Weak Feet = An Aging Body? What a 40-Year Foot Surgeon Learned - Mark Wallen, DPM

Your Feet Are Getting Weaker. Here's Why. | Dr. Mark Wallen

What if the root cause of your knee pain, poor balance, declining mobility, and even faster aging starts with something you rarely think about... your feet?

For decades, medicine treated the foot as an isolated body part—something to cushion, brace, inject, or surgically repair. But after spending more than 40 years as a podiatric surgeon, Dr. Mark Wallen began questioning everything he thought he knew.

In this eye-opening conversation, Dr. Wallen shares why modern footwear may be weakening our feet, how foot dysfunction impacts the entire kinetic chain, and why strengthening the foundation of your body could be one of the most overlooked keys to longevity, athletic performance, injury prevention, and healthy aging.

We dive into barefoot training, toe spacers, orthotics, balance, posture, foot mobility, aging, athletic performance, and the surprising mistakes millions of people make every day that may be contributing to chronic pain and movement dysfunction.

Whether you're an athlete, weekend warrior, healthcare provider, parent, or simply someone who wants to stay active for life, this episode may completely change how you think about your feet.

In This Episode

 Why Dr. Wallen changed his perspective after 40 years of foot surgery

The truth about orthotics, toe spacers, and foot strengthening

How modern shoes may be contributing to foot dysfunction

The hidden connection between foot health, balance, and longevity

Common footwear mistakes that can affect your knees, hips, and posture

Why foot strength matters for athletic performance and healthy aging

The most preventable foot conditions he saw throughout his career

What parents should know about raising healthy, resilient feet

About Dr. Mark Wallen

Dr. Mark Wallen is a retired podiatric surgeon with more than four decades of experience treating foot and ankle conditions. Having performed thousands of procedures and treated patients across every age group, he now focuses on educating people about foot function, movement, balance, and the role strong, healthy feet play in overall health and longevity.

Do you think modern shoes are helping us—or hurting us?

Have you ever tried barefoot training, toe spacers, or foot-strengthening exercises?

Let us know in the comments:

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Transcript

Dr. Spencer Baron (00:01.073)
For decades, medicine treated the foot like a disconnected body part, something you brace, cushion, inject, or cut. But what happens when a surgeon who has spent 40 years operating on feet suddenly starts questioning everything he once believed? Today's guest is retired podiatric surgeon Dr. Mark Wallin. After decades of surgery, orthotics, and seeing the worst foot damage imaginable, he's now asking a radical question.

Did modern shoes, weak feet, or old thinking create many of the problems we're trying to fix? From toe spacers, and barefoot strength, and balance, aging, athletic performance, and the shocking mistakes most people make every single day. This may completely change the way you think about your feet and your body. Welcome to the show, Dr. Mark.

Dr. Mark Wallen (00:52.703)
Thank you very much. for having me. It's a real pleasure.

Dr. Spencer Baron (00:56.583)
We look forward to it. There's a lot of questions that we want to know about from the bottom up. So you spent 40 years looking at the foot primarily from the knee down. What was the moment when you realized, ooh, maybe we're thinking about feet all wrong?

Dr. Mark Wallen (01:15.687)
As I discussed with Dr. Wayman, I had the honor and pleasure during my residency in St. Louis, Missouri of going over to the Logan College of Chiropractic.

The surgical residents and myself taught lower extremity biomechanics and just went there kind of on a consulting basis. So I was introduced to chiropractic relatively early. So I must admit that I've had an education that most foot doctors don't have with regards to how the feet affect the body and vice versa.

And then when I opened my practice in Los Angeles, I also had the honor and pleasure of working over at the Cleveland Chiropractic College. Some of the chiropractic physicians in my area, Santa Monica, invited me over and I'd go for the clinic. So I was able to really continue that course of not just thinking of the foot by itself, but the connections of the body.

The hospital that I trained in in St. Louis was the first hospital in the United States to allow chiropractic physicians to be on staff.

So very early on, we were getting admissions from the chiropractic physicians in the greater St. Louis area who had all of the ailments that you guys care for, but they also had a glaring foot problem, whether it was chronic plantar fasciitis or arthritic joint that didn't work, that negatively affected their gait.

Dr. Mark Wallen (03:00.711)
I was lucky enough to not just get tunnel vision on the foot. So for 40 years, I had a big referrals practice to the chiropractic physicians in the area because yes, I was skilled enough to fix the foot, but these are people that walked around for 10 or 15 or 20 or 40 or 50 years with foot issues that also affected their back.

I couldn't fix their backs if I fixed their great toe joint with arthritis, but they had to relearn to walk again. I had an advantage as far as my connections with chiropractic came early and I was never just completely focused on, here's a knife, fix the foot, goodbye. My patients after surgery went to...

many chiropractors because they literally had to learn to walk again not only from what I did but also because they've been walking for years ignoring their feet because as you both well know that's about the most ignored part of the anatomy.

Dr. Spencer Baron (04:09.712)
Well, congratulations on being so open-minded so early on. That says a lot as a testimony to who you are and how you practice. We've always had questions about orthotics, and they were once figured like a gold standard. How do you feel about orthotics now and the way they're?

Dr. Mark Wallen (04:29.653)
I'm glad you asked that question because since meeting Dr. Terry, I've had some thoughts about my 40 years in practice and I kind of came to this conclusion. There are some pretty pathologic feet that need some form of support or balancing. Let's talk about the first metatarsal phalangeal joint. Gout, arthritis, turf toe, whatever.

