Women are especially likely to cause harm to their feet in
the pursuit of fashion: Women account for nearly 90 percent
of all operations performed to correct common foot disorders
such as bunions, hammertoes and neuromas. The shoes women
wear are the biggest culprits, especially dress shoes which
are typically characterized by a tight fit, narrow toe boxes,
high heels and shapes that don't conform to the foot.
On average, American women squeeze into shoes that are two-
and-a-half sizes too small for their feet. You can test that
yourself: Take off one shoe and place it on the floor
alongside your foot. Chances are your foot will be wider than
To keep their shoes on, women who wear narrow-toed shoes, a
popular fashion item, must squeeze the forefoot tightly,
placing considerable pressure on the big and little toes and
all the bones in between. If the shoes also have high heels,
the pressure on the forefoot soars by a factor of five. As a
result, the forefoot is literally molded into an abnormal
The Damage Done
Bunions are among the most common problems caused by wearing
tight or ill-fitting shoes. A bunion is a painful bony lump
covered by a pad of tender flesh that develops as a result of
the body's attempt to cushion the toe from excess pressure or
friction. Although many people consider bunions to be simply
a cosmetic disorder, the problem is much deeper. The first
joint of the big toe is shoved out of alignment, and the end
of the foot bone just behind it juts out. A tendency toward
bunions may be inherited, since they often run in families.
But research has shown that shoes are mainly to blame.
Hammertoes usually accompany bunions. The condition develops
when a toe becomes fixed in a crooked position. Ultimately,
the end of the toe faces permanently downward, like the head
of a hammer. The second and third toes are particularly prone
to the condition because they're longer and apt to get shoved
backward as a result of the limited toe room in tight shoes.
Hammertoes can be painful and, when severe, may impede
walking. In addition, thick callouses or corns often develop
on the tops of the affected toes.
Neuromas, or trapped nerves, can also be brought on by tight
or ill-fitting shoes. The continual pressure squeezes the
bones of the foot together until they impinge on the nerves,
usually between the third and fourth toes but sometimes
between the second and third. The rubbing of the nerve
against the bone causes significant irritation, and the
entire lower foot may eventually become numb or develop a
burning or tingling sensation.
Step In The Right Direction
A change of shoes is often all it takes to alleviate foot
problems. Roomy, comfortable shoes, such as running shoes,
should be your first step. To get the proper fit, many women
may have to resort to wearing men's athletic shoes. Once
you've worn roomier shoes for a few weeks you may be unable
to squeeze back into your dress shoes. Comfort or fashion
— you decide.
In some cases, a bit of felt or foam padding placed in the
sensitive area of (roomier) shoes helps relieve discomfort.
Painful neuromas sometimes require corticosteroid injections
to reduce inflammation.
The last resort for treating any of these foot disorders is
surgery, which involves realigning the crooked toe bones in
the case of bunions and hammertoes, or removing the damaged
nerve itself in the case of neuromas. Foot surgery is not a
minor procedure, and it's not entirely risk-free. There's
always the chance of complications developing or of the
condition being made worse.
Although most surgical corrections of bunions and hammertoes
are successful, these conditions will recur in about 10
percent of cases. Women who develop bunions or hammertoes
early in life (in their 20s, for example) may be
"ligamentously lax," that is, the connective tissue in their
feet is easily stretched out of shape. For these women, the
risk of post-surgical relapse is considerably higher.
Surgical correction of a neuroma should be performed only
when necessary because it will result in permanent numbness
in the part of the foot that's served by the nerve.
Fortunately, women today are increasingly resisting the urge
to crush their feet in the pursuit of fashion. The trend is
due in part to changing fashions and in part to less rigid
dress codes in the professional world. There are now many
more options for women who want to dress professionally and
be kind to their feet.
(C) 2005 Dr. Reuven Bruner. All Rights Reserved.
Contact him at: POB 1903, Jerusalem, 91314, Israel; Tel: (02)
652-7684; Mobile: 052 2865-821; Fax: (02) 652-7227; Email: