Pod Insights StarTalk Podcast Feet of Engineering with Michael DiTullo and Jason Hanft About this episode Can a shoe design save your life? Neil deGrasse Tyson, Chuck Nice, and Gary O’Reilly explore how engineering can help save the lives– and feet– of thousands with diabetes, with industrial engineer Michael DiTullo and foot and ankle surgeon, Dr. Jason Hanft.
Transcript Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
0:01 Neil deGrasse Tyson? Welcome to StarTalk. Your place in the universe where science and pop culture collide. StarTalk begins right now. This is StarTalk Sports Edition. Neil deGrasse Tyson here, your personal astrophysicist. We're going to title this one Best Foot Forward. That's a little mysterious to me. I got to learn more about that in a minute. Let me introduce my co-host, Chuck Nice. Chuck.
0:30 Chuck Nice? Hey, what's happening?
0:32 Neil deGrasse Tyson? Yeah, and I got Gary O'Reilly. Gary, former soccer pro.
0:35 Gary O'Reilly? Hi, Neil.
0:36 Neil deGrasse Tyson? All right, dude, and also sports announcer.
0:40 Gary O'Reilly? Yes.
0:40 Neil deGrasse Tyson? And so Gary, you cooked up this episode, so I can't wait to find out what's going to happen. So tell me what you got in the oven.
0:48 Gary O'Reilly? A question. What links a clinical podiatrist, 130,000 amputations a year, and a world-class sneaker designer? Anyone? Have a guess.
1:01 Chuck Nice? I'm going to say an apocalyptic design war.
1:04 Neil deGrasse Tyson? I know. It's this is a...
1:06 Gary O'Reilly? Hold that thought. All answers accepted, but there's only one answer.
1:12 Neil deGrasse Tyson? It's some kind of Jason Takes Manhattan movie or something.
1:15 Gary O'Reilly? All right.
1:16 Neil deGrasse Tyson? Texas Chainsaw meets Jason.
1:18 Gary O'Reilly? All right. So here we are, a little bit more daylight and a little bit more of a reveal. So this show is about smart engineering, innovative material science, kick-off sportswear design, all converging, as I said, to help people recover faster and live longer. The link to all of this...
1:36 Neil deGrasse Tyson? Recover from sports injuries, I guess.
1:38 Gary O'Reilly? Hmm, patience.
1:40 Neil deGrasse Tyson? Oh, too soon. Sorry, sorry.
1:42 Gary O'Reilly? The link to all the above is sadly diabetes.
1:45 Chuck Nice? Wow.
1:46 Gary O'Reilly? So we are trapped, or are we, in a failing endocrine system? The results are only amputations, or is there a way to walk out of this particular hell? Let me introduce our two guests.
2:01 Chuck Nice? I see what you did there.
2:02 Gary O'Reilly? Thank you kindly.
2:03 Neil deGrasse Tyson? Rest on it, too.
2:04 Chuck Nice? We caught that, Gary.
2:05 Gary O'Reilly? I know. It won't happen again. So Dr. Jason Hamst, the person that chose to question why?
2:15 Gary O'Reilly? Things were not improving with his patients' conditions and then investigated. He is a foot and ankle surgeon and clinical podiatrist in Miami, Florida. This is the guy who had the gonads to then go out and do something about it. Uh, let me then introduce our second guest. An industrial designer, uh, Michael Di Torlo with a client list that has included Google, Nike, Jordan, that would be the Michael version, uh, and Honda. As well as having been the design director at the sportswear giant Converse. Winner of the Industrial Design Society of America Personal Recognition Award in 2019. So Neil, please welcome our two guests, the good doctor, Jason and Michael.
2:59 Neil deGrasse Tyson? Well, excellent. Welcome. Welcome to StarTalk, guys. My gosh.
3:02 Speaker 03 Thank you for having us.
3:03 Neil deGrasse Tyson? Yeah. So, so let me say, let me start out by saying, um, could you just remind us why diabetes has anything at all to do with like circulation, which ultimately ends up in amputations? Cause we hear that it has to do with, you know, your metabolism and processing of sugar. And then all of a sudden somebody gets their legs amputated. Like what, how do you, how do you get from here to there?
3:30 Speaker 03 Let, let's take a half a step back. Let's talk about who gets from here to there. So, so as of today, one in 10 Americans is diabetic. By 2025, it's going to be one in three. And three years?
3:45 Chuck Nice? In three years?
3:45 Speaker 03 In three? Correct.
3:47 Chuck Nice? Wow. And two out of those three will be black.
3:49 Speaker 03 No, that's true. So that is not an understatement.
3:52 Neil deGrasse Tyson? Right.
3:53 Speaker 03 People of color and people, uh, Native Americans have a 50% higher chance of becoming diabetic. Oh my, wow. So if you're looking at hundreds of millions of people around the world becoming diabetic. Yeah. Once they've had diabetes, the fluctuations in blood sugar affect the myelin, the covering of the nerves. And the nerves that are farthest from your central nervous system, your brain, have the longest amount of myelin. So this tissue, because of fluctuations in blood sugar, gets thicker and thicker. And the electrical impulse cannot be conducted. So they develop what's called peripheral neuropathy. Loss of feeling in the hands and feet. And this isn't if you step on a nail, you can't feel it.
4:37 Speaker 03 This is small amounts of pressure you can't feel. So here you have this large group of people who lose the feeling in their feet. And they get small amounts of pressure over time. A shoe rubbing, a sock balled up, an inappropriate fitting shoe. This cuts off the local circulation, leading to a wound. Of all the wounds that occur in the U.S., roughly three million a year. Eighty-five percent of those will become infected within six weeks. That's the pathway to amputations. Once you violate the tissue envelope of diabetic patient, bacteria get in. And that's the pathway to these hundred and twenty thousand plus amputations a year.
5:21 Neil deGrasse Tyson? So Jason, so specifically, what are, what are the most common symptoms?
5:25 Speaker 03 The typically, they have no symptoms. Oh, okay. Because they have no feeling, so. My God.
5:31 Chuck Nice? That's what I was gonna ask because I.
5:32 Neil deGrasse Tyson? Oh, man.
