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Welcome to The Dr. Kumar Discovery, a health and wellness podcast hosted by Dr. Ravi Kumar, a board-certified neurosurgeon. This is the medical podcast for anyone who wants honest, evidence-based answers to the health questions that matter most. No corporate influence. Just a physician who reads the research, questions the dogma, and breaks it down in plain language so you can make better decisions about your own health.
Dr. Kumar is a practicing neurosurgeon who brings a surgeon's precision to topics most doctor podcasts only scratch the surface of. Each episode dives deep into the science behind metabolic health, cardiovascular disease, heart disease, hormones, nutrition, brain health, mental health, pain, inflammation, weight loss, aging, blood pressure, sleep, and longevity. Whether it's the truth about seed oils, the real data on GLP-1 drugs and weight loss, the science of cold water therapy, how light can heal the body, or why your testosterone is declining, Dr. Kumar goes straight to the peer-reviewed literature and tells you what the evidence actually shows, not what the headlines say. This is evidence-based medicine in plain English.
The show features three formats. Solo deep dives explore a single health topic from the ground up, covering everything from the biology to the practical takeaways you can use today. Expert interviews bring on leading researchers, clinicians, and forward-thinking voices in health and medicine for in-depth conversations you won't hear anywhere else. The Tribulations series tells the true stories behind medicine's greatest breakthroughs, from the discovery of penicillin to the invention of vaccines to a father's fight to save his son's life. These are the stories of the doctors, scientists, and patients who changed the course of medicine.
Topics covered on the show include testosterone and hormone optimization, sleep science, photobiomodulation and red light therapy, exercise with oxygen therapy, creatine, uric acid and gout prevention, gut health and probiotics, cardiovascular risk and Lp(a), cholesterol, PANDAS in children, PTSD and trauma, acetaminophen safety, glyphosate, foot health, and much more.
If you're tired of generic health advice and want to hear from a neurosurgeon who actually reads the studies, The Dr. Kumar Discovery is your podcast. New episodes drop regularly. Subscribe and join the discovery.
For show notes, references, and more, visit drkumardiscovery.com/podcast
[00:00:00] Dr. Ravi Kumar: Hey, everybody. Welcome back to the Dr. Kumar discovery. Earlier in the week, I interviewed Dr. Ron Tallis on foot health, and I got a bunch of really good questions afterward. So I picked five of the best ones to do a mini episode on. I think this will tie together most of what we covered earlier in the week. So let's get started. Okay. First question. I've worn shoes my whole life, and my feet feel weak. Is the damage permanent, or can I actually get the muscle back? Okay. So there's good news here, and that is that you can absolutely get it back. And the research on this is encouraging. A study published in 2019 took 57 runners, and randomized them into three groups. One group did targeted foot strengthening exercises five days a week. One group just walked around with minimalist shoes for their daily activities, and one was a control group. After eight weeks, both intervention groups gained foot muscle size and strength. What I thought was really neat about this study is that the minimalist shoe walkers gained just as much as the people doing dedicated exercise just by changing what they had on their feet during normal life. And this fits into a bigger framework called the Foot Core System, and this was laid out in a foundational paper in the British Journal of Sports Medicine in 2015. The idea is that the small intrinsic muscles in your foot function in the same way as the deep core muscles function in your spine. They're the local stabilizers. They're small, they're routinely ignored, and they atrophy when you don't load them. But they respond to training the same way that any other muscle does. So, where would you start on this one? Well, honestly, the simplest things work the best. Spend time barefoot at your home, try the single leg balance that Dr. Talis talked about, which is standing on one foot on a pillow for thirty seconds. And once that gets easy, do it with your eyes closed. Pick up a towel with your toes. Do toe scrunches while you're watching TV. And if you wanna go further, transition to a wider toe box shoe with low or zero drop sole. You don't have to go the full Vibram five fingers overnight, but a minimalist shoe right off the bat is going to strengthen your foot. Just take the transition slowly because your feet do need time to adapt. But the muscles are still there, and they're waiting to work. Okay. Next question. The salesperson at the running store told me I overpronate and need motion control shoes. Is that actually based on anything? Okay. So this is a great question, because it gets into how marketing, dressed up as science, convinced the whole industry of consumers that something normal is actually a defect. First, pronation itself is not pathological. It's a normal, necessary part of the gait cycle. Your foot has to pronate to absorb impact when it hits the ground, And then it has to supinate to launch you forward. If your foot didn't pronate, you wouldn't be able to walk on uneven ground without rolling an ankle. So the idea that pronation is something that should be stopped is wrong from the start. Second, the science on matching shoe type to foot type is much weaker than the running store would have you believe. A prospective study published in the British Journal of Sports Medicine in 2014 followed 09/2027 novice runners wearing neutral shoes, and found that foot pronation was not associated with increased injury risk. And a large randomized trial published in the American Journal of Sports Medicine also showed that matching shoe type to foot type did not reduce injuries. But the picture isn't fully black and white. There was a secondary analysis published in the Journal of Orthopedic and Sports Physical Therapy in 2021 that did find that motion control shoes reduce pronation related injuries in recreational runners who already overpronate. So there may be a subset of pronated runners who do benefit from this. But the blanket recommendation that everyone who pronates needs a $150 motion control shoe is not what the evidence supports. So what should you do? Well, I say just try shoes on, run-in them, and then pick a pair that feels best. If something hurts, change it. And don't let a sales pitch override your body's own natural biofeedback. And also remember that in the end, you wanna use the muscles in your feet, not immobilize them. Okay. So next question. I've had plantar fasciitis for over two years, and I've tried stretching, ice, and anti inflammatories. Nothing's working. What am I missing? Okay. So this is a really common frustration, and the