Cruel Shoes -- It's No Wonder Your Feet Are Killing You, According To Study

Is there an adult female who doesn't shudder at the story of Chinese women having their feet bound in childhood to conform to an idea of beauty that horribly deformed them?

Along with that story has alway come the implication that we're more civilized because we don't do that.

Well, surprise.

Now comes a national survey by a group of orthopedic surgeons that charges we're not so pure after all. Its main finding: Shoes are responsible for the majority of foot deformities and problems that physicians encounter in women.

"It's a real problem; shoe wear has it impacts on women's feet," says Seattle's Dr. John E. McDermott, incoming president of the American Orthopaedic Foot and Ankle Society, the study's sponsor.

It's also a problem that results in women being by far the majority of patients visiting orthopedists with foot complaints, McDermott says.

Some 80 percent of the study's 356 women reported foot pain. Count their agonies: bunions, hammertoes, pinched nerves, corns and calluses.

And all this from individuals, ages 20-60, who reported no previous foot trauma or surgery and no medical conditions that may affect foot health, like arthritis or diabetes.

"There's always been a lot of suspicions and accusations that women's footwear causes a lot of problems, but there were no studies to back up those accusations," says the report's primary author, Dr. Carol Frey, a professor at the University of Southern California School of Medicine.

Although Frey denies feminism was at work, she does acknowledge that the six physicians who took part were women and "biased from the start," she jokes.

The study found enough blame to go around, spreading it among shoe manufacturers, retailers, and women themselves.

To begin with, when doctors measured the subjects' feet, they found 88 percent were wearing shoes too small. But the problem wasn't in the length so much as the width. While the average woman in the study said she was an 8B, in fact she was an 8C.

The crunch comes when women try to find dress shoes that fit their heel snugly but leave room for their toes. Although most women have narrow heels, manufacturers commonly give wide shoes wide heels.

"For a shoe to give support or help, it has to give you heel control," McDermott says. To get this, many women buy shoes too tight across the base of their toes.

In addition, shoe manufacturers commonly buy their dress-shoe lasts - the form upon which the shoe is modeled - in Asia, where women have narrower feet. The result is a slender shoe, which manufacturers believe U.S. women find more appealing.

Style also conspires to cause problems. Is there a woman alive who hasn't painfully regretted buying a pair of cruel shoes, those high-heeled killers that thrust her weight into pointed toes?

"The shoe should be longest at the great toe - not in the center of the shoe," McDermott says. "That's one of the big problems of design. The big toe is pushed over toward the other toes by the shape of the shoe, and you end up with a deformed foot."

According to McDermott, high price doesn't necessarily buy better-fitting shoes - because big bucks often equate to a stylishly higher heel and more pointed toe. Nor will flats guarantee against damage.

Commonly this damage is done gradually, over years and sometimes painlessly, resulting in a bunion at the base of the big toe, a misshapen big toe, and smaller toes that have clawed under and developed calluses on top. These are called hammertoes.

"Women start having problems in their 20s and 30s," McDermott says. "Then we see them in their 40s and 50s when their big toe slips out of place and they need surgery.

"If you have a serious problem, it's hard to get over it," he says. "Bunion surgery is very difficult; there are about 10 ways to do it. Doctors see bunions recur all the time, especially with women who wear ill-fitting shoes after surgery."

Men rarely have these problems, study physicians found, because their shoes conform more naturally to the shape of their feet, and are generally better made of higher quality materials. Thus they get more support and cushioning, especially important when walking on hard surfaces.

The average American woman owns 15 pairs of shoes and expects to replace dress shoes after about a year. Men, on the other hand, wear theirs three times as long.

In the study, women also come in for their share of the blame. Although 60 percent believed their shoe size had increased since age 20, some 75 percent had not had their feet professionally measured in five years.

Indeed, the women were right about the increase. The doctors found that by age 29, 18 percent had larger feet. By age 50, 69 percent had experienced an increase. And by 60, some 95 percent had larger feet than when they were 20.

"Women's feet can go up about a size to a size and a half as they age," McDermott says. "Also, pregnancy relaxes the ligaments, and the feet tend to spread" except for the heel, which generally stays the same size throughout life.

Another recent study, conducted here in Seattle, confirms that older patients also don't know what size they should wear.

Performed by Linda Hanna, a foot-care nurse and certified pedorthist (trained shoe fitter), the study examined 100 people age 65 or older. Almost 80 percent were women.

Hanna found only 33 percent wore shoes that fit. The rest were bothered by shoes too small or too narrow. Only 3 percent, by comparison, bought shoes too wide.