5:33 Chuck Nice? I read that the myelin is like a, I don't know, like a conductor. It allows the electrical impulses to run, you know, travel up your spinal cord and whatever. So if that stops or slows down, you just, you're not feeling anything then.
5:47 Speaker 03 Correct, so typically, the only time that people present with a wound is when someone visualizes it. They don't know they have it until they either look, which most people can't see the bottom of their foot. Or someone else looks at their foot. Wow.
6:01 Gary O'Reilly? Is this nerve damage repairable? Or is this just one way street?
6:07 Speaker 03 Right now, there's no cure for diabetic peripheral neuropathy. There are adjuvant therapies, vitamins, et cetera. And there are medicines to manage the symptoms, but there is nothing to bring back the feeling.
6:22 Gary O'Reilly? All right, Jason, medical science throws a lot of resources at a number of problems. Has it thrown the resources at this particular condition? Or is this condition just particularly baffling right now?
6:37 Speaker 03 It's quite baffling. Resources in the billions have been thrown at it, including genetic modifications, gene therapy, oral medicines, injectable medicines, tissue transplants, and to date, nothing has worked. Wow.
6:53 Chuck Nice? Well, that's our show, people.
6:54 Neil deGrasse Tyson? We're done.
6:58 Neil deGrasse Tyson? Okay, so, dear, allow me to dare such a suggestion that your only solution is for diabetes to go away.
7:08 Speaker 03 So curing diabetes doesn't cure neuropathy, even if you have patients who have peripheral neuropathy?
7:14 Neil deGrasse Tyson? No, no, no, I'm saying, no, no, no, no, I'm, I'm, I'm, I'm saying, preventing diabetes in the first place, eradicating it from the species, puts you out of business, is that correct?
7:28 Speaker 03 Oh, please, yes, that would be wonderful.
7:30 Neil deGrasse Tyson? Okay, there you go. That's all I'm trying to say here, that, that we can try to keep putting Band-Aids on a problem when the problem perhaps should be solved in a different way, rather than bring out all the Band-Aids and the, and the hacksaw for your amputations. I mean, that's, that's all I'm saying, I'm just making a simple point.
7:49 Chuck Nice? And that's, that's, that's the difference between a truly caring medical professional, and, you know, capitalism. The real answer is, no, Neil, we don't want to cure it, we just want to find a way.
8:05 Neil deGrasse Tyson? Want to keep treating it.
8:06 Chuck Nice? That's right.
8:07 Neil deGrasse Tyson? Yes, yes. Yeah, there's no money in the cure.
8:09 Chuck Nice? There's no money in the cure.
8:10 Neil deGrasse Tyson? Only in the treatment.
8:12 Gary O'Reilly? And I must ask, from, from a patient walking into your clinic, and with the fact they're now, they're aware they have a diabetic ulcer, and things go wrong, what is the timeline? I know you said it could be six weeks, and an infection, so what then is the timeline to amputation, and then what after amputation are we talking about for their future if there is going to be one, and how long are we talking about?
8:41 Neil deGrasse Tyson? So this would be, just to be clear, this would be an ulcer in one of your extremities that would go unnoticed and then gets infected.
8:48 Speaker 03 So this is an ulcer in the foot typically, because the hand amputation rate is a hundred times less than the foot amputation rate. Because you don't walk on your hand, and you can see them. The real issue is the pressure of walking, right? Once you get a hole, the pressure of walking keeps the wound from healing, it doesn't allow the body's healing processes, or even external healing processes, to take place. Seven to 26 times your body weight goes on the bottom of your foot with every step, so if you're trying to heal a wound and you can't take the pressure off... Low likelihood. So to answer your question about timing,
9:23 Neil deGrasse Tyson? Yeah.
9:23 Speaker 03 Um, it depends. The extent of when the infection is identified, right? If you're at home, you don't know you have a wound. You're not looking at your foot. If this infection has spread to the bone, there's a very high likelihood north of 70% that you'll end up losing a portion and/or all of your foot.
9:41 Neil deGrasse Tyson? Don't you, doesn't the body respond to infection with a fever? And wouldn't that be a noticeable symptom?
9:47 Speaker 03 So in the non-diabetic or healthy, non-immunocompromised patient, fever, redness, swelling, pain are the signs of infection. But the diabetic patient is considered immunocompromised and they don't mount the same type of response. So frequently goes unnoticed.
10:05 Gary O'Reilly? Doctor Jason, how many of your patients would you clinically identify as obese? Because that means that I may not be able to see my feet. I have been compounding literally the pressure and weight through my, my lower limbs. And it's built almost in a perfect way to end in a destructive process.
10:28 Neil deGrasse Tyson? You mean the perfect storm?
10:29 Gary O'Reilly? Yeah.
10:30 Neil deGrasse Tyson? Cause if you're, if you're morbidly obese or obese in almost on any category, you don't really see the lower half of your body at all, right?
10:36 Gary O'Reilly? Yeah.
10:38 Speaker 03 So this is absolutely correct. There are two types of diabetes, type one and type two. Type two is by the vast majority, people are overweight, increased BMI. So they not only can't they touch, feel the bottom of their feet, they can't see them. And unfortunately, this is one of the pillars of why this epidemic has not only expanded and continues to grow, but has gone sort of a shameful mark has been put on it, right? Because people who are heavy have this.
11:12 Chuck Nice? So let me ask you this, when, since there's no symptoms, we also know that you're at risk if you are obese. Is there any preventative, uh, self-diagnostic, uh, tools that you might be able to use, uh, to say, hey, I'm in this risk category now. Let me keep an eye on this.
11:31 Neil deGrasse Tyson? A foot mirror.
11:32 Speaker 03 Well, that is, that is the simplest answer, absolutely correct. With new technologies with Bluetooth-enabled mats, temperature-sensing mats, visualization and temperature measurement can be done remotely. So you can have a mat at the foot of your bed every night. You stand on it, it can measure temperature, pressure, and report to a cloud where a medical practitioner can follow up on that. So there's absolutely technology available to assist. But in the simplest format, a mirror on a stick, or a spouse inspecting your feet daily. And the American Diabetes Association recommends regular routine visual inspection of the foot.
12:12 Chuck Nice? Wow, look at that. It'd be great if, as a part of, you know, your regular medical insurance, you'd be able to get some of those, you know, technological assistance. But then you said mirror on a stick, it's over. That's, that's what, that's what you get.
