By Kym McNicholas, CEO, Global PAD Association
Imagine losing your toes—the very foundation of your balance, mobility, and independence. For millions living with Peripheral Artery Disease (PAD), this nightmare becomes reality far too often. Yet most medical textbooks and physical therapy protocols completely overlook one of the most fundamental approaches to preventing this outcome: toe exercises.
“What’s the first thing you lose with PAD? Toes,” explains Dr. Kevin Morgan, an 82-year-old pathologist, PAD patient, and competitive world triathlete who joined me on our latest Collateral Nation podcast.
Understanding PAD: A Growing Global Crisis
Peripheral Artery Disease affects over 200 million people worldwide, with prevalence rising dramatically with age. This progressive disorder is characterized by narrowing or occlusion of arteries that supply the limbs, most commonly affecting the lower extremities. The restricted blood flow can cause intermittent claudication (pain during walking), slow-healing wounds, and ultimately, tissue death leading to amputation.
Despite its widespread prevalence and significant mortality risk, PAD remains chronically underdiagnosed and undertreated. Even more troubling is the insurance industry’s approach to PAD treatment. As I discussed in my recent article, “The $100 Billion Amputation Crisis,” insurance companies provide “carte blanche reimbursement for amputation for any reason,” while making advanced limb salvage procedures increasingly difficult to access.
“All of the evidence supports trying something because as soon as you have an amputation, people are dead within 12 to 18 months for the most part,” I explained during our conversation, highlighting the urgency of finding alternatives to amputation.
Interestingly enough, walking is the best medicine to improve the prognosis of peripheral artery disease, especially in early stages. Even if a procedure is needed to manually open the arteries and restore blood flow, walking is critical to keeping the vessels open long-term.
Walking as Medicine: The “Claw” Technique
The power of walking as medicine for PAD patients has been well-documented, but the specific technique matters tremendously. In our very first podcast episode, Dr. Morgan introduced a game-changing concept that I’ve personally benefited from - waking up your toes and engaging them.
“You had told us in the very first show to use your toes to claw your way as you’re walking to strengthen those toes,” I reminded him during our recent conversation. “I’m going to tell you that it took the pressure off my hip. My hip after like 30 minutes of walking sometimes starts to get a little cramp in it, and that solved the whole problem. It was how I was walking, but adding your tip truly helped me out.”
“My pleasure,” Morgan responded, confirming the importance of this often-overlooked technique.
This “clawing” method activates the muscles in your feet that help pump blood through the tissues, transforming a simple walk into a more effective circulatory exercise. While focused exercise is a proven way to stimulate collateral vessel growth in PAD patients, the right techniques can make all the difference in comfort and effectiveness.
The Science of “Waking Up” Your Toes
Dr. Morgan’s insights on toe health represent a critical yet overlooked aspect of PAD management, which is THE TOES. “I’ve never seen any of the textbooks out there, any of the physical therapists out there actually sharing the types of exercises that [Kevin] talks about and the importance of really using your toes in every aspect of your workout,” I noted.
The foundation of his approach begins with understanding how modern footwear compromises circulation. “By compressing your foot laterally in tight shoes or tube socks, you’re going to reduce blood flow through your feet,” he explained. “You’re squashing arteries that run between the metatarsals, but you’re also squashing the connective tissue, the interstitial connective tissue, so you’re impairing flow.”
Morgan’s Method: A Systematic Approach to Foot Health
Dr. Morgan outlines a clear progression for improving toe circulation and function:
- Free Your Feet: “The first thing is get out of tight shoes. Have shoes with a wide toe box, but not one you float around in so you might fall. Get rid of tube socks. You don’t want anything that compresses your foot laterally from side to side.”
- Spread Your Toes: “Most of us have had our feet squashed for years. You spread your feet by spreading your toes.” For this, Morgan recommends yoga toes, special devices that separate and stretch the toes.
- Use Yoga Toes Properly: “When you put them on, you have to really push them down between your toes. You push the little bridges between the toes. You push that right down as far as you can. And then you move your foot around.”
- Strengthen Foot Muscles: “Once you can spread your toes, next you have to strengthen the muscles in the bottom of your feet. There are two sets of muscles in your feet. One set runs towards your toes and the other runs towards the base of your metatarsals.”
- Create a Pumping Action: “Every time a muscle contracts, it drives the blood out of the muscle. And once it relaxes, it allows fresh blood to flow back in… So by contracting a muscle, especially in your calves, it improves venous return.”
- Integrate Into Walking: “You contract the muscles in your feet. You drive the blood out. You drag your foot along the ground using those muscles. And then as you lift your foot, you spread your toes, and fresh blood is able to flow back in… It’s not just waggling your feet up and down. It’s a circular motion.”
The importance of focusing on your smallest toes cannot be overstated. “You really want to get blood to that pinky toe,” Morgan emphasized. “Because it seems like that’s the one that’s most at risk. In fact, I have a picture of gangrene of the foot in one of my books. And it’s those three toes, lateral toes, that are gangrenous.”
