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Kick the high heel habit; A simple step to cure some bunions: switch shoes

OB/GYN News, Sept 15, 2004 by Anne Scheck

There's a newfound commitment among orthopedists to avoid surgery in the treatment of hallux valgus, but their campaign to promote prevention and practical footwear is often no match for a pair of knock-em'-dead Jimmy Choos.

Dr. James W. Brodsky, clinical professor of orthopedic surgery at the University of Texas, Dallas, is among the growing ranks of orthopedic surgeons who maintain that for some patients the cure for bunions can be as easy as switching shoes. But it's an unpopular crusade.

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Up until a few years ago, women in the workforce eschewed high heels and pointy-toed shoes for footwear that helped them blend in with their male counterparts. Suits were navy or gray and shoes were sensible and dark, Dr. Brodsky said. But in many of today's work environments where it has become acceptable for fashion trends, rather than office politics, to dictate what's worn, high heels now trump comfort.

And, he contends, that shift in nine-to-five apparel is taking a toll: Women today are nearly twice as likely to visit a physician for toe problems as their male counterparts, according to the National Center for Health Statistics.

Clearly one need only stand on the street of a major city to witness that many women would rather sacrifice their feet to fashion than wear flat-heeled shoes to avoid pain and the need for surgery later on.

Indeed, in an era when medicine in general is trending toward increasingly noninvasive procedures, foot surgery remains an exception. Bunionectomy is one of the top 15 most common musculoskeletal surgeries in the United States, according to the American Academy of Orthopaedic Surgeons.

A survey by the American Orthopaedic Foot and Ankle Society (AOFAS) documented that more than half of the women who answered questions about their shoes admitted experiencing pain from high heels, and about 11% of them said they wore heels that were 3 inches or higher.

Still, "You can't blame the patients." Young women who seek help for foot pain belong to a generation of people who perceive fashion footwear to be a job requisite, explained Dr. Brodsky, who is also director of the Foot and Ankle Surgery Fellowship Training Program at Baylor University Medical Center, Houston, and at UT Dallas.

And to be fair, bunions are not known to be caused directly by tight shoes. Other factors contribute to their development, including the fact that girls are now playing more bone-stressing sports than in the past, often beginning at an early age, when pressure on the metatarsal-phalangeal joint can predispose osteoarthritis, and in turn, hallux valgus formation. But ill-fitting shoes do hasten disease progression. Footwear can play a role in susceptible individuals, according to "Podiatry Sourcebook" statistics.

And if nothing else, the emergence of cosmetic foot surgery in the last few years underscores the extreme lengths to which people will go to look good. In a 2003 survey of orthopedic surgeons, about half had treated patients for foot problems resulting from complications for cosmetic foot surgery.

Such procedures, undertaken largely to improve the foot's appearance in open footwear, include altering hammertoes, removing bunions before they have become symptomatic, and shortening the length of toes that exceed that of the big toe.

The AOFAS, noting a substantial increase in cosmetic foot surgery, has recommended against all procedures that are performed solely to enhance the look of the foot.

In helping a patient decide whether or not to undergo surgery, Dr. Sharon Dreeben, who chairs the AOFAS Public Education Committee, said the guiding principle should be pain.

"Surgery should be done to improve function or quality of life," she said, adding that she knows of cases in which women had surgery to narrow their feet, shorten their toes, or simply make their feet prettier. Complications are too big a risk to take to don fashionable shoes, she said.

BY ANNE SCHECK

Contributing Writer

Health Care Industry

Kick the high heel habit; A simple step to cure some bunions: switch shoes

OB/GYN News, Sept 15, 2004 by Anne Scheck

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