12:30 Chuck Nice? You're like, I'd like to avail myself of some cloud technology. They're like, here's a mirror on a stick.
12:37 Gary O'Reilly? So, Doc, Jason, we've, we've, we're getting into a medical universe now that has brain-machine interfaces. And that work and development, would that be of any use to this peripheral neuropathy?
12:54 Speaker 03 So you can stimulate the central nervous system, and you can interface with the central nervous system and trigger it. But when the wire leaving the junction box isn't working properly, nothing goes any farther than where that myelin has been thickened.
13:09 Chuck Nice? Right, right. It's like a jamming signal, that's crazy.
13:15 Speaker 03 Exactly, it's an accurate description.
13:16 Gary O'Reilly? Is there a chemical, a potential chemical solution once it thickens to reduce that?
13:23 Speaker 03 There are a number of companies that have tried. To date, nothing has been successful in clinical trials. The best way to keep your myelin thin is to keep your blood sugar under control. So if you don't have these massive swings of blood sugar, the myelin doesn't get thick.
13:40 Speaker 03 And there's lots of technology for assisting in keeping your blood sugar under control, continuous glucose monitoring, pumps that instill medications, Wi-Fi communication to phones, vibrating headsets. I mean, there's all sorts of devices available out there to help you control your sugar.
13:56 Neil deGrasse Tyson? All right, guys, we've got to take a short break. When we come back, we're going to find out why Michael DiTullo is actually one of our guests, as well as Jason Hanft on StarTalk.
14:19 Neil deGrasse Tyson? We're back, StarTalk, Sports Edition. We're talking about your lower extremities, like your feet, and boots that might be worn over them. And we've got with us two guests, Dr. Jason Hanft, and who's an expert on, dare I say, amputations. And we bring on, in this segment, in full force, Michael DiTullo. Michael, you came in on the other side of this. What's your role in what's going on here? How are you trying to make this a better world?
14:51 Speaker 04 So, thanks, Neil. My background is as an industrial designer. Most people listening probably don't know what an industrial designer is.
14:58 Neil deGrasse Tyson? I so know what it is, and you guys are my favorite people.
15:01 Speaker 04 Thank you.
15:01 Neil deGrasse Tyson? In the world.
15:02 Speaker 04 Thank you.
15:02 Neil deGrasse Tyson? Oh, my gosh. It makes living not only helpful, but beautiful. Chuck, Chuck, we're going to leave Michael and Neil to get together.
15:11 Chuck Nice? I was about to say, I'm going to have to turn my camera off for a minute. I was Neil's favorite person in the world. I'm like, damn.
15:21 Speaker 04 No, no.
15:21 Chuck Nice? This is terrible news I just found out.
15:24 Neil deGrasse Tyson? It goes to be like a Rodney Dangerfield says, hey, get a room.
15:29 Speaker 04 Yeah, I'm going to make a Zoom breakout room for Neil and I, so. But I explain to people, like, if you think of what an architect does for buildings, and what a fashion designer does for apparel, I do that for literally everything else in your life. Your phone, your pen, your car, your chair, for better, for worse, everything you touch was designed by an industrial designer at some point. And so for me, I love working on challenges. I love learning. I always say I'm not a subject matter expert. I'm a creative generalist. So I love partnering with people like Jason, who are super passionate and crazy knowledgeable, because I feel like I could pull out of them
16:12 Speaker 04 some crazy parameters that we can use to find an innovative solution. And in most cases, I mean, when you're, you know, design is like this fun mix of science and art. And I think when you're putting these two things together, the right solution oftentimes afterwards seems painfully obvious. But it's only until you get to that, that it seems that way, if that makes sense.
16:38 Neil deGrasse Tyson? Yeah, things like a paperclip. I mean, the word on paperclips before somebody invented a paperclip.
16:42 Speaker 04 Exactly.
16:43 Neil deGrasse Tyson? And so that's probably in the Hall of Fame of industrial design.
16:46 Speaker 04 Yeah.
16:47 Neil deGrasse Tyson? Among things. So, so, all right, so let's take a, let's take a sample case. 400-pound person with diabetes walks in and, and Jason has a look and you have a look at this person. Now, how do you put your heads together and address what's going on here?
17:04 Speaker 04 Well, when Jason came to me about four years ago, the first thing we did was put together three basic principles. One, it has to functionally perform, obviously, right? We have to-
17:14 Neil deGrasse Tyson? But the it is now, the it is a what?
17:16 Speaker 04 Correct. So, so we wanted to create this protective boot, right, that would create an environment where someone's wound could heal, right? Because if you're walking, right, if you, if you're a person, a normal person, you're going to still go to work, you're going to still go to the grocery store. So you can't avoid putting pressure on your foot. So we have to create an environment that alleviates the pressure so that someone's wound can actually heal. So that's principle one, has to function. Principle two, it has to be easy to put on and take off. Because, again, we're, we're dealing with a person with reduced mobility, reduced feeling, right? So they have to be able to put it on and off, error-free, even at 2:00 in the morning when they have to run to the bathroom real quick.
18:01 Chuck Nice? And I'm gonna channel Chuck here, and it has to look fabulous.
18:04 Speaker 04 Well, that's the third principle.
18:08 Speaker 04 The third principle is it couldn't work if it stays in someone's closet, right? Because if they feel too ashamed to go to work in it, it can't work. It will fail 100% of the time that it's not used.
18:21 Chuck Nice? And listen, you know how many people need orthopedic shoes?
18:23 Speaker 04 But.
18:24 Chuck Nice? They will not wear them.
18:25 Speaker 04 Yeah.
18:25 Chuck Nice? Right, good point. I refuse.
18:28 Speaker 04 Yeah.
18:28 Speaker 03 That is exactly what was going on here before Chuck. The devices that were on the market, there are other boots to protect the foot. But people couldn't or wouldn't use them, all because of that appeal. They were not usable or good looking.
18:44 Speaker 04 Yeah.
18:44 Chuck Nice? Right.
18:45 Speaker 04 So my goal is, my goal is if you put this on with a pair of jeans, you know, it's gonna look as much like a pair of Jordans as we can make it. You know, so that instead of going, instead of someone saying like, oh, what's that? I want someone to say, oh, what is that? Tell me about that.