The PAD100: Turning Feet Into Pumps
One of Dr. Morgan’s most valuable contributions is his PAD100 exercise, modeled after the Pilates 100. This structured routine transforms feet into active pumps that drive circulation.
“You’re pumping blood through your feet by actively turning your feet into pumps,” Morgan emphasized. “When I bring my feet up, I’m attempting to spread my toes as much as I can. And when my feet go down, they pull in and the muscles in the bottom of my feet are contracting.”
“It’s not just wiggling your toes,” he stressed. “It’s not just flapping your feet up and down. It’s a very important process to understand.”
Morgan performs this exercise first thing every morning, completing 100 repetitions. “In that video, I do the full 100 so someone can come online and copy what I’m doing. Because when you get to about 80 or 90, your feet and calves get pretty damn tired. It’s actually a hard workout, but you have to do it right.”
Beyond Walking: Water-Based Alternatives
For PAD patients who struggle with claudication pain during land exercises, Dr. Morgan highly recommends water-based alternatives, particularly swimming and water running.
The Freedom of Swimming
“The problem with PAD is it’s very hard to get good cardiovascular training because of all the pain in your calves and your feet,” Morgan explained. “It prevents you from getting your heart rate up. Whereas if you go into the pool and do freestyle, PAD has no effect at all. And you can hammer a couple of miles in a swim and get a really good cardio workout.”
He specifically recommends freestyle swimming: “I use freestyle kick because it helps spread my feet… When you see their feet, they’re really wide and spread and they really provide propulsion.”
Water Running: The No-Impact Alternative
Perhaps most intriguing is Morgan’s detailed explanation of water running, a technique he demonstrates in his videos and practices regularly:
“You’re literally running. I don’t use a float aid. Initially, when you start to run, if you’re worried about buoyancy, you can have your hands like paddles, so you can spread your arms and have them like paddles to hold you up. But after a while, you can just bring them by your side and run normally.”
Critically, he emphasizes that proper water running is done in deep water without touching the bottom: “You’re running in deep water, and you’re not using a float aid. You’re not touching the bottom. You don’t want to run off the bottom. It puts too much strain on your legs and your hips.”
The resistance of water makes this an excellent workout: “You can increase the workload by pushing hard because the kinematic viscosity of water is about 16 times that of air. So the resistance of the water makes this really hard work.”
Cycling for Circulatory Health
For those interested in cycling, Dr. Morgan offers valuable guidance based on his experience as both a coach and competitive triathlete:
“The bike has to fit. That’s number one. Number two, if it doesn’t fit, you’ll be uncomfortable and get back strain. And usually people have a bike that’s too long for them.”
Safety is paramount: “It needs to have a mirror. You have to have mirrors on your bike… Riding a bike on the roads is dangerous… Never ride a bike on your own. It’s better to ride with other people.”
For serious cyclists, he recommends clip-in pedals: “If you don’t have clipping pedals, you’re only using your quads. But if you have clipping pedals, you can use the entire muscles for the spin, which is all the muscles. I mean, your glutes are stronger than your quads and your quads are massive.”
The Evidence of Commitment
Dr. Morgan’s approach isn’t just theoretical—he lives it every day as an 82-year-old triathlete with PAD. “I pretty well completely eliminated claudication when I walk,” he reports. His ongoing ability to compete internationally stands as powerful testament to the effectiveness of his methods.
His forthcoming book, “Peripheral Artery Disease Training Plan,” will provide a structured 14-week program with detailed guidance for beginners through advanced patients. “There’s actually a spreadsheet they can put on their fridge week by week,” he shared. “And each line on the spreadsheet comes with a short chapter in the book that goes with it.”
Perhaps most importantly, Morgan highlighted the importance of consistency: “You have to do the work. You have to do the work. And if you do the work and wake up your feet, wake up your toes, the chances are you’ll keep your toes for the rest of your life. I’m pretty sure of it. If you don’t do that, you’ll gradually lose toes, feet, legs, and you’ll be in a wheelchair.”
Join Our Collateral Nation
If you or someone you love is struggling with PAD symptoms or facing the possibility of amputation, don’t wait for the healthcare system to catch up. Take action today:
- Call our Legsaver Hotline at 1-833-PAD-LEGS if you’re experiencing symptoms or are at risk for amputation. We can connect you with resources, including Dr. Morgan’s expertise. We can also sign you up for our My Steps Walking Program to track your progress and grow your collateral circulation under guidance.
- Visit inspirationalselfhelpbooks.com to subscribe to Kevin Morgan’s newsletter and purchase his books, including “How To Fight The Crippling Pain of Peripheral Artery Disease.”
- Join our walking support group at WalkingSupportGroup.com
- Watch the full interview below to see demonstrations of the toe exercises and hear more insights from Dr. Morgan.
Together, we can build a Collateral Nation of empowered patients who understand that circulation is not just about what doctors can do for you—it’s about what you can do for yourself.