Chapter 7: The Billion-Dollar Blind Spot. Anatomy of a Collapse
The civilized man has built a coach but has lost the use of his feet. ~ Ralph Waldo Emerson, Self-Reliance 1841
Dropped in mid-journey? Walk Straight is best experienced from the beginning.
In 2014, the American Podiatric Medical Association (APMA) released survey results showing “that we view our feet as the least important body part in terms of our overall health and well-being…”
83% admit to chronic foot pain.
77% of Americans experience foot pain.
50% of all adults say foot pain has restricted their activities.
39% say that they would exercise more if it weren’t for their foot pain.
41% say they would participate more in activities if it weren’t for their foot pain.
The numbers speak volumes, and they come with a price tag. In their 2014 abstract, Economic Burden of Foot and Ankle Surgery in the US Medicare Population, DA Belatt and Phinit Phisitkul estimated that in 2011, the economic burden of foot and ankle surgery in the Medicare population was $11 billion! “…Direct health care costs were responsible for only 11% of this total, while indirect productivity costs contributed the remainder.” So, basically, treatment costs a cool billion! In 2011! Wow. Just wow.
And that figure only reflects the Medicare population, a limited segment with narrow coverage. The true cost grows exponentially when you factor in everything Medicare doesn’t cover: the millions not on Medicare and the billions more spent out-of-pocket or through insurance on podiatrists, physical therapy, chiropractic, acupuncture, reflexology, foot massage… the list goes on. Mind blown yet? Because the number further skyrockets when you add in the costs of footwear and commercial products designed to make or keep the foot more comfortable. Insoles and inserts alone are a multi-billion-dollar industry.
“Our feet are literally and figuratively the furthest things from our minds,” noted APMA President Frank Spinosa, DPM, Director of Podiatric Medicine. With a price tag this steep, monetarily, emotionally, physically, and socially, it’s clear something needs to change. The foot isn’t just a body part; it’s a neglected structural hub with systemic consequences.
As it turns out, while we are prematurely loading the hips and sea legs of our babies, as discussed in the last chapter, we are also wreaking havoc on their feet and ankles. Unsurprisingly, it shows up later in our adult feet and ankles. I hate pointing it out, but it is what it is. One of those things that, once seen, can’t be unseen. They might be small, but their impact is massive. Each baby and toddler foot contains 26 bones, 19 muscles, 107 ligaments, and three crucial developing arches. The primary arch, the one we are most aware of, runs at the base of the foot from the balls of the toes to the heel. There’s also a transverse arch across the ball of the foot, spanning from the first to the fifth toe, and a lateral arch that curves along the outer edge, from the base of the fifth toe to the heel. Our feet are complex foundational structures, ground zero for our lifetime standing posture, yet we typically view baby feet as adorable, pudgy things meant for smooching and ripe for ridiculously cute shoes.
In a perfect world, baby feet would be uncovered or with as little covering as possible so that they can move and grow unencumbered. Babies are naturally captivated by their feet, often playing with them, sucking and pulling on their toes. An instinctual response, as their feet are integral to pushing when trying to roll over, sit, crawl, and eventually walk. Once babies can pull themselves up, bare feet allow their soles to experience the ground. The interaction between nerves in the soles of the feet and the ground sends critical information upward, alerting the body to what muscles are required to accommodate whatever challenge is beneath them. The muscles of the foot then respond to this stimulus by drawing up under the arches in conversation with the legs and torso, and voila, the Medial Line (ML) is in the house! When this line is clear and responsive, our entire structure operates in a state of continuous correction and balance, adapting in real time for optimal efficiency and agility.
Unfortunately, more often than not, babies’ feet are covered first with socks and then with shoes. Although it’s easy to forget, shoes were no more a part of the evolutionary design of the human musculoskeletal system, any more than they were for other animals. Early humans went barefoot, or nearly so, using soft, flexible coverings and walking on uneven terrain. Their feet were strong, and more importantly, the systems connecting feet through the legs, pelvis, spine, and skull functioned as nature intended.
Shoes may protect the skin of the feet, but they also block the soles from this meaningful interaction with the ground, dulling the neuromuscular connection we were built to rely on. And don’t get me started on shoes with marshmallow soles. They’re soooo popular because they feel soooo comfortable, until you take them off, and your feet hurt without them. The good news, though, is that once we know how we got here, we can take the steps to reverse course and reclaim this extraordinary system.
Sure, it’s easy to look at our babies and children running around and proclaim, “Everything works! They are strong! They are happy! Isn’t that proof that everything’s fine?” But adaptation isn’t optimization. It’s not just adults spending money on foot pain. The fact that children are regularly prescribed insoles is an enormous red flag waving wildly that we’ve gone off track. We’ve built a multi-million-dollar industry around pediatric orthopedic insoles as an “easy fix” instead of pursuing true preventative foot care.
Despite their profound impact on everything above them, our culture continues to treat feet as an afterthought. We overlook the long-term consequences of early interference. Then later, as adults, we tend to add insult to injury by ignoring them unless we're shoe shopping, getting a pedicure, they’re cold, or they hurt.
But feet aren’t passive platforms; they’re dynamic players in our musculoskeletal orchestra. Like a suspension bridge, our feet are meant to stay flexible in a constant state of readiness to accommodate vertical and horizontal variations in the environment. Unfortunately, many feet today are heavy, squashed, ignored, atrophied, and deformed. Sounds harsh, but it’s true. Walking, and even just standing, is exhausting in large part because we underestimate our feet’s role in posture, locomotion, and balance.
Still, before we can change them, we have to see them. Today, while you brush your teeth or wait in line, pay attention to how long you can stand still before you feel the need to move. Take note of what becomes uncomfortable first. After a night of rest, how do your feet feel in the morning when you stand for the first time of the day? Shouldn’t rested feet feel refreshed after hours of time off? When was the last time you really looked at your feet or gave them a good rub? They are more than length, width, arch, and height, requiring inserts, stability shoes, or custom trainers. But instead of seeing the role of environment, footwear, and compensation patterns, we blame genetics. If your ankles roll in or out, here’s an orthotic … and bunions? Thank your mom and schedule surgery. Meanwhile, we spend hours building cosmetic muscle in all the usual places, while our feet, our foundation, languish, braced and forgotten. We massage aching shoulders, weary from holding up our heads, while ignoring the parts that hold up everything else, including our head.
Our feet are our substructure, and they deserve more than a passing thought or a stylish shoe. Even if we start late, sooner is better than later, now is better than never. The body adapts, but it can also recover. We can reawaken the neuromuscular pathways that run through the arches, the bones, the muscles, restoring our feet to their original role: a dynamic, intelligent control center at the base of it all. My next chapter tells the story of how the feet I once tried to hide became the powerful foundation for how I live and teach today. The title? Sexy Feet. It started as a joke. The results were anything but.
Do you have any observations or stories you’d like to add? Please drop down to the comments and share! XxD
Sometimes, all it takes is a shift in perspective or a nugget of information considered in a new light to spark the ah-ha moment that changes everything! Subscribe for free to get a new chapter delivered to your inbox each week!