"The most important point was that 75 percent of people had pain, but didn't know what to do about it," Hanna says. "They had bunions, hammertoes; they couldn't find shoes that fit. They didn't know who to talk to, and they didn't ask their physicians.

"They felt everybody's feet hurt; that was just part of becoming more mature." Hanna says that's not true.

The problem of women not having their feet properly measured is compounded, McDermott says, by the lack of standardization of women's shoe sizes. And it's not helped by the move toward self-service where little or no professional help is available.

So what should women do?

Complain to retailers, shoe manufacturers and employers whose dress codes require high heels, suggests Carol Frey, author of the orthopedic society study.

She also encourages women to send their comments, complaints and suggestions to the American Orthopaedic Foot and Ankle Society, which will pass them along to the shoe industry. The address is 1300 Cabrini Tower, 901 Boren Ave., Seattle, WA 98104.

"Ninety percent of women can't find shoes that fit, so there's a huge market out there," Frey says.

For technical reasons, it takes about seven years for a manufacturer to make significant changes in shoe fit. Still, Frey says some companies already are realizing the need and trying to fill it.

She gives kudos to Nike, Easy Spirit, Rockport, New Balance, Naturalizer, and Soft Spots, among others, for trying to make fashionable, well-fitting shoes.

Oregon's Nike, in particular, recently bought Cole-Haan, a fashion manufacturer. For several months, Cole-Haan has been selling women's pumps bearing Nike's Air-Sole technology, says John Barbour, Nike product line manager. This gives the wearer "a springier sensation under her foot. It helps absorb shock over the life of the shoe."

Barbour says Cole-Haan is continuing to innovate, looking for improved cushioning, flexibility, support and comfort.

He predicts more of the industry will follow suit if the consumer demands it.

"This is just going to be the first wave, moving out into comfort footwear. We feel as this (baby-boom) customer matures, she'll start elevating fit and comfort to the level of style."

In the meantime, Frey's study has prompted the National Shoe Retailers Association to begin developing a consumer awareness campaign to teach women how to get good fit.

Then perhaps there'll be something behind the old saying, "If the shoe fits, wear it." ----------------------------------- IN EXTREMITY? DO RIGHT BY YOUR FEET -----------------------------------

-- Have your foot professionally measured, both length and width, once a year, while standing. Because one foot commonly is larger than the other, have both feet measured.

-- Look for a shoe that conforms as closely as possible to the shape of your foot. This means a rounded toe box and sufficient width across the base of the toes.

-- Heels should be 2 1/4 inches or less.

-- Fit the largest foot first. It should have a thumb's breadth from the end of the longest toe to the end of the toe box.

-- A shoe is too tight if the toes can't be completely uncurled when standing.

-- Natural uppers are preferable to man-made materials, and suede or glove leather are preferred for their softness, according to orthopedic surgeon Carol Frey.

-- Fit shoes at the end of the day, when the feet are largest. "The upper should not wrinkle with flexion of the foot, and the foot should not bulge over the welt (strip of leather that joins the insole with the outer sole)."

-- Walk off the shoe department's carpeted area onto a harder surface. Trade secret: stores "sometimes put extra padding under the carpeting because the soles are thin," Frey says.

If you have foot pain and can't find comfortable shoes, don't hesitate to see your doctor or a foot specialist. You may also benefit from the services of a certified pedorthist, or specially trained shoe fitter. Such experts often work in tandem with orthopedic surgeons, and can custom fit shoes in a number of ways not available in regular shoe stores. Pedorthists often work out of orthopedic shoe stores. They're listed in the Yellow Pages under "shoes-orthopedic."

Some people erroneously believe everyone's feet hurt as they grow older, says Seattle pedorthist Linda Hanna. "But from a professional standpoint, they don't have to. People should be able to be put in a comfortable shoe to accommodate whatever their problems are."

And last, don't ever let a sales clerk talk you into buying killer shoes with the line "you just have to break them in and they'll be fine."

"That's just not good advice," Frey says. "What's going to happen after years of you breaking shoes in is your foot is going to break, not the shoes. You should be comfortable the minute you put it on."

------------------ PITY THE POOR FOOT ------------------

High-heel shoe -------------- Toes cramped Thin soles A high-heeled shoe forces the ball of the foot to bear almost the entire weight of the body. High heels also direct the entire body weight downward toward the single joint of the big toe encouraging the development of bunions, a painful condition that affects three times as many women as men.

Fitted shoe ----------- Room for toes Support soles The foot needs to be able to relax and distribute the body weight evenly. To protect the foot against a downward force of from five to six times total body weight, a shoe must be constructed of quality foam supports and have sufficient space up front to allow the toes to relax and position correctly.