There is no way in the world that a patient with arthritic first MTP joint is going to be able to walk normally without

surgery or without putting something in their shoe that makes them a little bit more balanced or at least takes the pressure off the joint because as you know you go to propel off of your heel you're going to have a substantial limb and then eventually have knee pain hip pain back pain lumbar pain neck pain so that would made me think about the fact that

would probably never give up on the idea of an orthotic for an arthritic first MP joint or even some of the lesser, second, third, fourth, fifth. And the severe, severe, rigid, cavus foot, like the letter C, that had to be balanced no matter what.

interventions and care and treatment they got from you or physical therapists or whatever other physicians they were seeing or the opposite which is more common the complete pes planus. Not everybody needs a rigid orthotic but a lot of patients from my perspective

Dr. Mark Wallen (06:20.669)
needed to have something in their shoes to rebalance the foot or compensate in some way, form, whether they went on to surgery or whether we were able to deal with it from the podiatric standpoint, chiropractic standpoint, physical therapy standpoint. One of the oldest treatments for

first MPJ arthritis was the orthotist, the pedorthotist would put a steel shank in their shoe. So you walked with a shoe that didn't bend. That will get rid of the pain from a first MP joint that's arthritic or damaged or whatever the pathology is.

the knee, the hip, the back, the spine is going to suffer. But certainly if you don't bend your big toe when you raise your heel, you're going to feel one heck of a lot better.

That was one of the simple treatments and some people did well with it and were willing to go with it. People with active lives or a job that kept them on their feet, obviously they couldn't walk around with a steel shank in their shoe if they were stocking shelves at Costco or doing any number of activities, recreational activities that they needed to move their toe.

So I think that long answer to your short question is there are times where I think an orthotic is important. After meeting Dr. Terry and with the problems that he's been helping me with, there is no question the foot is the foundation of the body. Putting a rigid orthotic just to support somebody's mild pronation or supination, you're not treating the patient properly. You've got to get them to strengthen that foot or rebalance the muscles in their leg.

Dr. Mark Wallen (08:10.071)
legs, lower extremities that we couldn't take care of. We were just kind of cutting and splicing into the foot and the ankle.

I've kind of come to a position where I'm kind of in the middle, but again it was my introduction to chiropractic early on that I didn't immediately go to. That needs a rigid orthotic. That needs to be operated on. There was more of the connection between the foot and the rest of the body.

Dr. Spencer Baron (08:41.562)
You know, I'm glad you're bringing that up and making such a big deal about about the big toe. You know, one of the questions that I often ask interns or when I'm teaching a class is what is and this is a group of chiropractors. What's the most important joint in the body for an athlete? And I'll mention that like quarterbacks and football, you know, whatever it might be, baseball. And they sit there and go low back and I go, no, no, the big toe.

because all that pressure, all that momentum is coming off the big toe. And so with that said, I'm glad you're delving into that area. Doctors are always talking about now toe spacers, foot mobility and strengthening. Strengthening is a key word right there. What are your thoughts on the evolution of all that?

Dr. Mark Wallen (09:37.788)
Strengthening is of utmost importance because of the foot. If your tires are semi-flat on your car, it doesn't matter what you're driving, you're not going to stay on the road and you're going to end up on the side of the ditch.

Dr. Spencer Baron (09:44.038)
You

Dr. Mark Wallen (09:50.997)
The problem is because, and I'm sure you have seen in your practices, patients with deformed feet, the big toe takes a big beating. There are times where a patient can't, won't have foot surgery, let's say to straighten out a bad hallux valgus, a bad bunion deformity.

Besides strengthening, there's going to have to be some rebalancing where, again, from my podiatric experience and point of view, some form of orthotic can at least...

make the patient use their second, third, fourth, fifth MPJs a little bit more if there's some kind of angular deformity of the great toe. But yeah, strengthening is key. Weak foot, weak body, weak foundation. Walking on sand versus walking on a wooden floor.

Dr. Spencer Baron (10:48.409)
Yeah. So I want to ask you a series of a couple of key words that we always wonder if it's any good or not, or if it's important. But, you know, the biggest mistake people make are, you know, obviously every day they eventually destroy their knees or their hips, you know, balance and posture, especially balance in South Florida with all the old folks like myself, you know, you know, balance starts to deteriorate. So

I want to ask you a series of a couple different sections on this. How do you feel about shoes that have these narrow toe boxes? Like cleats.

Dr. Mark Wallen (11:31.62)
I think one of the most frequent answers I gave to female patients in my 40 years of practices, they'd say to me, Dr. Wallin, what do you think of high heels? I said, I think women look beautiful in them. And I said, they create business for me. And then we would really get down to brass tacks and go, how bad they are.

Dr. Spencer Baron (11:47.653)
Ha

Dr. Mark Wallen (11:57.077)
You're not going to change an athlete from wearing a cleat, whether it's track and field or on the pitch with soccer or football. I had an interesting discussion with Dr. Terry recently about six months after COVID started. We found in our practice more and more patients coming in saying, Dr. Wallin.

I'm having foot pain. When did it start? Six months ago, four months ago. Are you telecommuting? Yes. Are you wearing shoes in the house? Well, no, I'm in the house now. So I walked down the kitchen tile floor and the marble floor and the cement in the backyard to fetch the trash cans and my feet hurt. I go, well, you your feet didn't hurt when you were shod going to work, whether you were a waitress, whether you were a chiropractor, whether you were stocking shelves.

at Ralph's or Smart and Final grocery store. I said, invest in a pair of decent house shoes, be they Birkenstock, something with a little bit of art so you don't step on a thumbtack, you don't step on broken glass and have to come to my office to have the pieces of glass removed, which a lot of people did during COVID. They'd break a glass in the kitchen.

