Style over comfort: are you sacrificing foot health for fashionista status?

American Fitness, March-April, 2004

According to researchers, one in five women suffers from foot pain because of her shoes. Moreover, with kitten and cone heels as well as wedges destined to fill Manolo Blahnik and Jimmy Choo shelves this year, fashion plays a large part in dictating what shoes women wear, despite the fact that they could be risking long-term problems. For many, the sense of empowerment and improved self-esteem derived from wearing high heels and other fashionable shoes outweighs foot health concerns. Dr. Oliver Zong, a Manhattan podiatrist, sees a direct correlation between female foot problems and what he dubs, "high heels from hell." He offers tips on how to safely and comfortably put your best foot forward.

The Correct Fit

Well-fitting shoes with a firm sole and soft upper are the best way to prevent most foot problems. Zong suggests "they be purchased in the afternoon or after a long walk, when the feet have swelled. There should be a half-inch space between the largest toe and tip of the shoe. Also, the toes should be able to wiggle upward. A person should stand when being measured and [have] both feet sized, with shoes bought for the [size of the] larger foot. It is important to wear the same [type of] socks you plan to wear with the shoes. Women used to wearing pointed-toe shoes may prefer the feel of tight-fitting shoes, but with wear, their tastes will adjust to less confining, properly fitted shoes."

The Heel

Unfortunately for high-heel lovers, the healthiest women's shoes have wide heels and are no more than a half or three-quarters of an inch in height, according to the American Podiatric Medical Association. "High heels are the major cause of foot problems in women," says Zong. Although people believe foot binding is a Chinese problem of the past, many fashionable high heels constrict the foot by up to an inch. One study suggests wearing high heels may even lead to arthritis in the knees. Zong cautions, "women who insist on wearing high heels should at least look for shoes with wide toe room, reinforced, relatively wide heels and cushioned insoles. They should also keep the time spent wearing high heels to a minimum." It is even more important for older women to wear low-heeled, comfortable shoes. High heels do not offer the protection and stability needed to keep aging feet healthy.

For women unwilling to give up high heels, there are ways to minimize the damage these shoes cause. Wearing flats for part of the day and avoiding high heels that are too tight will lessen their impact on feet. Pain and other foot problems are less likely to occur if high heels are worn as infrequently as possible and replaced with sneakers of flats as much as possible. Also, some shorter pumps combine the comfort of sneakers with the look of high heels.

The Soles

Ideally, shoes should have removable insoles. This way, when they become worn out or do not provide enough cushioning or support, they can be replaced by more appropriate insoles or orthotics. However, wearing removable insoles with orthotics or another insole would cause too much "cramping" in the shoes.

Thin, hard soles may be the best choice for older people. Elderly people wearing shoes with thick inflexible soles may be unable to sense the position of their feet relative to the ground, significantly increasing the risk of falling. Some research suggests thick soles may even be responsible for foot injury in young adults who engage in high-impact exercise. With the popularity of platform or wedge sneakers, many young adults are wearing them at the gym. However, these are not meant to be used for running, jumping of lateral movements (e.g., movements in tennis, basketball, football, etc.) and can lead to ankle sprains or fractures.

Laces

The way shoes are laced can prevent specific problems. Laces should always be loosened before putting shoes on. For a tighter fit, people with narrow feet should buy shoes with eyelets farther away from the tongue than people with wider feet. Eyelets closer to the tongue allow a looser fit for wider feet. If after tying the shoe, less than an inch of the tongue shows, the shoes are probably too wide. Tightness should be adjusted both at the top and bottom of the shoe. Where high arches cause pain, eyelets should be skipped to relieve pressure.

Stockings

High heels aren't the only corporate-attire culprits. Pantyhose, their common companion, may also cause health problems. "Stockings prevent air from circulating around the foot and create the perfect damp, warm environment for the growth of fungi, such as athlete's foot," Zong explains. "The abrasiveness of nylon, which is compounded when pantyhose is wet or sweaty, can cause blisters. Some pantyhose, usually cheaper ones, don't have adequate elasticity, which may cause the toes to be constricted and forced upwards, leading to ingrown nails and hammertoes."

Platform Shoes

In a replay of the '70s, platform shoes have made a comeback and women should be aware of the following. Although platforms do not awkwardly throw the body forward like traditional heels, they cause other unique problems. With conventional high heels, the length from ball to heel of a woman's foot limits the shoes' height, but there is no limit with platforms. While this added height flatters the legs and buttocks, women increase their risk of lateral ankle sprains with each extra inch.