Fashion Footwear & Foot Health

I was recently interviewed for an article about women’s footwear and fashion. Most of my answers didn’t end up in the article (the author chose to focus more on fashion than foot health), but I wanted to share them with you here:

What foot issues are commonly caused by women's fashion footwear?

Many. Among the most common are bunions, plantar fasciosis (often inaccurately referred to as plantar "fasciitis"), hammertoes, neuromas, and ingrown toenails. There are three main "features" of fashion footwear that, over time, cause foot problems in women. These design elements are heel elevation (the heel is elevated above the forefoot), tapering toe box (the toe box gets narrower as it goes from the ball of your foot toward the ends of your toes), and toe spring (the toes are elevated above the ball of the foot).

How can a woman prevent these issues, yet remain stylish?

This is not an easy task, as the very things that we find attractive about shoes—high heels, small and pointy toe boxes—are the direct cause of most foot problems. The best way to prevent foot problems from developing, then, is to avoid footwear with heel elevation and tapering toe boxes. It can be quite difficult to find footwear that is healthy and also conforms to society's fashion ideals. The good news is that, while options are still few, an increasing number of shoe manufacturers are starting to develop footwear that has the health-positive attributes of being flat, wide, and flexible, while also having eye-catching appeal.

Another approach would be to define "stylish" as the attractive quality of looking and feeling healthy—a state of being in which you experience good posture and painless, unrestricted movement. From this perspective, the poor posture, pain, foot deformation, and restricted movement that fashion footwear causes renders this type of footwear rather unstylish.

Is foot health more important than fashion, and why?

As a woman who has always loved pretty shoes—shoes that make me feel taller and more attractive—I cannot downplay the importance of fashion. But as a doctor, I've seen firsthand the long-term implications of fashion-footwear use. Wearing footwear with elevated heels, toe taper, and toe spring, over time, causes your feet to become misshapen. Your big toe points toward your second toe, your other toes become bent, your foot and leg muscles and tendons become imbalanced, the joints in your feet become stiff, and painful conditions arise. It's easy to take your feet for granted until they start to hurt. Then, suddenly, pain affects your ability to walk, stand, and just move in your daily life. Your feet are your support base, so when you experience foot problems, it affects your entire body.

So if fashion footwear hinders your ability to feel good in your body, and it predisposes you to bunions and fungal toenails, which are certainly not attractive, it makes me question whether appearing fashionable is worth the drawbacks. Ultimately, I'd say both foot health and fashion are important. Unfortunately, you often find that you have to trade one for another. Like with many things in life, you have to balance all your options, weigh all benefits and drawbacks, and make educated decisions about what's best for you.

If a woman does not want to give up her heels, do you have any tips for ways to limit her exposure?

We are born with feet that are perfectly designed for walking, running, and standing on a level surface. Elevating the heel, squeezing the toes, and springing the toes upward (the common foot configuration in conventional fashion footwear) compromises this natural design and predisposes you to foot and body problems. Any heel elevation negatively impacts your feet and body. So the best bet is, indeed, to limit your exposure. I recommend that women wear shoes that are flat, widest at the ends of the toes (not just the ball of the foot), and flexible (the soles can be easily bent or twisted in multiple directions).

Wearing high heels once in a while, such as on a date, or to a formal event, is okay for most women. It's what you do most of the time that matters. Even if a woman does not wish to give up wearing high heels completely, she can still opt for using flat footwear in casual situations, such as when walking to work, exercising, running errands, walking the dog, hanging around the house, or meeting with close friends. In terms of preventing foot problems, the less time spent weight-bearing in heels, the better.

What signs of discomfort should women look for that acknowledge perhaps a deeper problem or medical condition?

Your feet are not supposed to hurt. Any pain, including pain in your ankle, heel, arch, or forefoot can suggest a medical condition. Also, you can check for foot deformities, which can be painless initially. These include your big toe pointing toward your second toe, the appearance of a bump near the base of your big toe, bent or curled toes, or toes that point upward even when your foot is relaxed.