answer might be hiding in the name of the condition itself. A paper published in 2003 looked at tissue samples from fifty cases of chronic plantar fasciitis. What they found or actually what they really didn't find was inflammation. There was no inflammation in those tissues. And this is something that Dr. Talis talked about in the podcast. In that study, not a single sample showed cellular signs of inflammation that the suffix it is in plantar fasciitis actually means. What they did find was degeneration of the plantar fascia. These were microscopic fiber damage, scarring, fragmentation. The authors proposed that the condition is more accurately called plantar fasciosis, not fasciitis. So it's a degenerative problem, not an inflammatory one. So if the underlying tissue is degenerated rather than inflamed, that changes the whole treatment logic. Repeated steroid injections, which work for inflammation, might be the wrong tool for degeneration. The paper actually raised real concerns about steroid injections weakening the fascia and increasing rupture risk. And that wasn't Dr. Talis' experience, and he talked about it in the podcast. He actually thought for the right patient, a deep steroid injection could give them significant relief. So what works? Well, anti inflammatories will reduce pain in an acute flare, but they don't fix the underlying issue. What actually fixes it is the slow boring work of remodeling fascia. That's calf and Achilles stretching, plantar fascia stretching against a wall, eccentric loading, and restoring strength in the intrinsic foot muscles we talked about in the first question. Dr. Talis also pointed out something that I thought was really insightful. A lot of what gets diagnosed as plantar fasciitis is actually just fatigue in those small foot muscles, and there's no diagnostic code for your feet are weak. So it gets billed as plantar fasciitis by default. But either way, the treatment for both is the same. You need to rebuild your feet from the inside out with strengthening and stretching. Okay. Next question. My pediatrician said my kid has flat feet, and we should put them in arch supports. Is that really necessary? Okay. So this is one of my favorite parts of the conversation because Dr. Talis explicitly pushed back on the idea that flat feet are inherently pathological. He called it a type of normal, which I totally loved. And the data backs him up on this one too. A classic paper in the Archives of Family Medicine in 1993 looked at 246 army trainees, and tracked the relationship between foot type and exercise related injury. And the strong predictive relationship with flat feet and injury that most people would expect just wasn't there. So the foot type that everyone worries about, flat feet, might actually be safer in some context. But the picture is still nuanced. A rigidly flat foot in a child who can't keep up with their peers because they're in pain, that does need attention. An adult whose arch suddenly collapses in their forties, that's likely a posterior tibial tendon dysfunction, and worth seeing a podiatrist about. But the kid whose feet are just flat, and they're running around like every other kid, no pain, no obvious gait issues, probably doesn't need orthotics. The bigger question is whether putting a flat foot in an arch support actually changes the long term trajectory of the foot. The evidence for that is weaker than most parents are led to believe. Arch supports can relieve symptoms when symptoms exist, but they're not a vaccine against future foot problems. If your kid has no symptoms, the better intervention is probably the one Dr. Talis kept coming back to. And that was time spent on uneven surfaces, time barefoot on the grass or sand, or some natural surface, and using feet the way feet are actually designed to be used. Okay. Next question. Dr. Talis said the foot is the canary in the coal mine for vascular disease. How seriously should I take that? Okay. Take it very seriously. This is one of the most important things Dr. Talis said, and it ties the whole episode back to Metabolic Health in a way that I want to make sure that everyone gets. The blood vessels in your feet are small, and they're as far from your heart as anything can be. So if your circulation is starting to fail, your feet are actually where it shows first. Cold feet, hair loss on your toes, dusky color, slow healing cuts, leg cramps when you walk that go away when you rest. These can be the earliest signs of peripheral artery disease that shows up first in the foot. So the screening test on this is simple and cheap. It's called ankle brachial index or ABI. You measure the blood pressure in your ankle and divide it by the blood pressure in your arm. A ratio under 0.9 is considered diagnostic for peripheral artery disease. So what should you do with this information? Well, I'd say, first, just pay attention to your feet. If they're getting cold, if the hair is thinning on your toes, if your skin color is changing, if cuts aren't healing the way they used to, don't just shrug it off. Ask for that ABI, and work on things that drive vascular health overall. So that's don't smoke, control your blood sugar, move your body. So I've done full episodes on metabolic health, and they pair really well with this topic that we're talking about right now. And if you want to go deeper, you should definitely go back and listen to them. But let's just say this for now. The foot may be whispering warnings to you. All you have to do is listen to it and look at it. Okay. So those are all the questions, but there was one bonus topic that I wanted to talk about a little more because I thought it was really interesting. Dr. Talis recommended soaking your feet in warm brewed black tea once or twice a day for about fifteen minutes at a time as a treatment for hyperhidrosis, which is the technical term for excessive sweating of the feet. And the mechanism here is real and science backed. Black tea contains tannic acid, which is the same compound that gives tea that astringent taste if you drink it just plain black without milk in it. Tannic acid also causes mild contraction of your sweat glands, which physically reduces sweat output. So if you start doing this, it'll take a couple weeks of consistent use to really see the effects, but it's cheap, it's safe, and it's the kind of thing your grandma might have known about that turns out to have a legitimate biology behind it. So if you're struggling with sweaty feet or athlete's foot, before you go down the rabbit hole of antiperspirants and powders and antifungals, maybe try some black tea. Dry out your feet and see how you feel. Okay. That's it for today. Big thanks to Dr. Ron Talus for coming on the show. If you haven't listened to that full conversation I had with him, please go back and take a listen. It was a master class on the foot, and one that everyone should listen to. Your feet are the foundation of everything you do, and most of us have never given them five minutes of real attention. Okay.
So cheers, and I'll see you next week.