimulates osteoblast, which is the cell that maintains proper healthy bones, and that's important. So that's where I focus on sensory movement bone is from that perspective. And then obviously you need the intrinsic muscles.
that surround it because our muscles act as splints to our bones. And when we move dynamically to absorb this vibration is the muscles have to contract isometrically and they stiffen, but they only stiffen upon stimulus. So they need to feel the ground in the first place. And that's really, really important. And I remember practicing in New York City and I would get patients, so women kind of 50s, 60s in that,
and they would come to me and there'd be so many stress fractures and they were like, I just walked from Grand Central to Union Square and I got a stress fracture and I was like, absolutely not. Like that is so unacceptable. Like that is what? Less than 30 blocks and you got a stress fracture, right? This is telling me this is not a, uh-oh, well, better check my bones. I was like, uh-uh, this is.
Kim (48:37.833)
Yeah. Yeah.
Dr Emily (48:48.506)
You got to strengthen your feet. You got to strengthen those intrinsic muscles. You have to strengthen your foot to core connection. You have to strengthen your perception of your foot and the ground, right? So, so important, so important.
Kim (48:56.669)
Yeah, yeah. Yeah. Okay, last question. I was watching one of your videos recently and it was you doing I think you were doing a deadlift. It was the bottom part. It was mainly highlighting your feet, but you're barefoot. Of course, no public gyms will tell you that you can be in their gym without shoes on. would you recommend barefoot or with your the recovery socks, the ones that have the almost like the top of the neboso?
Dr Emily (49:26.766)
Yes, so I was at a lifetime fitness and I was barefoot. So yes, they're probably just scared of me and they're just leave her alone. But I see people lift in the gym, commercial gyms, know, 24 lifetime, whatever it is with their socks, right? So they'll kind of like, okay, I'm on the weight lifting platform, right? So I'm in a contained area and I'm just like, honestly, I'm just like, fuck it. And I take my socks off and I...
Kim (49:35.241)
Just leave her alone.
Dr Emily (49:58.088)
my bare feet because it's totally different when you can actually get the the tactile stimulation and the digits I mean I I Looked at the video and I was like, I don't think it's demonstrating how hard my toes are contracting and like I am suctioned to that wood to that surface as I'm doing deadlifts and I'm just like right and I was like
Kim (50:13.886)
Yeah.
Dr Emily (50:21.86)
There's no way I could do that in a sock, even in a Boso sock or in a shoe, even the most minimal shoe. So that's why I'm often like, whatever, I just do it. So yes, I do encourage people to do it, feel it. If you want to first do some of that movement, like let's say kettlebells and you go into a group exercise studio, so you're like out of the way of people, right? Or you're your contained area and you feel the difference, then you will be like, there's no way that...
Kim (50:29.737)
Yeah. Yeah.
Kim (50:43.743)
Mm-hmm.
Dr Emily (50:51.598)
You can do that. What's funny is that I will do what, so I do a lot of, what is it called? The, when the bar is extended, my gosh, this is like the end of the day. Anyway, it's like a squat thing, a landmine, landmine. Right. I love landmine exercises. So I'm doing it and I'll have my minimal shoes on and I'm doing it and I'm like, okay, like I'm getting into my glutes, but something's like a little tweaky, whatever it is. And these are minimal.
Kim (51:07.006)
Okay, yes, yes, yes, okay.
Dr Emily (51:20.912)
And then I'm like, I gotta take my shoes off and like, boom, it's like everything aligns, I have maximal range of motion. So even a minimal shoe that doesn't seem like a lot of interface or blocking of the range of motion and the activation of the foot, still does to some degree. And that's why I will always default to truly, truly barefoot when you are doing movements like this. And I just challenge people.
Kim (51:37.18)
Mm-hmm. Yeah. Yeah.
Dr Emily (51:49.696)
challenge the authority in the cultural challenge and feel what it feels like.
Kim (51:51.474)
Yes. Yeah. Yeah. Yeah. Yeah. Okay. Awesome. Awesome. That was so, it's always amazing to chat with you. I love all your information and everything that you stand for pun intended. and, yeah, thank you for sharing your wisdom. Where can people follow you and find out more and learn more about Naboso?
Dr Emily (52:13.392)
Absolutely, so on Instagram, the functional foot doc is my handle that is probably the easiest one to find. And then my website, I do see patients virtually all over the world. I do see patients in person in Arizona, which is where I live now, thefunctionalfootdoc.com. So that is a great way to do it. I have a book called Barefoot Strong, which is a great way to just kind of start to explore this if people are curious. Any of the Noboso products, these are at noboso.com, N-A-B-O-S-O.com.
We're on Instagram, noboso underscore technology. And then I have hundreds of videos on YouTube. If people want to just start to search how to do short foot, how to do foot to core, how do I do X, Y or Z of how I look at the foot and the foot to the hip and the pelvis. I have many, many videos out there.
Kim (52:59.273)
Yeah, you do. You're amazing in what you're sharing. So thank you so much for sharing your wisdom here today.
Dr Emily (53:02.608)
Thank you. Thank you. It was such a pleasure.