18:58 Chuck Nice? Oh, yeah, very good. More importantly, more importantly, you want them to say, who is that?
19:06 Chuck Nice? Oh, dear, my, those are, who is that? Who is wearing those? Who are you wearing?
19:12 Speaker 04 So what's crazy is that we're, we're building this out for function, right? But the world of fashion, you look at like what Kanye West is doing with Adidas. It's like, it's not far off from where this is going, where, where a $600, $800 pair of Balenciagas is. Uh, so we're kind of like, these worlds are kind of colliding right now.
19:30 Gary O'Reilly? All right, Michael, you mentioned Jordan, so we'll bring up the GOAT, uh, if you wish, and I do. You designing specifically for Michael Jordan, right? Back in your day. Now, that.
19:42 Chuck Nice? Wait a minute, Michael Jordan has diabetes?
19:44 Gary O'Reilly? Do behave.
19:50 Chuck Nice? Oh, come on, that was good.
19:52 Gary O'Reilly? I know it was, but I don't wanna give you any credit. I don't wanna give you any credit.
19:56 Chuck Nice? Okay. Sorry, Gary, sorry.
19:58 Gary O'Reilly? That's okay, man. So, everything you've designed for him and every other elite world-class athlete has, uh, maybe like a rise and you are pushing the foot forward. So as the, the weight goes through the ball of the foot, so as I can sprint, or maybe in this case, Michael rather than me, so you offset the heel. It's not a, a level flat. So think of it as a skater's. Sneaker, it's flat to sit on a skateboard, right?
20:23 Speaker 04 Right.
20:23 Gary O'Reilly? When you've got a sneaker that's like a basketball sneaker or a rash,
20:27 Speaker 04 I guess.
20:28 Gary O'Reilly? It's raised, the heel is raised, you've got to drop. That's putting pressure on the ball of the foot for a reason, so as you can launch forward. Now, everything you've learned to make that for those athletes, you have to kind of pull apart. So how do you start to do the retrofit? Because you can't put the pressure through the ball of the foot, surely.
20:48 Speaker 04 Yeah, that's exactly right. This is, this is the Jordan 22 PE that I worked on. This has got a 10 millimeter drop, you know, from the, from the heel to the toe. A running shoe might have even more. That's, that's pretty common, right? They're anatomically like forcing you onto the balls of your feet, which is exactly where the wounds from a diabetic foot ulcer are. They're typically on the balls of your feet. You know, that's aggravating those diabetic foot ulcers. And as Jason said, most folks who are getting treatment, they're, they're leaving the office in their shoe. So they're, they're leaving the office in the product that's aggravating their wound. So, so this product that Jason and I worked on, the Foot Defender, has a slight negative two millimeter heel drop. It deceptively looks like a footwear materials,
21:33 Speaker 04 but underneath this is a injection molded brace that goes all the way around the product. And then we've got a piece of sprung carbon fiber here. So that is really forcing the geometry of your leg backwards. So you just cannot put pressure on it. The bottom is also flat. So unlike a sneaker, right? Where you have these, these huge rockers and leading you into and out of the product. By having flat, again, you can't get out over onto the balls of the feet. So there's so much kind of geometry and science that goes into this thing. It deceptively looks a lot like a shoe.
22:10 Chuck Nice? That's amazing.
22:11 Speaker 04 Yeah, we developed.
22:12 Chuck Nice? Michael.
22:12 Speaker 04 Go ahead, go ahead.
22:13 Chuck Nice? Michael, I'm sorry to cut you off here because first of all, ingenious design. Secondly, love the, the form and function playing together. Thirdly, and most importantly, how do you get me Jordans? He just wants.
22:31 Gary O'Reilly? Anyone else know that that was coming?
22:34 Speaker 04 Just come, just come visit me in, in Portland, Chuck will take care of you. Yeah, I'm not that far from campus.
22:40 Gary O'Reilly? You've conquered the bit where the foot must move but remain rigid. You've redistributed the weight. But in doing that. Are you then the blessing and the curse? Are you then creating other mysteries that you need to solve in this particular solution?
22:59 Speaker 04 I'll let Jason take that.
23:01 Speaker 03 So the answer to your question is yes, but that's where 35 years of biomechanical analysis comes into play. So if you look at the foot really carefully, the mid part of the foot is a rigid arch. It rarely if ever touches the ground and it doesn't move. So you now have a structure by which you can transfer force to without causing a problem.
23:23 Gary O'Reilly? Nice.
23:24 Speaker 03 And this is part of the reason, well, this is part of the reason it took seven years and 39 iterations to get to the device you're seeing today, was once we, you know, force doesn't disappear, Neil can appreciate that. But once you move force from one place to another, you have to come up with a mechanism by which to deal with it, whether you're decreasing it by creating unique materials, viscoelastic materials that rebound and push it in another direction, or you use very rigid materials to transfer it up the leg.
23:59 Neil deGrasse Tyson? Right, so because you're not making this out of just one, you know, one supply of rubber or plastic.
24:05 Speaker 04 Right.
24:05 Neil deGrasse Tyson? Did, were there commercially available materials to do this? Or did you have to be creative beyond that?
24:13 Speaker 04 Both.
24:13 Speaker 03 So there were some in the footwear world. We used a number of materials that you would find in the footwear world, you know, wicking, anti-friction foams and cloth materials, textiles. But we were looking for maximum impact attenuation, right? So you have a 400-pound person whose muscles don't work and nerves don't work, so their foot's slapping the ground, much like you take your hand and just slam it on the table. So we, we... Looked at 700 different materials to try and find the best impact reducing material around. And we then modified it. So we essentially created a new material.
24:54 Speaker 03 It's a viscoelastic polyurethane that we are calling absorbium that has.
25:00 Chuck Nice? Wow. That sounds like something you find in Wakanda.
25:05 Neil deGrasse Tyson? Yes. Absorbium is next to the.
25:08 Chuck Nice? Right, you find it right next to vibranium.
25:10 Neil deGrasse Tyson? Yeah, and on obtanium is in the same column.
25:13 Speaker 03 On obtanium, exactly. So it removes somewhere between 87 and 90% of the impact force.