They break a glass in the kitchen, they're walking around the house barefoot, and two days later in their office with foreign bodies in their feet. I said, for no other reason but to not step on a spider or a scorpion or a piece of glass or a thumbtack, put something on your feet. But it was astounding.

the volume of patients that went up who began to telecommute because of work. So can't stop people from wearing dressy shoes if they are female attorneys who have to dress up to the nines to meet their clients, et cetera, et cetera, or if a restaurant has a dress code. It's please get out of your shoes when you get into the house, and please do your foot strengthening exercises, and.

Dr. Mark Wallen (14:03.155)
Don't do anything else that can further hurt your foot because there are some vocations and have vocations and sports where you can't help it. You're going to be in a closed toe tight shoe for whatever the reason is, be it an ice skate or ski boots aren't so bad. Where you just have to convince the patient that they're doing damage with work or recreational activity they've chosen and they've got to take care of their feet when they're not doing that activity.

Dr. Spencer Baron (14:33.859)
Yes, high heel shoes with those pointy toe boxes are murderous from what I understand. But second most offensive to the foot was the cleat of especially the football player because they're

feet are so big and strong. And there was a year at Miami Dolphins where I can't mention the year because then you'll figure out who the sponsor was and then, you know, of all the equipment. But that particular year we noticed during preseason, they're issued standard cleats and clothing and all that. And we noticed

There is like several ankle sprains in the preseason. We couldn't figure out why in the head athletic trainer was astute enough to realize that the cleat he sent them all back to almost. I almost mentioned the sponsor. He sent all the cleats back and requested another type of cleat because they were producing so many injuries. It's we take it for granted that.

You know, everything is A-OK. Could you make a comment? Yeah, sorry. Go ahead. Yeah.

Dr. Mark Wallen (15:42.805)
If you don't mind me, you reminded me of something when I was in podiatry school, college in Cleveland. The head professor of our sports medicine department was working with the Cleveland Indians team. And way back when, to show my age, baseball cleats were basically just a cardboard bottom, three spikes, and vinyl or leather or some faux thing on the top.

He was able with orthotics for the flat-footed pitchers to increase their ball speed at home plate by one to two miles an hour with an anti-pronating device in those garbage cleats. And I was there witnessing it because I was a student in sports medicine at the time.

Dr. Spencer Baron (16:27.109)
Yeah.

Dr. Mark Wallen (16:31.987)
That was probably the most enlightening part of my education, seeing how a flat foot, and you raise up the arch into a more neutral foot position, increased the ball speed at the plate. They loved us.

Dr. Spencer Baron (16:48.005)
Yeah. You started. Thank you for that. You started to mention about foot strength. Could you elaborate more on the people don't realize that you have several muscles that control the foot biomechanics, the intrinsic ones? Could you share your thoughts on that?

Dr. Mark Wallen (17:07.605)
A lot of times, especially in Southern California with the bodybuilders and stuff and people being able to run 360 days of the year, big calves, big calves always walk into our office and your offices as well.

and if the calf is big because you're doing squats or toe raises at gold's gym or whatever that's that's like walking around all day in a high heel and the big athletes male or female couldn't figure out why their metatarsal arch would be sore or the metatarsal heads would be sore but you'd walk and walk in the office and have them take out their foot and do you know the quick hallway walk and they were walking around like they were

women on the on the red carpet at a fashion show. So you can have the strongest you can have the strongest calf in the world what they weren't doing is they weren't strengthening their anterior tibialis muscle. So these people that strengthen their calves doing weighted squats with 300 pounds, God bless them, were pounding the heck out of their first MPJ and were never on the tennis court or never on the squash court.

or were males and weren't wearing high heeled shoes, but yet they wondered why their big toe joint was sore. Do you play soccer? No. Do you do squats? Yes. What do you do squat? 300 pounds on the assisted machines. I go, well, you are tearing up your big toe joint. it's like walk around all day on the ball of your foot and tell me how your foot feels.

So strength, from my perspective, because of what my profession was, strength was more of a balancing thing. Somebody had tight, congenitally tight achilles, we had to start concentrating not only getting more elasticity from the physical therapist, my chiropractic colleagues had to work on their anterior tip.

Dr. Mark Wallen (19:13.801)
they'd lost the ability to move that foot up. that's a first MPJ problem caused by not arthritis by the pathomechanics of having calves the size of Arnold's.

Dr Terry (19:29.292)
Yeah, I don't have that problem.

Dr. Spencer Baron (19:32.261)
No comment. That's one of my strong points.

Dr. Mark Wallen (19:37.407)
And it's fine to have. It looks great on women when they have beautifully shaped legs, but you walk around in high heels all day in a profession or whatever your job was, they would beat the living daylights out of their big toe joint. And then if they had a family congenital issue of hallux valgus, we were already booking them for bunion surgery.

Dr. Spencer Baron (20:03.845)
Cushioned shoes. People step into these, I was going to give brand names again, but I'll probably get the axe. They go by running shoes or running sneakers and they put their foot in and love, they're like walking on clouds, but that could be the problem. Thoughts on cushioned shoes.

Dr. Mark Wallen (20:31.039)
when those cushion shoes that you did not mention by name came out and were popular, people were flooding into our office. Doc, what do you think of this shoe?

Dr. Spencer Baron (20:34.611)
Ha ha ha, yeah.

