High Fashion and Feet

We seem to suffer a disconnect between what logic dictates is good for our health and what we do. We exercise, but we also sunbathe. We eat large salads instead of dinner, but snack on high-calorie, high-cholesterol junk foods.

This habit extends down to the toes, or at least the toes of many women. Just ask the podiatrists and foot and ankle surgeons who do a brisk business in repairing feet wounded by the fashion industry’s love affair with high-heeled shoes.

“The current trend in fashion is very bad for women’s feet,” said Dr. Lloyd Smith, president of the American Podiatric Medical Association, who practices in Newton, Massachussetts. “Superhigh heels with very narrow toes create problems and exacerbate existing conditions.”

Round-toed shoes with five- or even six-inch heels, fashionable this season, are hardly better; likewise the popular thong sandals, which completely expose the feet.

“Flip-flops are close to horrible for the feet,” Dr. Smith said. “They are totally flat, soft and squishy, and offer no support and no protection,” not to mention their penchant for causing accidents by catching on things or inviting being stepped on. Even athletic shoes, experts say, occasionally lead to problems that require medical intervention.

Medical experts agree that the best shoes for healthy feet mimic the foot’s natural shape, while offering support in the arch and a flexible sole underneath the toes, the way most athletic shoes do.

“A good shoe has a relatively flat sole and something that fits the heel snugly,” Dr. Smith said. “There is lots of room in the toe box for the toes, and the uppers are of soft materials. Ideally laces make the shoe adjustable.”

So-called healthy shoes manufactured by the athletic industry bring in $11 billion annually, nearly one-third of the $35 billion Americans spend on shoes each year, said Marshal Cohen, chief industry analyst for the NPD Group, a fashion market research organisation.

But Cohen said sales data indicated double-digit growth for women’s dress shoes in the last four months.

High heels can be bad for wearers for several reasons, said Dr. Tzvi Bar-David, a doctor of podiatric medicine at Columbia Presbyterian Medical Center in New York.

An elevated heel lifts the foot out of its natural position and shortens the Achilles’ tendon. Such shoes also pitch the weight of the body forward disproportionately onto the ball of the foot, which in turn upsets the stabilising mechanics of the foot.

“High heels have a narrow area of contact and they point the toes downward, which puts the foot in an internally rotated position and makes their wearer more prone to spraining an ankle,” Dr. Bar-David said.

Pain in the back, neck and knees can be the result of shock that travels up the skeleton from a non-resilient heel.

“When you start playing around with shoes that take away from the natural functions of your feet, you start to have problems,” Dr. Bar-David said.

In addition, fashionable shoes that try to convert the foot into an ideal form, with the toes narrowed or tapered to a point, often require cramming the foot into less space than it would normally occupy.