Sole Survivors

By staff May 1, 2005

The American Orthopedic Foot and Ankle Society tells us there are 26 bones and 33 joints in the human foot, more than any other part of the body. Our feet carry adult weights of 100 pounds or more and allow us to tread myriad ground surfaces, run at lightning speed and leap to heights of six feet or more.

So it's a puzzle to doctors and scientists why so many women persist in cramming these marvels of biological engineering into constricting, unventilated shapes that in some cases challenge the laws of physics. An estimated 75 percent of foot surgery in America results from wearing bad shoes. Bunions, corns, calluses and hammertoes are reported at rates eight times higher in women than in men, and women account for nearly 90 percent of all operations performed to correct common foot disorders, leading Dr. Steven Lasday, of Sarasota's West Coast Podiatry Center, to joke, "Shoes are designed by a secret panel of podiatrists to keep us in business."

But come in cradling a beloved pair of shoes and ask why you can't wear them, and his answer is dead serious: "Why would you?"

According to the American Academy of Orthopaedic Surgeons (AAOS), nine out of 10 American women can directly attribute a bunion, hammertoe or other foot deformity to the practice of wearing shoes that are too tight. Another study of 356 healthy women found that 88 percent were wearing shoes that were two sizes too small, and of those, 80 percent exhibited some type of foot deformity. Women are nine times more likely than men to develop a foot problem because of improperly fitting shoes, and eight out of 10 admit that their shoes are painful.

"High heels are a mechanically unsound situation for a foot," claims Lasday. To maintain proper balance, "A flat foot acts like a tripod. In a high-heeled shoe, the slant of the foot throws the balance backwards."

Over time, and in addition to the perils already mentioned, that can lead to osteoarthritis in knee or hip joints or a chronic shortening of the Achilles tendon. Dr. Richard Berkun, a podiatrist at Cortez Foot and Ankle Specialists in Bradenton, says that because sneakers elongate the tendon, switching back and forth can aggravate the tendon. And although it's rare, Lasday has even seen elderly female patients who cannot touch their bare heels to the ground because they've worn high heels since their teens.

If you must wear heels, stick with those no taller than two inches. "Even three inches is starting to get high," says Berkun, who's been practicing podiatry for 23 years. He has even harsher words for the flashy, strappy sandals so popular today: "I think those are terrible." Not only do they provide no arch support or padding along the sole, but, "It's easier to pick up athlete's foot and other nail conditions because there's no protection against the elements." And fungus infections, he says, "are very hard to treat. Just like those gross ads on television."

Even so, Berkun isn't willing to attribute every female foot problem to women's shoes. He says some women wear high heels their entire lives without developing a single bunion. "Sometimes, it's just the foot you're born with."

Lasday adds that people with chronic heel pain actually do better in some heels because it takes pressure off the Achilles tendon. Plus, he says, "It's interesting to note that there is a history of bunions in societies like India and parts of Asia where shoes are not a big factor. So we know that while most feet deformities are acquired over time, some people are just born with a tendency to develop problems."

Combine that sometimes innate disposition with a poorly fitted shoe, and you can wind up with all sorts of problems. Neuromas are often benign inflammations of nerves in the foot, but left untreated, they can cause numbness, tingling or even burning sensations. Bunions are painful, bony, flesh-covered lumps that result from friction or pressure. They can shove the first joint of the big toe out of alignment and cause the foot bone directly behind to jut out. Hammertoes are the result of toes being fixed in a crooked position. As the name implies, a hammertoe faces downward, inviting corns and calluses to form on top.

Unfortunately, there's little consensus on what makes a shoe safe, at least for women. Five years ago, Lasday and three other local podiatrists were asked by this magazine to judge several different dress shoes for men and women on the basis of fashion, comfort and medical soundness. "None of us agreed on what made the [women's] shoe safe," says Lasday. "We all agreed on the men's shoes."

But settling on a safer shoe is crucial for diabetics, says Lasday's partner, Dr. Alissa Zdancewicz. A size 10 who favors deep, wide, flats during the day, she admits to harboring several pairs of high heels for nights out. "But if I'm wearing high heels at a wedding, and [my feet] get tired, I can sit down and rest."

Not so with diabetics, who have one of the highest rates of limb loss. Damage to nerve endings in the foot caused by the disease can leave patients without the ability to feel pain, so even a minor hammertoe can turn into a dangerous wound. "Their feet won't hurt," says Zdancewicz. "They'll blister, then ulcerate. Now they've got a diabetic ulcer than can lead to amputation."

Traditional treatments for most of these problems include cortisone injections, physical therapy, even shockwave therapy (the same technique that's used to break up gallstones). Most problems can be avoided by exercising a little common sense. Having your feet measured every few years, for example, will prevent you from buying undersized shoes. That's especially important after childbirth, when women's feet tend to widen. A healthy stretch at the end of the day helps circulation and eases tension on the Achilles tendon.

"Your feet don't have to hurt," says Lasday, who adds that any pain that lasts for more than a few days should be looked at. After all, he cautions, "The smallest foot problem can turn into a large one pretty quickly."


Old Mother Hubbard wasn't the only one who lived in her shoe. If you're squeezed for space, here are 10 tips for finding your foot its perfect home.

·Try it on. Shoe sizes vary from one manufacturer to the next, so one woman's size eight may well be another's six-and-a-half. Podiatrist Dr. Richard Berkun, who's been jogging for 30 years, wears a size 11-and-a-half running shoe, but his golf shoes are size 12.

·Shape up. Buy shoes that conform to your foot's contour.

·Measure twice. Berkun says that as women age, their feet tend to elongate or widen. Weight loss can also affect shoe size, so have your feet measured every few years.

·Realize that all things are not equal. For most of us, one foot is larger than the other. Be sure to measure both.

·Wait until later. Feet tend to swell during the day, so try your shoes on in the afternoon to make sure you'll always have enough room.

·Don't just sit there. Stand up, so you can ensure that you have enough room at the end of your longest toe. You should have three-eighths to half an inch of breathing room.

·Widen your horizons. The ball of your foot should sit comfortably within the widest part of the shoe.

·Get real. If a shoe is too tight in the store, it will be too tight when you get it home, even after you try to stretch it out.

·Don't slip up. Make sure your heel stays put when you walk. Otherwise, you risk spraining an ankle if your foot falls out of the shoe.

·Walk on. Traipse up and down the shoe aisle to assess a proper fit. That's why the carpet's there, to protect the bottoms of new shoes. Take this small step to protect your feet.

Source: The American Orthopedic Foot and Ankle Society

Calling All Cuticles

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