Dr. Mark Wallen (20:41.617)
if the patient was anywhere over fifty because that's where we still were you and and i am the physicians that deal with patients all the time start to deal with balance issues people falling having arthritic hip or arthritic knee or arthritic foot and their balance their gait is not good anyway it was almost a guarantee that if they came in with those shoes

Modely chastise them and say it's like you're walking around in Sander on Jell-O and if you think your balance is bad now God forbid you fall and break your neck or get a concussion or break your hip or break your femur Yeah, it's fixable. But some people die after those major injuries because we send blood clots to our brain or to our lungs or to the calf Yeah, soft shoes are great for

cooking in the kitchen. Soft shoes are great if you're walking around your backyard and you got a pool, but soft shoes contribute to weakness of the foot, weakness of the general lower extremity, and in your patient, could be a 30 year old patient who God forbid is starting to develop some kind of neurological condition, be it early MS,

or something like that, they put on cushion shoes that are like walking in a bowl of jello, they're going to fall and break something or not go home the next day. So yeah, the cushion shoes, not a great idea, even though they feel so good.

Dr. Spencer Baron (22:19.519)
for the late.

for the lay person, I think it's so important to give reasoning. The way the nervous system, I try to share that having your bare foot touch the ground, the way that the nerves fire off all the way to the brain, they determine the texture and the type of

hill or valley that their foot is stepping in and then you have to make an emotional decision on which way you're going to go. There's a lot going on so a cushioned shoe kind of masks a lot of what is supposed to be happening naturally. So I just want the lay people to realize the importance.

Dr. Mark Wallen (23:09.351)
Absolutely. no, absolutely. To back up a little bit, asked me about my thoughts on orthotics, et cetera. One of the important things about orthotics, and they don't have to be rigid, hard, unforgiving plastic orthotics, is the fact that they do provide proprioceptive input to the brain. People who have diabetes and they have lower extremity neuropathy.

The one thing about giving them an orthotic is I'm not going to try to radically change their foot position. But the one thing about an orthotic is most shoes are flat on the inside. It improved their balance because now they could feel the ground. So anybody with a neurologic condition.

We'd do an orthotic not because they had a terrible pes planus or pes cavus. It was because we wanted their feet to know where they were in time and space because those are the people, elderly, neurologically compromised, who were more prone to falling and hurting a major part of their body where they needed surgery or they were in the coroner's office.

Dr. Spencer Baron (24:26.308)
Loss of toe mobility.

Dr. Mark Wallen (24:28.137)
Yes.

Dr. Spencer Baron (24:29.898)
important is that to the body and biomechanics and what can someone do for something like that.

Dr. Mark Wallen (24:39.751)
it's key you know once the heel is off the ground at heel lift that phase of gait what's the foot really doing it's the toes gripping the ground gripping the inside of the shoe which is why soft shoes weren't a great idea because it's like gripping mush or being in quicksand that's where the strength of the foot really comes in that's where the strength

opposite pathology weakness of the muscles in the lower extremity really show their ugly side is because now the heels not on the ground so all of your body weight is essentially on your arch mid arch and forward so toe strength is is vital

Nobody there very few perfect feet out there most people because of either the shoes they wear Pointed shoes cleats, whatever the whatever the situation their toes get crunched together. There's no room. Those are weak toes There's got to be an ability the ability for the toes to individually touch the ground grip the ground when that heel is in the heel off phase of gait or Your your barefoot on an ice rink

Dr. Spencer Baron (26:01.38)
how terrible is a sedentary lifestyle to a foot.

Dr. Mark Wallen (26:12.169)
guys know as well if not better than me because you treat the whole body whereas we podiatrists tend to get a little bit of tunnel vision you know in our practices because we just got to focus on that sedentary lifestyle is a killer

We know it from so many aspects, not only mentally, if you're sitting around doing, if you're sitting reading a book and expanding your mind and going online education, yeah, you're exercising your brain. But if you're still sitting on your backside, so there's brain, there's foot, there's cardiovascular. One of the greatest things was the stand up desk.

I was blown away when patients of mine who were in the business where they had to stand at a desk, sit at desk and then became standing at a desk and started to develop problems with their feet because they were now standing at a desk. said, great that you're standing at a desk, but you've been sitting for 20, 30, 40 years, ignoring your feet. We've got to take care of your feet now because now you're standing at a desk 20 minutes out of an hour, 40 minutes out of an hour.

go by the 30-30 rules. If you sit for 30, you got to stand for 30. Obviously, you have to take the patient's physical health and age and other factors into mind when you dish out that advice. But sedentary lifestyle is an early entrance to the funeral home office.

Dr. Spencer Baron (27:54.853)
Quick question about the sedentary, or about the standup desk, and that is, some people ask about the, whether they should be standing on a foam pad or the bare floor or in their bare feet or in a sneaker, suggestions.

Dr. Mark Wallen (28:09.905)
It's a hard, that's an individual case. I'd say, let's say somebody who has an elderly person who has rheumatoid arthritis, psoriatic arthritis in their metatarsal area. That's a patient that shouldn't be standing barefoot on a hard floor at a desk. You know, they would probably go to a place and buy a commercial kitchen chef mat and be in a, you know,

middle of the road athletic shoe that gives them some support and stability. there's, you you've got to take whatever pathology is there. I don't know that I would say that you couldn't stand barefoot on a thin...

kitchen mat and do your thing if you're you know young and healthy and don't have a bunion or hammer toes or overly somebody with a with a tremendously strong calf muscle standing barefoot at their work desk on a hard floor they're gonna they're gonna get metatarsalgia

pretty you know within a few days or weeks of being in the office because it's like standing on the balls of your foot on a wooden floor. That would be a good case to get a professional kitchen mat or yoga mat or if it's a cement floor because of the work environment, it's a warehouse or a factory, then you know a good quality supportive athletic shoe, lace-up shoe, even the ones that you step on.

light in ones just to give the foot a little bit of some cushioning and a little bit of external support.