25:21 Chuck Nice? Wow.
25:22 Speaker 03 Just by the mechanical and material properties.
25:24 Chuck Nice? Okay, I hate to say this.
25:26 Neil deGrasse Tyson? Just to be precise, just to be physics precise, I would say, but tell me if I'm wrong, that it dissipates the force.
25:33 Speaker 03 You are absolutely on point.
25:34 Neil deGrasse Tyson? Okay, okay.
25:35 Chuck Nice? Sends it someplace else.
25:36 Neil deGrasse Tyson? Yeah, yeah.
25:37 Chuck Nice? But here's the thing. Now, guys, please don't judge me for this. It's just how I think.
25:43 Neil deGrasse Tyson? We do anyway, Chuck, so don't worry.
25:44 Chuck Nice? Okay, good, all right. So you're talking about something that is probably, you know, the most prolific shock absorber for the foot in history. Um, there's a crap load of money in running shoes for something like this. I mean, are you thinking about that, maybe?
26:05 Speaker 04 In some ways, it actually does the opposite, right? So in a running shoe, you want the foam to rebound really quickly, right? You want that force return.
26:14 Neil deGrasse Tyson? You don't want to lose the energy you put coming down.
26:16 Chuck Nice? This is a dampener.
26:18 Speaker 04 Right.
26:18 Chuck Nice? So you want a return of energy if you're running.
26:21 Speaker 04 Right.
26:22 Neil deGrasse Tyson? It's a shock absorber.
26:23 Chuck Nice? Right, so this takes, I got it.
26:25 Speaker 04 Yeah, and that.
26:25 Neil deGrasse Tyson? And by the way, Chuck, that's why the blade, the blade works so well. Because all the energy that you use to land on it.
26:33 Chuck Nice? Oh, the prosthetic.
26:34 Neil deGrasse Tyson? Is recovered when the thing springs back.
26:36 Speaker 04 Right, it's that.
26:36 Neil deGrasse Tyson? So, yeah, that's a very different utility. Cool.
26:40 Gary O'Reilly? Michael, if we disassembled this defender boot, how many pieces are there? So like you do in an engine, the classic, take the engine apart and you lay all the bits out on the, on the table. How many pieces are in there? Because my guess is this has a ridiculously large amount of pieces.
26:57 Speaker 04 Yeah, it's probably over 100. I mean, there's just so many different things going on inside of this product. I mean. Jason talked about that absorbent material. I even just wanted to aesthetically give you the hint of where those are, right? We talked about the industrial designer's job to make it functional, but also I want to draw attention to that function. So those two pucks are under the heel and the forefoot here. So kind of visually telling that story.
27:24 Gary O'Reilly? Can you hold that up again? Michael, can you hold that up again? See the sole of the shoe right there? The guys, if you're listening to this on the podcast, apologies. But that's like a foot within a foot within a foot. What's going on there? Because you can't tell me that's just cosmetic because it's on the sole of the foot and one gets seen. So there must be a really good reason.
27:45 Speaker 04 Well, it is. I'm trying to kind of basically draw the eye inward because we have a symmetrical product here, right? So it fits left and right. So that automatically makes it aesthetically a little off. But I'm trying to kind of fool the eye to make it feel slimmer, more acceptable. You'll notice like all this traction is kind of oversized because you're wearing this inside and outside. And I want kind of dirt and grime to kind of fall out as easily as possible, but give you this traction that's going to give you that kind of the grip you want. So we're actually using basically a cupsol technology. So this is like one giant piece of rubber that's very stiff, that's used in kind of 80s basketball shoes, skate shoes.
28:28 Speaker 04 It's heavier and stiffer than a typical outsole, but we want that rigidity, right? So we're making all these choices to have functional benefits. Even this little hint of these kind of red embroidered pits, right? You don't, they don't need to be there, but they tell you without you having to look at the manual, like this is how you get into and out of this thing. These are the touch.
28:51 Neil deGrasse Tyson? It's called design.
28:52 Speaker 04 It's called design, people. So.
28:55 Gary O'Reilly? So it's very, very.
28:56 Neil deGrasse Tyson? By the way, I gotta, I gotta interject here. I gotta interject for those who didn't otherwise think about this. I'm not talking to you, Michael, but Chuck or Carrie.
29:04 Speaker 04 All right.
29:05 Neil deGrasse Tyson? One of the greatest contributions to this world that Apple Computer gifted us is not even the computer. It's the fact that.
29:18 Neil deGrasse Tyson? They made it normal for you to open the package and operate something without ever looking at an instruction manual.
29:25 Speaker 04 That's right, intuitive design.
29:27 Neil deGrasse Tyson? They made that commonplace.
29:29 Chuck Nice? Yeah.
29:30 Neil deGrasse Tyson? Correct.
29:30 Chuck Nice? Mm-hmm.
29:31 Neil deGrasse Tyson? And I remember growing up, okay, here's this box, where's the on switch? Open up the manual. Where's the on, where's this switch? What happens if it says this? If it makes this sound? It's three flashes of light. What do I do now? That, we have people growing up that have never looked at an instruction manual because of that. I'm just, I've got, I told you, Michael, I'm all, me and you are tight.
29:51 Gary O'Reilly? Get in a room, it's a period.
29:53 Speaker 04 Thank you. And that was my goal with this, right? Like this person, they got a life to live. I don't want them to spend time reading a technical manual. I want them to just get this thing from their doctor and be able to put it on, kind of idiot proof, I hate that term, but, but, you know, foolproof in terms of just putting it on correctly and not have to read a manual and to be able to use it and heal.
30:15 Gary O'Reilly? So, Michael, the boot's open-toed, which is great if you live in Florida all year round, but you're up there in a different latitude, it's cold and your foot's cold. So how are we, are we solving this problem with an open-toed boot?
30:32 Neil deGrasse Tyson? Yeah, Michael, not everyone lives in Florida.
30:34 Gary O'Reilly? What about us up here in Canada, eh?
30:35 Speaker 04 Very, very intentional, as you would have guessed, right? And Jason could speak to this more, but most of folks that have this condition, right, their, their foot may be not a normal size, it might be swelling, it might be wrapped in bandages. And Jason, do you want to speak to that from, from your professional?
