Do You Abuse Your Feet? 

Women are especially likely to cause harm in the pursuit of fashion.

Women account for an estimated 90 percent of all operations performed to
correct common foot disorders such as bunions, hammertoes and neuromas. 
The shoes women wear are the biggest culprits, especially dress shoes, 
which are typically characterized by a tight fit, narrow toe boxes, high 
heels and shapes that don't conform to the foot.

On average, women squeeze into shoes that are two and a half sizes too 
small for their feet. If you're a woman, you can test that yourself: 
Take off one shoe and place it on the floor alongside your foot. Chances
are your foot will be wider than the shoe.

To keep their shoes on, women who wear narrow-toed shoes, a popular 
fashion item, must squeeze the forefoot tightly, placing considerable 
pressure on the big and little toes and all the bones in between.
If the shoes also have high heels, the pressure on the forefoot soars by 
a factor of five. As a result, the forefoot is literally molded into an 
abnormal shape.

James D. Michelson, M.D., associate professor of orthopedic surgery at 
the Johns Hopkins University School of Medicine and director of the Foot 
and Ankle Service, describes the harm that can result — and what you can 
do about it.

The Damage Done

Bunions are among the most common problems caused by wearing tight or
ill-fitting shoes. A bunion is a painful bony lump covered by a pad of 
tender flesh that develops as a result of the body's attempt to cushion 
the toe from excess pressure or friction. Although many people consider
bunions to be simply a cosmetic disorder, the problem is much deeper. 
The first joint of the big toe is shoved out of alignment, and the end 
of the foot bone just behind it juts out. A tendency toward bunions may
be inherited, since they often run in families. But research has shown 
that shoes are mainly to blame.

Hammertoes usually accompany bunions. The condition develops when a toe
becomes fixed in a crooked position. Ultimately, the end of the toe 
faces permanently downward, like the head of a hammer. The second and 
third toes are particularly prone to the condition because they're 
longer and apt to get shoved backward as a result of the limited toe 
room in tight shoes. Hammertoes can be painful and, when severe, may 
impede walking. In addition, thick calluses or corns often develop on 
the tops of the affected toes.

Neuromas, or trapped nerves, can also be brought on by tight 
or ill-fitting shoes. The continual pressure squeezes the bones of the 
foot together until they impinge on the nerves, usually between the 
third and fourth toes but sometimes between the second and third. The 
rubbing of the nerve against the bone causes significant irritation, and 
the entire lower foot may eventually become numb or develop a burning or 
tingling sensation.

Step In The Right Direction

"In treating all of these foot conditions," says Dr. Michelson, "I use a 
stepwise approach. In many cases, a change of shoes is all it takes to 
alleviate the problem. I begin by having my patients wear roomy, 
comfortable shoes, such as running shoes." To get the proper fit, many 
women may have to resort to wearing men's athletic shoes. Once you've 
worn roomier shoes for a few weeks, warns Dr. Michelson, you may be 
unable to squeeze back into your dress shoes. "I get a fair number of 
complaints about that, but you have to decide what you want most: 
comfort or fashion. If you really must wear high-fashion shoes, you can 
at least have the leather stretched out at the key pressure spots to 
better accommodate your toes and forefoot." Most shoe repair shops can 
handle this procedure.

In some cases, a bit of felt or foam padding placed in the sensitive 
area of (roomier) shoes helps relieve discomfort. Painful neuromas 
sometimes require corticosteroid injections to reduce inflammation.

The last resort for treating any of these foot disorders is surgery, 
which involves realigning the crooked toe bones in the case of bunions 
and hammertoes or removing the damaged nerve itself in the case of 
neuromas. Foot surgery is not a minor procedure, and it's not entirely 
risk-free. There's always the chance of complications developing or of 
the condition being made worse.

Although most surgical corrections of bunions and hammertoes are
successful, these conditions will recur in about 10 percent of cases. 
Also, Dr. Michelson says, women who develop bunions or hammertoes early 
in life (in their 20s, for example) may be "ligamentously lax" — that 
is, the connective tissue in their feet is easily stretched out of 
shape. For these women, the risk of postsurgical relapse is considerably 
higher.

Surgical correction of a neuroma should be performed only when necessary 
because it will result in permanent numbness in the part of the foot 
that's served by the nerve.

"Fortunately," says Dr. Michelson, "women today are increasingly 
resisting the urge to crush their feet in the pursuit of fashion. The 
trend is due in part to changing fashions and in part to less rigid 
dress codes in the professional world. There are now many more options 
for women who want to dress professionally and be kind to their feet."

The American Orthopaedic Foot and Ankle Society has evaluated heel
design, toe room, slip resistance, comfort, cushioning and breathability 
for a number of popular women's dress shoes. Styles that received the 
AOFAS Seal of Approval in 1999 were Easy Spirit Jet, Aerosoles Mocc A 
Rena, Dexter Rio, Nine West Espy and Hush Puppies Earl. Although these 
shoes certainly aren't the only ones on the market that you can safely 
wear, they may give you a good starting point for finding foot-friendly 
footwear. 

5 responses total.

Don't even get me started!
But since you did...
Have yet to find man-shoes short enough or woman-shoes wide enough.
And believe me when I tell you I have "try this place" mail from many of 
the finest...

Tried wearing them sideways yet?  ;)

 Otter, have you tried New Balance sneakers? They come in different 
widths. I think they are one of the only athletic shoes that do that. :)

Yes, I have tried New Balance. Their widest ladies' size is D.
But thanks.

I'm in the opposite boat...or was.  My feet were too narrow for most
shoes....and the ones that were narrow enough didn't give enough room for my
really high arch.  Due to retail, though, my feet have spread right out. :)

For comfort: Birkenstock now makes innersoles that are like their shoes. :)
I also get a full length arch-support pad from my local shoe repair.  $20 for
a pair, they last several months, and can be switched from shoe to shoe. I
*LOVE* those things.

Down with the pointy shoes!!!!

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