Dr. Spencer Baron (29:51.524)
great advice

Dr Terry (29:54.073)
You know, Doc, you and I have had some fun conversations because being the surgeon, I'm always fascinated with stuff that I never see. And with all the thousands of surgeries you've done, what's some of the craziest, most shocking foot conditions that you've seen over the years, and how many of these were actually preventable if people had a better lifestyle and thought process?

Dr. Mark Wallen (30:18.357)
The one that comes to mind and you and I did talk about it was I had the honor and shock of seeing a Chinese woman who came into the office whose feet were bound. I was telling Dr. Terry, yeah, only once in my life the foot looked like a cauliflower. I got to admit I had to, I almost held back tears because

you realize just how much pain this poor human endured because of her gender to have a foot two feet that looked like this it was it was they were unrecognizable and she allowed me to take an x-ray so that was the extreme dr terry and that obviously was not

fixable. Her problem was she was developing ulcerations in the skin. She was elderly, so she'd lost all, had long since lost all of the fatty layer under the skin that's, you know, protective during our formative years, till we get about 15, then we start losing the fat on our foot. So she was developing ulcers because she had literally

even if she was even if she had these she had shoes that were made for by a by an orthotist she was still breaking down on the skin because her bones were literally newspaper away from the external surfaces when i was a early in practice a pediatric from southern california used to go down to baja california to go to club foot clinics

And our senior colleagues ahead of us would go down there and do club foot surgery with the local surgeons. And we'd see the young boys and girls playing soccer with club feet where the only point of contact with the ground was the medial malleolus.

Dr. Mark Wallen (32:20.797)
And they'd still kick a ball and they'd still run up and down. And when I say pitch, this was not Dodger Stadium grass. This was dirt and stones. And you can imagine in the poorest areas of Baja, California, where they would run, they needed, you know, club foot, reconstructive major surgeries to get their foot back underneath their ankle. So those were some of the things. But generally speaking, in the office, would be the people with

severe bunions where the big toe was literally, you know, probably pressing under the fourth toe, where a patient was a busboy working in a warehouse, 50,000, 100,000, 500,000 square foot warehouse on cement.

not having the ability to afford maybe the best shoe and get ulcerations on the skin because a callus would become so hard that it would split like a horse's hoof.

abnormal pressure that would go on the lateral part of the foot because the big toe wasn't functional. They would be probably better off losing, amputating the big toe than walking around with a foot that was like this because all of the pressure was being born on the foot, the part of the foot that's not supposed to carry that much weight. But the standout was the Chinese woman whose foot was bound and these kids in Baja that had uncorrected club feet.

And the good news was anybody that came into my office who lived in Southern California around our office had access to quality care and we were able to fix most things. But astounding.

Dr Terry (34:06.798)
You know, Doc, we've talked about this too. We've talked about this too, but a lot of doctors, MDs, DCs, PTs, they'll look at ankle injuries, they'll look at knees, they'll look at hips, and they never look at the bare foot. They never even take them out of the sock. And when we started taking people out of the sock and actually looking at their feet, and you and I have talked about this, it's amazing how many webbed feet I've seen. And, you know, people think of that as being

but it's actually I see at least one or two web foot every other month and You and I have talked about that. So people that have web feet are embarrassed They don't want to show you their feet. They don't want to take off their sock Yet it's more of a cosmetic thing. Can you talk to address the people have web feet that may be embarrassed about that and let them know? How it affects them and if surgery is necessary?

Dr. Mark Wallen (35:08.629)
Web.

Web toe and it's very rare to see web toes, know, Halleck's second toe, second toe, third, third, fourth, fourth, fifth. The only one who was fortunate enough to have that was Michael Phelps. That's made him such a great swimmer because his kick was so efficient. It was like wearing scuba diving fins because I think he had size 13 or 14 feet anyway. So he was fortunate to have web toes. It's really just a cosmetic condition that you just get fusion of the soft tissue between

usually between just two digits. Women, frankly, are a little more embarrassed about it than...

men, but in general, you know, it's really a cosmetic thing. It has nothing really to do with foot function unless it's the entire two toes, three toes that are webbed. Then instead of having a little bit of motion between the toes where there's a balancing effect, it's almost like having three toes is one that could potentially, depending on recreational activity, job, you know,

body attitude overweight, underweight, sitting, standing at work, you know, could affect balance, et cetera. it's rarely did I find patients had to have their toes desyndactylized. You know, we call toes that are stuck together, syndactylization. Sometimes it's just soft tissue. Sometimes it's just the flesh. Sometimes it's osseous, where in utero, as the fetus is developing,

Dr. Mark Wallen (36:45.769)
there's a genetic deformity where the toes actually fuse at the internal interphalangeal joints of the toe, then the skin just forms over it. That's more problematic because that's an osseous thing. that we would tend to fix more frequently than just somebody who's got flesh between the toes. That extends a little bit more towards the knuckles or the toenail.

Yes, it's embarrassing, but it's usually not a biomechanical dysfunction. admittedly, I separate a lot of toes that were either osseously fused or just soft tissue fused because the patient said, doc, this is ugly. My husband doesn't like it. My wife doesn't like it.

you know, girls or boys, they would want to fix just because they didn't, you know, unfortunately with our society, you have to look perfectly. Didn't like looking, didn't like the fact that they didn't look like their best friend or older sister or younger sibling. We would correct those, but I was very hesitant to because any surgery can go wrong and then you can make somebody worse than what they were before.

Dr Terry (38:08.845)
Yeah, you and I have talked a lot about footwear, but are you excited about the trend? Well, the trend of footwear now, it's like for years it was like Spencer talked about the narrow toe boxes and all that. And now the big trend is wide toe boxes. And now you also have a lot of barefoot shoes and stuff like that. So people are listening going, oh, I'm on this gushy cloud shoe. I should probably be a barefoot shoe. And we've touched about it.

but there needs to be a transitional period of months to go from high gush to a barefoot shoe. are, but what's your thoughts on this new trend of the wide toe box, minimalist shoes and all that?