30:51 Speaker 03 Sure. So everybody, everybody that goes in a foot defender has an open wound. That wound requires a bandage. If you put a closed toe on it, you're now confining a space and you'll more likely get a rub or an area of pressure and it'll be self-defeating.
31:05 Chuck Nice? Right.
31:05 Speaker 03 What we found in cold temperatures is people are using really high technology. It's called a sock.
31:13 Speaker 03 You put a cold weather sock and even available are some thermally assisted socks, right? They have a battery that can warm the foot.
31:22 Neil deGrasse Tyson? Yeah, I've seen those. Electric socks? Yeah, yeah, yeah, they're totally toasty.
31:25 Speaker 03 Okay.
31:26 Neil deGrasse Tyson? So, so just, just our audience and I can remember, Jason, you're based where? Where are you now?
31:30 Speaker 03 South Florida, Miami.
31:31 Neil deGrasse Tyson? South, oh, and, and Michael? Portland, Oregon, opposite corner. Oh, Portland, Oregon, okay, got it. But it's never really sub-freezing in Portland, right? It's always just, it's just cold and dank. Yeah, get a little snow, but, but not much. Yeah, yeah, okay, so that's where the Miami connection is coming in. So, you're in South Miami, Jason, right?
31:51 Speaker 03 Correct.
31:52 Neil deGrasse Tyson? Yeah, yeah. All right, let's take a quick break. When we come back, more on this sort of diabetic boot solution that might prevent amputations, which is something we would all want, when StarTalk continues.
32:16 Neil deGrasse Tyson? We're back, StarTalk, Sports Edition. We've got Dr. Jason Hemphd. Did I say that right, Jason? Hemphd. Love it. And Michael DiTullo. Jason is a, is a surgeon who unfortunately is confronted with having to amputate many lower extremity from diseases, complications from diabetes. And Michael DiTullo is figuring out how to not make that happen. And we need more folks like this walking among us in the world. So, let's, let's just pick up the conversation with this, with this boot. Are we to say here that if you have a sore that develops on the bottom of the feet from
33:01 Neil deGrasse Tyson? complications from diabetes, this boot will allow it to heal? And do diabetics heal the way non-diabetics do, like on the same timeframe? And do they respond to the same topical medicines, this sort of thing? Jason?
33:15 Speaker 03 Really interesting question. So, the, the best way I can give you the answer to that is diabetics don't do anything the same as non-diabetics. But we do know that-
33:25 Neil deGrasse Tyson? There it is, yeah.
33:26 Speaker 03 We do know that diabetics have the ability to heal because wounds elsewhere in their bodies don't lead to- An amputation every 20 seconds. And that's in the United States. Every 20 seconds, someone in the US is losing their leg to the complication of a diabetic foot ulcer.
33:41 Chuck Nice? Wow, that's disturbing.
33:44 Speaker 04 Yes. It's something we don't talk about, right? It's like, because like Jason said, there's this shame associated with it that someone feels like they're at fault. You hide it, you hide your wound in your shoe, you don't show anybody. And so I think a big part of what we're trying to do is just get this out into the open and be like, hey, there's no shame in this, let's fix it.
34:03 Chuck Nice? I love that because, you know, this is one of the diseases that we often refer to as a lifestyle malady. And so the moment you add lifestyle to the description of the problem, it makes it seem like, well, you did this to yourself. You know, it's like lung cancer. People are far less likely to have compassion for a person with lung cancer, like, oh, you shouldn't have smoked. That's, you know, it's terrible.
34:28 Neil deGrasse Tyson? Interesting point, interesting point.
34:30 Gary O'Reilly? So, Michael, maybe you can answer this. You would have traditionally gone to a medical device, equipment manufacturer to do this, but you turned around because you weren't getting the results you wanted and went to a shoe factory. Am I right? And why? What was not being delivered for you in the medical equipment manufacturer that you could get with a shoe factory?
34:56 Speaker 04 We struggled for two years. You know, we're working with some medical device makers to hit the performance targets, but we couldn't get the fit and finish that made it feel like an acceptable consumer product, that made it feel like you could get it at Foot Locker to be short. And so finally, we had a, we were having a brainstorm session in my studio, Jason and I, and I was like, you know, maybe we're just thinking about this totally wrong. We were, we were working with a medical factory who were exposing all the hard plastic parts. And it just was a real challenge to make it look right. And then every time we wanted to make a change to tweak the performance, like massive tooling costs. I was like, let's start thinking about this less like a medical device and more like
35:41 Speaker 04 a technical shoe that has to do something. And I think we'll be able to train a footwear factory how to make something with our technical parameters a lot easier than it would be to train a medical factory how to sew something like this. So that's what led to hiding all of the technical parts. You could just see these little, little peaks of it. You could see a tiny peak into the carbon fiber here. We expose it subtly, but by hiding all of it, we could create this nice piece of footwear. And then as we were prototyping and testing all different internal braces, we can make all those changes internally until we got the spec exactly right and then confirm that with the factory. And now we just check to
36:24 Speaker 04 make sure they're they're executing it exactly to the specification.
36:28 Neil deGrasse Tyson? Will you come live with me and design everything in my house?
36:32 Speaker 04 Yes, let's do it.
36:36 Chuck Nice? Do you do it all? Are you, do you, will you do something as simple as like a Michael Graves teapot?
36:41 Speaker 04 I love it.
36:42 Neil deGrasse Tyson? No, no, no. If you're a designer, every, everything in front of you is subject to your
36:46 Speaker 04 I did this, I did this watch.
36:47 Neil deGrasse Tyson? Oh, my gosh.
36:48 Speaker 04 You know, I, yeah.
36:50 Neil deGrasse Tyson? There's no escaping it.
36:51 Speaker 04 It's a curse.
36:51 Gary O'Reilly? So, Michael, you've incorporated, you've incorporated a pump into this boot, haven't you? Now, for those of us of a certain vintage, flashback to what? Was it late 80s, early 90s?
37:03 Neil deGrasse Tyson? Yeah, yeah, 80s, totally 80s.
37:05 Gary O'Reilly? You've gone Reebok retro with a, with a high top pump in the.