Dr. Mark Wallen (38:56.373)
Great question. I definitely am pro wide toe box.

because from a podiatry standpoint, there weren't many people that came into our office with toes that were completely rectus. It was a hallux valgus, was hammer toes, it was the arthritic patients where there was crossover toes, things of that nature. You shove that into a pointed toe, you're going to worsen the deformity and there's nothing I'm going to be able to do for you. So there's a tendency for the human foot because when we went from quadrupeds to bipeds,

Dr. Spencer Baron (39:20.099)
you

Dr. Mark Wallen (39:33.198)
at whatever pleocene era that was, the foot takes a beating. So wider toe box, great. Not everybody can go barefoot. You know, the big question, because I saw a lot of, I did a lot of training in podopediatrics foot, the pediatric foot. And parents would come in, should I have my child wear shoes in the house or not wear shoes in the house?

We love children to go barefoot because that would strengthen the foot, promote more proprioception so their balance was better as they learned to go from, you know...

crawling on their knees and hands to be able to walk. But there were some kids with congenital deformities where they would not be able to walk barefoot. So we would have to recommend straight last shoes or an outlast shoe for a kid that had out toe or pigeon toe or out toe deformity, metaductus or one of the other deformities where they had to be in a shoe to straighten out their feet. So there are some adults that can't go barefoot. But generally speaking, why?

toe box is great because the most common thing we see in the foot is contracture. Whether it's hammer toes or bunions or that kind of deformity or the problems that come from pronation, hyper pronation or hypersuppination. So yes, wide toe box for sure. The transition from soft cushiony jello shoes to barefoot

It's worth a try because I think that barefoot has its advantages even over wide toe box shoes. But the patients just have to know that if they're having a problem transitioning, they may have a foot or some mechanical...

Dr. Mark Wallen (41:30.889)
dysfunction of their lower extremity where they can't go barefoot they can't just pound down and I'm going to go barefoot I'm going to go barefoot I'm going to go barefoot they're going to create some problem those are the ones that would have to go back to you know a softer accommodating stabilizing shoe so everything's worth a try but I think one of the themes that you would ask me to

talk about before the podcast started was what do people do to their feet that you know that's the worst that they can do and the worst thing is ignore the problem

You know, I gave credit to the people who came in during COVID, you know, three months form a sync doc. I'm having foot problems. I never had them before. I sit in my, you know, sit, sit on my desk in the office. At least they came in. Mrs. Smith, put on some shoes when you're standing in the kitchen, chasing the kids around. Mr. You know, Mr. Jones, you can't go in the backyard barefoot to get the trash cans or, you know, get the dog or do something. I said, because you're beating up your feet. They came in and they prevented problems because they listened.

to their feet. Like Dr. Terry taught me to listen to my neck.

Dr Terry (42:47.117)
you

Yeah, on that thought, longevity is a big term. We've talked a lot about athleticism, but everybody wants to be longevity and be healthier longer. And, and, you know, so by the time we do get to the age of Dr. Spencer, we're actually feeling pretty good about ourselves. So we, people don't realize these jealous shoes we've been talking about were originally designed for ultra marathoners as a recovery shoe, and they're only designed to be worn for a couple of weeks. They

Dr. Spencer Baron (42:48.578)
There you go.

Dr Terry (43:18.511)
weren't designed to be worn every day. And so, yes, I'm a big foot strengthening guy and all that, but we talked a little bit about how when you wear these jealous shoes, your balance is off and you touch about that Mark. So what is yet the older, I see the older population hiking in them, wearing them, and because they feel good, yet that's actually decreasing their longevity. Can you talk a little bit about how

the foot actually talks to the brain and how the foot is. We've heard stories about the feet have to be twice as strong as the hands. The new measure of longevity is foot strength. Can you kind of talk a little bit about that, about how the feet strength and what you put there is really important for longevity and for balance?

Dr. Mark Wallen (44:08.373)
Great question and absolutely the foot is the foundation of the body. So you're walking around, take a senior citizen who is still physically able to go for some hikes, you're walking around in jello shoes and on whatever the terrain is, doesn't have to be the top of the top double black diamond hike or trail.

But if the foot is moving around like you're stepping in three-week-old jello, then the knee and the hip and the sciatic joints and the spine from literally sacrum all the way up are going to be stressed. So you get off the trail and your feet may still feel good. You might be little exhausted. Your heart might be pounding and you're sweating.

What have you done to the other joints superior to the foot? And you wonder why you wake up the next... I'm sure people wonder after a hike in soft shoes why they wake up the next day and go, gee, my back didn't hurt me during the hike. And my back didn't hurt me when I was sitting down eating dinner last night. But wake up in the morning with lumbosacral pain or wherever it is, you know, above the ankle.

There's that disconnect going, can't be my shoes because my feet felt OK. yeah, longevity for a lot of reasons. Longevity as far as wearing the correct hiking shoe, walking shoe, whatever it is, so that you're not damaging other joints in the body. That if you damage them, it's, well, there's always a surgeon to fix something, but some things are not fixable.

But the other thing is creating problems that are caused by being in the incorrect shoe that you could prevent. seniors wearing soft shoes to go for a hike up in the Pacific Palisades, which is out here where we live, is terrible for the reasons that they lose their balance on the edge of a cliff and fall and break their neck, fall and break their hip.

Dr. Mark Wallen (46:30.229)
God forbid some other major injury where they have to be lifted off the hillside by the Los Angeles Sheriff's Department or whatever. That's the worst scenario.