37:09 Neil deGrasse Tyson? Wait, let me just remind people. So it wasn't Reebok, it was a pump, Pump It Up, where it was a high top sneaker.
37:15 Gary O'Reilly? Oh, that's right.
37:16 Neil deGrasse Tyson? That, that had an airbag in it where you put on the sneaker, lace it up, but maybe it didn't fit perfectly in all places. So it had a pump on it, which filled the gaps with air so that your entire foot would be more smoothly.
37:31 Chuck Nice? Snugly fit.
37:32 Neil deGrasse Tyson? Snugly fit.
37:33 Gary O'Reilly? Is that the inspiration, Michael? Were you borrowing?
37:35 Neil deGrasse Tyson? And it lasted, it's like six months, I think.
37:37 Speaker 04 Neil, you let, you took my whole description from me, but yeah, you got.
37:40 Neil deGrasse Tyson? Oh, I'm sorry. I was just, I was just getting people up to speed so that we can now listen to you.
37:45 Speaker 04 It's awesome. No. And so Jason was like, hey, maybe we should put this, put a pump in it to, to fill the gaps, right? Exactly like, you know, you, nobody's two legs are exactly the same. Even though it fits great and performs well, there could be this ceiling of gaps. So you fit it up and then you pump up the rest. And now you're basically just pushing the internal sleeve in constant contact with the body. So you get this proprioceptive effect that you feel much more secure.
38:16 Neil deGrasse Tyson? So the bladder, the air bladder would fill in where it needs to and not fill in where it can't?
38:21 Speaker 04 Yes, because it's a totally custom fit. And then the bladder is basically shaped like a pair of lungs. So there's basically two chambers. It hovers over your heel. So you're kind of really locking the heel into place. You know, so again, we don't want to cause any more injuries. So any kind of repetitive movement inside is a potential for more injuries.
38:43 Neil deGrasse Tyson? Okay, Chris Rock was the lead performer in a Saturday Night Live skit back when that Reebok sneaker was popular. And it was Thanksgiving dinner. And it was in the spirit of the pump of the Reebok. They now sold turkeys that you could pump up. So the turkey had a little pump and you can make it bigger if you had more people coming for Thanksgiving. Just look that one up on Google. You should be able to find it.
39:08 Speaker 03 So the other, the other important and functional part of a pump is not only fit, but you can imagine if you're trying to control forces and the heel is pistoning up and down as the person walks because it's a rigid device. If you don't lock the heel in, you're going to load the front of the foot. So it really, it's all about this decreasing the pressure on the front of the forces on the front of the foot. Because that's where 88% of the wounds happen.
39:35 Neil deGrasse Tyson? So how widespread is this product right now?
39:38 Speaker 03 It's available everywhere in the United States. We're shipping to other countries. We really had our first product launch in April commercially.
39:46 Gary O'Reilly? Larry, that's so, so, so recent. Okay, I heard first product launch. You've learned lessons from this. Obviously, it's taken more than five minutes to bring it from a clean sheet of paper to this, what is it, a calorie one medical device? What lessons have you learned along the journey and have you applied those then to new products?
40:08 Speaker 03 I don't think this show has enough time for all the lessons we've learned. Our entire team has learned lessons because we're doing things that no one's done before. Nobody has built a medical device or the lower extremity that is patient centric, right? Everything we did is built so that a patient will want to use it because if you had rocket boots and patients wouldn't wear them, what good are they?
40:29 Gary O'Reilly? You've got rocket boots?
40:31 Speaker 03 Not yet, but we'll get there.
40:34 Chuck Nice? Working on it.
40:35 Neil deGrasse Tyson? By the way, not to beat a dead horse, but in the early days of the PC wars between IBM and Apple, Apple did not have much entry into the business world because IBM was already there and Apple got great inroads into the art world. So then how's Apple going to reach the business world? So they had a commercial where there's an Apple PC, there was a Mac and there was a early in the Mac and then there was an IBM PC and the two executives are looking at it and they say, which one is more powerful, the Apple or the IBM PC? And then the person answers, the one that's more powerful is the one that people want to use. It was a line of people waiting to use the Apple, the Mac.
41:20 Neil deGrasse Tyson? I love that. And there was like one person on the IBM. That's all it is. That's that whole principle. Are you using it, then it's useful.
41:27 Speaker 03 We don't claim to be the perfect pressure reducing device, but we really are a pressure reducing device that people can easily get on and off. And one of the things we discovered along the way was Michael and I and some other engineers spent a long time on this front spat, the interior brace that Michael showed you earlier and how it almost auto closes. You pull off three tabs, open it like a book and then you let go and it falls back on itself. So it's really easy to do. But what we found was patients, about the first 50 to be exact, 49 out of 50, adjusted it once, put it on and off like a cowboy boot. They just slid their foot in, slid it out. They leave it by their bed at night. They don't have to adjust anything.
42:11 Speaker 03 They just slide their foot right in. And the device isn't designed to fit skin tight. It's designed to fit. It's small, medium, and large, so that's also where the pump part comes in handy. So if they're in between sizes, it'll help. But with the device on and adjusted appropriately, it doesn't have to hug you tight or reduce circulation.
42:35 Neil deGrasse Tyson? Okay, so Michael, Jason just opened up a whole nother product line here, which is you make this out of ostrich skin and other common leathers of cowboy boots, and you can start a whole new style. Oh, man.
42:48 Speaker 04 Right.
42:49 Neil deGrasse Tyson? Tell me about the market. Yeah, and alligator skin.
42:53 Chuck Nice? You're a corner of the Texas market, that's.
42:58 Speaker 03 So the other learnings we found in all of our business has been built on what patients have told us. We essentially polled 5,000 patients and said, why aren't you using the devices you have? And the first answer was, I can't. The second answer was the stigma, I can't go to work and do it. And the third one was, when I get home, I need to take my device off because it's dirty from being out in the world. So here are these people that are protecting their foot all day. They come home and they walk around in a sock or a flip-flop or a slide. And there's data out there that shows you actually walk more at home than you do at work for most people. So here they are, all day being diligent. Then they come home and put their body weight times seven or more on their foot all night long.
43:43 Neil deGrasse Tyson? Okay, so Michael, you heard about that, and then what did you do?