But the less worse scenario for longevity, I want to keep hiking until I'm 70 or 80 or whatever it is, is being in a soft shoe that, gee, my feet really don't feel bad because feet take a licking and keep on ticking. They're like a Timex watch. It takes a lot to make a foot. It takes a lot. You can tell how old I am, Dr. Barron. The feet can take a beating.

Dr Terry (47:03.629)
Yeah, but we all got that.

Dr. Mark Wallen (47:08.255)
But then it's the patient who starts damaging their knee or their hip or their lumbosacral spine and go, where did that come from? And that's...

That's the shame of it is because the foot is so tough. It's a may you guys well know with the patients that you see what kind of abuse, feet taken and patients don't come in with foot complaints. But to you, come in, me as well. But to you, you're more focused on the other body parts. My knees start to hurt me six months ago. What are you doing? Well, I started took up hiking with my church group.

whatever the age groups but the odds are they're going to be a little bit older and nobody's asking the question about what are you wearing on the trails that's causing you to put more pressure on your knee because your feet are walking around in quicksand.

Dr. Spencer Baron (48:09.153)
Do you feel that doctors get stuck in doing these outdated treatment plans? And if so, could you share with our listening and viewing audience what those more progressive approaches would be as an alternative to some of the old approaches?

Dr. Mark Wallen (48:30.495)
Sure, I think that's very important.

you know there were in discussions with Dr. Terry, there's some things in the foot that come into a foot, to a hammer everything's a nail. So when you come into a foot doctor's office, a surgeon, deformities are fixable. I think.

Dr. Spencer Baron (48:46.145)
Yeah.

Dr. Mark Wallen (48:55.625)
think the problem is, and again, Dr. Thayer and I have talked about it, is all physicians, whatever your profession and education is, that there's a body attached to the foot, there's a body attached to the spine, there's a body attached to that wrist, is the fact that, I can fix a hammer tone, I can fix a bunion, I can fix somebody who's got arthritis in their ankle or whatever, we're not going to talk about broken bones, et cetera.

that there's a body attached to it. And if somebody has an arthritic big toe joint, my job, foot doctor's job is not just, okay, Mr. Smith, you've got an arthritic big toe joint, we can put a steel shank in your shoe, we can put an orthotic and supinate your foot a little bit, or we can try some anti-inflammatories or cortisone injections, is...

They've been walking on that for a long time. Mr. Smith, how's your back? Do you sleep through the night? Can you pick up groceries? Do you have a hard time picking up your kid or picking up your dog or whatever it is? it's the fact that all of our, all the health professions tend, unfortunately, to develop tunnel vision because we're so pressed for time and...

all the other things that force us to have to get in, get out, get in, get out, to forget that the body attached. So for me, it was, and again, going back to my chiropractic roots, having been trained early to ask the questions about the rest of the skeleton that most podiatrists who didn't have the exposure to chiropractic profession wouldn't have done, but it's also...

your profession. My back's been hurting me for 30 years. Well, so they're hunched over when they walk, which means they're leaning forward. So they're firing their Achilles a lot. And maybe there's other weaknesses where you've got to ask more questions than how long has your back been hurting you? How long has your big toe been hurting you? How long has that second toe been hammered and curled up? So I think we all tend to do that. And I think it's just...

Dr. Mark Wallen (51:17.705)
going back to what we talked about just a few minutes ago that you'd care about longevity is if you're gonna if you're going to talk about longevity you've got to take people's shoes off you've got to take people's shirts off I took a lot of shirts off of people and people go Dr. Wong why are you looking at my back I said because if you've got a scoliosis even though your legs might measure out

equally there's there's a functional leg length discrepancy and a structural leg length discrepancy and the only way I'm going to know that is for all my chiropractic colleagues at the two schools I was blessed to work at to show me how to look at a back and I knew how to measure somebody's leg length from the ASIS down to the medial malleolus but I had to watch them walk and see

walking like that those are the ones that immediately went to the chiropractor if they didn't have one before or the orthopedic back specialist and i think that's where longevity comes in is we've got to be looking at the body from head to toe but we're not given the time that's the big that's i think that's the big shame is we're not given the time we're in and out of doctor's office like the like the front door at at a five and dime store

Dr. Spencer Baron (52:41.001)
viewers and listeners would love to start doing something today to make a difference and if there's anything that you might want to suggest if you had the opportunity to take a child and you know what could kids do with their for their feed or their with their parents or athletes or the aging adult need to start doing today

Dr. Mark Wallen (53:06.837)
For the kids, I'm glad you brought that up. For the kids, it's, you know, the little ones, unfortunately, can't speak for themselves. There were some great opportunities when the parents would bring a small child, an infant, or an early walker, and the 10-year-old daughter or the 12-year-old son would come in. And I'd say...

Mom and dad and 12-year-old, take off your shoes. And there'd be an early bunion on the teenager. And the father would have a bad pest plantus. I say them, what do you think your three-year-old is going to be looking forward to? That's the kid that didn't go barefoot in the house. That's the kid that we would send off to one of the better foot stores that sold pediatric prefab orthotics or go online to

some of the online sellers and have them because that little every every infant's foot who starts to stand at around age one is a little ball of play-doh and the arch is going to collapse

the family doctors and I was fortunate the pediatricians all around me sent the early walkers to me to say, Mark is this a flat foot or is this just a pudgy early foot? So I have to the parents and the older siblings take off the shoes. So for children, mom and dad look at your feet, at look at grandma and grandpa's feet and if you were taking grandma and grandpa to the podiatrist or the tropidist, you've got to take your child, your

early walker to a podiatrist, chiropractor, some health professional who's familiar with the footer, understands the foot little bit more because dad's got flat feet or mom's got a cavus footer or 12-year-old teenage child has an early bunion. So for children, it's look at the older siblings, look at the parents, look at the grandparents. For athletes,

Dr. Mark Wallen (55:06.677)
little tougher uh... again yes if it's a if it's a teenage athlete mom and dad have foot problem with dad an athlete when he was in high school or junior high and did he have foot problems that either cut his career short or whatever um... you know so there's you still asking the parents of the grandparents was there foot problems but then you gotta kind of narrow it down to what's the sports football turf

baseball I'm gonna look at that catcher who's squatting down on his big toe joint more than I'm gonna watch the shortstop or the outfielder because he's gonna do more damage to the foot.

long distance runners versus the track runners. Track runners run down the track on the balls of their feet. They're going to have more lesser metatarsal pain than the quarter mile, the half milers or the 3,000 mile or the 5K or the 10K runners who run pretty much heel to toe, although everybody's been taught to run on the ball of their foot these days. So there's the sport specific problems.

But I think one of the things is don't ignore your genetics.

And if grandma and grandpa and mom and dad were going to a foot doctor or whatever the health practitioner was because of some lower extremity thing, you're going to have to figure out that something's going to change in your foot as well that's going to need addressing now so it doesn't become a problem when they're in their sophomore year of high school or freshman year of college and want to make that transition to a higher level of competition.

Dr. Spencer Baron (56:54.379)
Hey Dr. Terry, are we okay with rapid fire questions? Because I would love to hear some of those answers.

Dr Terry (56:59.213)
yeah, hit it.

Dr. Spencer Baron (57:04.171)
Dr. Mark, this is nearing the end of the show and our rapid fire questions, there's five of them and we look for the most brief, concise answer. And if you're ready, I'm gonna fire off number one. Ready? Okay, Dr. Wallin, what do you think is the most overrated shoe trend that you have seen today?

Dr. Mark Wallen (57:34.165)
The cushiony soft shoe.

Dr. Spencer Baron (57:38.113)
Good, question number two. After 40 years of fixing other people, what's something life had to break you in before you finally understood what was going on?

Dr. Mark Wallen (57:50.633)
I'm sorry, repeat that?

Dr. Spencer Baron (57:52.01)
Sure. What's something life had to break in you before you finally understood it as far as fixing other people? What is... I don't know any other way to ask that question.

Dr. Mark Wallen (58:09.779)
No, I get it. I'm going to go back to the exposure that I had to chiropractic, that the foot is connected to the rest of the body just like the rest of the body is connected to the foot. And I think I always had the ability to not get that tunnel vision and address the body as a whole.

Dr. Spencer Baron (58:36.801)
Question number three, what moment in your life are you most proud of that had absolutely nothing to do with medicine or success?

Dr. Mark Wallen (58:57.503)
That's great. No, I think you got me. nothing to do with medicine.

This is a stumper.

I... I'll... Very quickly. I guess it's the fact that... or the times where somebody came to me with some non-medical, more emotional issue and I didn't shoo them away. I forced them to address it.

Dr. Spencer Baron (59:34.251)
Well, I must say you have that character where people would trust you with some of their personal stuff and I commend you on it. Because sometimes even Dr. Terry and I, we play more psychologist than just biomechanics specialist or anything. Very good. Very good. I'm glad that caused you to think about it. Good. You will never forget that. Good. Question number four. There's two more. You spent a lifetime helping people walk better.

Dr. Mark Wallen (59:55.829)
I got a headache now.

Dr. Spencer Baron (01:00:03.668)
But what experience taught you the most about being human?

Dr. Mark Wallen (01:00:13.875)
I think that because walking, running, staying active is so very important to everybody, but especially here on the West Coast, because we're outdoors 360 days a year. I was always talking to my patients about family situation, their job, their recreation, et cetera.

So wasn't just, you've got a sore big toe. I'm going to fix it. Here's your prescription, or you'll do surgery next week and you'll go on. The discussions about what my patients were doing in their life and how their foot affected their life and how their life affected their feet and where the disconnects were. And I tried to make that connect.

Dr. Spencer Baron (01:01:02.688)
I'll tell you, from your story about the Asian woman and her bound feet and that tearful affect that it brought on to you personally, that was human. That was about being human and not just a clinical perspective of being what you were taught. So I appreciate that. That was a great story you shared. Question number five, last one. When people remember Mark Wallen, what do you hope?

they say about the man, not the doctor.

Dr. Mark Wallen (01:01:39.647)
that I treated everybody with respect that each individual deserves.

Dr. Mark Wallen (01:01:52.853)
open to allow them to spill their pain without judgment but not just listen to it give them direction on how to get better

Gee, you need to see a therapist. You need to see a physical therapist. You need to see a chiropractor. You need to see your rabbi or your priest. We all try to do a good job of listening. I think the one thing that I'm most proud of myself, and I think people will say is, they helped me get to a better place, whatever it was.

whatever they needed.

Dr. Spencer Baron (01:02:44.096)
Thank you, Dr. Mark Wallin. That almost got me choked up. felt it. Those are those deep questions that leave a legacy. So thank you for being on our show today. We appreciate you.

Dr. Mark Wallen (01:02:56.501)
I'm honored to have been here. I learned so much from you, your profession, from life itself, just to be able to. The thing I miss about being retired is not being able to continue to do this on a one-on-one basis with my patients.

Dr. Spencer Baron (01:03:17.534)
stuff.

Dr. Mark Wallen (01:03:17.877)
still giving. I give, I give in, I'm trying to give in other ways now. Well thank you gentlemen, this was just honorable and I loved it. It just made my day.

Dr. Spencer Baron (01:03:22.334)
You are, you definitely are.