43:47 Speaker 04 Yeah, so I thought of like, if we could think of the Foot Defender as like our F1 car, right? This is where we're going to do all our research.
43:54 Neil deGrasse Tyson? F1, Formula One car, listen to you, oh my gosh.
43:57 Speaker 04 Yeah.
43:57 Neil deGrasse Tyson? Okay.
43:58 Speaker 04 This is where we're doing all of our R and D, right? How can we take that down into like the BMW M3 that someone could drive to work every day, right? So we developed this product, the Cloud9.
44:09 Neil deGrasse Tyson? I drive my F1 to work every day.
44:11 Speaker 04 Oh, man. And you get a ticket every day. That was my 12-year-old dream. But, um, so this has all the same material science that went into the Foot Defender, but this is something someone could wear at home or when they don't need the Foot Defender anymore, or maybe before they even need the Foot Defender, if we could get them ahead of time into something like this. We're gonna launch it in a bunch of different colors. And it's just something you could rock around the house really comfortably.
44:40 Chuck Nice? I would totally wear that no matter what. There you go. That is just like a super cool looking house shoe.
44:47 Neil deGrasse Tyson? Wait, what's the difference between that and like clogs?
44:51 Speaker 04 It's the same architecture, right? The same form factor.
44:54 Neil deGrasse Tyson? Yeah, it looks very Netherland-y, right?
44:57 Speaker 04 Yes, but internally, we've got all the same material stack that's inside the Foot Defender. So that absorbium, those two absorbium pucks, there's like, how thick is that insole, Jason? Like 22 millimeter, yeah, 30 millimeter insole. So it literally feels like you're walking on cloud nine. And then the last we developed, so.
45:17 Neil deGrasse Tyson? Just to be clear, cloud nine was a cloud rating system that, where the ninth of the, in the system was a cumulonimbus cloud, which included cumulonimbus clouds, the puffiest of the clouds. So that led to the tradition of saying, I'm on cloud nine, because you don't want to be on cloud seven, because that's like cirrus clouds and, you know, other whatever.
45:38 Chuck Nice? That's where angels go to die.
45:40 Neil deGrasse Tyson? Okay.
45:41 Speaker 04 I actually never knew the origin of that.
45:43 Neil deGrasse Tyson? Yeah, it was a meteorologist who went around the world.
45:47 Speaker 04 Welcome to the show.
45:47 Neil deGrasse Tyson? And he classified cloud types. And it just so happened that cloud nine was the cumulus puffy cotton cloud in the sky.
45:54 Gary O'Reilly? So Jason, before we have to wrap all of this up sadly, 130,000 amputations in the US each year. How many do you estimate you could possibly take out of that number?
46:07 Neil deGrasse Tyson? Good, good question.
46:08 Gary O'Reilly? With this boot and this foot?
46:11 Speaker 03 Imagine if we could get this, our technology on 10% of that number. Each one of those amputations costs the healthcare system half a million dollars.
46:21 Chuck Nice? Each one.
46:23 Gary O'Reilly? What?
46:23 Speaker 03 Ooh. Now, the price of the amputation isn't for the surgery. It's the prosthetic. It's for the rehab of the patient. But it's for the
46:34 Gary O'Reilly? It's for everything.
46:36 Speaker 03 That patient. And by the way, the mortality rate at five years for these amputated diabetics is 50%.
46:44 Gary O'Reilly? Damn.
46:44 Speaker 03 Higher than most cancers. So.
46:47 Gary O'Reilly? So you go from amputation to five years of 50% mortality, right?
46:51 Speaker 03 Correct.
46:52 Gary O'Reilly? Oh, my.
46:53 Speaker 03 So the whole idea behind our business, the whole idea behind the Foot Defender and its offshoots is stopping that moment of tipping from treating a wound to a mortal amputation.
47:07 Chuck Nice? Right. Wow. So can you talk to us about price point? Because it seems as though that might be an important factor. I looked online and there's like crap boots for like $60. And then there's like these super like high tech looking boots for $400 and everything in between.
47:26 Speaker 03 So we're the, we are a approved reimbursable code by insurance. The code is L4361. It pays on average around the country around $295 for reimbursement. So we're selling to doctors and medical distributors. They fix their own prices. Our current retail price is right in the middle of the range you just talked about at $250.
47:50 Chuck Nice? Okay.
47:51 Neil deGrasse Tyson? Isn't that cheaper than modern Air Jordans?
47:53 Speaker 03 It's cheaper than a good pair of shoes or running shoes at this point in time.
47:58 Chuck Nice? Yeah. And that is just tremendous on every level. Congratulations, guys.
48:03 Neil deGrasse Tyson? Yeah, you guys, I mean, you know, it's, it's possible to, to put design and science together and, and try to save the world.
48:11 Gary O'Reilly? Didn't I tell you with the top nail, the Sportiverse? Try to find a solution to this problem.
48:17 Neil deGrasse Tyson? Exactly, exactly. Well, Michael, Jason, thank you for being guests on StarTalk. You've enlightened us and you've enlightened our, our audience. And we look forward to the end of an entire category of amputations because nobody wants to lose any part of their body at any time. All right, so you guys have a website or something that people can dial in on? Footdefender.com. Okay, that's clean and simple enough. Excellent. And Michael, do you have like a design page or something where I can just hang out in it?
48:46 Speaker 04 Yeah, you can, you can just go to MichaelDTulo.com or if you're on Instagram, the, the letter D, the number two, L O. D too low phonetically.
48:56 Neil deGrasse Tyson? Oh, okay.
48:58 Speaker 04 Yeah.
48:58 Neil deGrasse Tyson? I see what you, he designed that.
49:00 Speaker 04 Yeah, I see that.
49:01 Neil deGrasse Tyson? Even design your own damn name. All right.
49:05 Neil deGrasse Tyson? All right, guys, this, and Gary, Chuck, always good to have you. Oh, it's a pleasure. I love this topic and Gary, keep digging up these topics. That this is coming out of your, out of your satchel.
49:14 Gary O'Reilly? Yeah, this, you know, we've got a production team and we're going to keep mining and hopefully we can find people of this quality and go forward.
49:24 Neil deGrasse Tyson? Let's keep doing it. All right, Neil deGrasse Tyson here, as always, keep looking up.
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