NY Times article

[ulli]

From today's NY Times. Of course, I disagree about the last statement. In the Relentless Pursuit of Fashion, the Feet Pay the Price By LORRAINE KREAHLING Americans seem to suffer a disconnect between what logic dictates is good for their health and what they do. They exercise, but they also sunbathe. They 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, Mass. "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 organization. But Mr. 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 stabilizing 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. The padded human heel is there to absorb the shock, he said. When the heel hits the ground, the pressure is that of two and a half times one's body weight. "When you walk on your heel, you need to be able to absorb the impact of the heel strike," Dr. Bar-David said. "Your foot then becomes a rigid stabilizer, so you can push off in the toes in a balanced way. You don't want that rigidity to travel up through your bones." Pain in the back, neck and knees can be the result of shock that travels up the skeleton from a nonresilient 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. Regular tight shoes put pressure on nerves and even damage them, and also contribute in the long run to arthritis, doctors say. Shoes with pointed toes or stiff soles, like the leather versions common in many high-quality shoes, can impede the foot's mechanical function by limiting toe and ankle flexibility, said Dr. Thomas Novella, who practices podiatric medicine in Manhattan and counts many professional dancers and athletes as well as leisure-time runners among his patients. "Metatarsal pads or stiff shoes inhibit the toes' range of motion and can make you lose toe strength," Dr. Novella said. "You are cheated of the power of your toes, those little muscular soldiers lined up in your feet that are there to help carry you forward." Dr. Novella said inflexible toe beds were one of the most common causes of shin splints. "If you can't push off with your toes, you begin to pull up or grip with them," he said. Because tendons in the toes attach to the tibia, when the toes tug, it can register in the shins. Tight shoes also can produce foot deformities in the toes, and can lead to symptoms from deformities that might otherwise go unnoticed, said Dr. Gary Jolly, president of the American College of Foot and Ankle Surgeons, who practices in Hartford. People have a genetic predisposition toward bunions and hammer toe deformities, he said, but shoes are often the factor that turn conditions into problems. "Almost all bunion surgeries are done on women," he said, adding that because men's shoes normally fit the natural contours of the foot and have plenty of space inside, men may have bunions but no pain. "I don't remember the last time I did a bunion surgery on a man," Dr. Jolly said. He also advised against a practice that is becoming more common: surgery for exclusively cosmetic reasons, like having toes shortened, straightened or even removed so the foot will fit into fashionable shoes. "The foot is a highly unique weight-bearing mechanism with a rich network of nerve endings, and a complex system of muscles and ligaments that stabilize it," Dr. Jolly said. "Foot surgery carries risks that can be greater than the more common forms of cosmetic surgery." He added that the college of surgeons did not support this surgery when there was no medical gain. Bunion surgery is sometimes deemed elective by insurance companies. Dr. Smith, who said bunion surgeries in his practice had doubled last year, also said recuperation time had recently been cut in half, to an average of six weeks from three months. Increasingly, bunions and other foot ailments are being treated in earlier stages with orthotics. The American Podiatric Medical Association reports that about 13.7 million Americans over 18 have used prescription orthotics at some time, and 23.5 million more have bought orthotics over the counter, though few of the devices will fit into a high-fashion dress shoe. Orthotics are used to do more than fix foot pain, said Dr. Lori Weisenfeld, a podiatrist who began practicing 15 years ago with her father, the late Dr. Murray Weisenfeld, who wrote "The Runners' Repair Manual." Dr. Weisenfeld said imbalances that begin in the feet can create groin pulls, knee pain, and back and neck pain. "When the alignment is off or the range of motion is limited in the foot, other joints compensate for it, and this is what often causes pain," Dr. Weisenfeld said. "An orthotic can correct faulty biomechanics, including how the foot is tilted. It can disperse pain away from painful areas by taking the pressure away." Foot specialists agreed that the wide variety of athletic shoes make it almost worth seeking the advice of a medical professional before selecting a pair. "People need to choose the right shoe for their foot type and their activity," Dr. Weisenfeld said. For example, she said, people with high arches may need more cushioning, and people with relatively flat feet may need more arch support. Dr. Novella said he had seen innovations in athletic shoes that caused problems, including plantar fascial tears from overly flexible arches. He has also seen bruised heels and sprained ankles from shoes with heels that were soft on the outside and hard inside, he said. His advice to his patients is that if the shoe fits, keep on wearing it, and if pain coincides with a new pair of shoes it is probably the fault of the shoes. "I tell my patients, 'Don't throw your old running shoes away until you are comfortable in your new ones,' " Dr. Novella said. "You may save yourself a trip to the doctor, simply by comparing the old with the new and finding what is different." With all this use and abuse of feet and fashionable foot flesh on display, it is no surprise that the pampering and repairing of feet has become a booming industry. Day spas have evolved new therapies for comforting tired, well-used, expensively shod feet. There are hot-towel foot "facials"; grainy rubs to remove the outer layers of dry skin; soaks of rosewater and milk or almond oil; and lengthy massages, which often use applications of stimulating menthol, which gives the skin a rosy glow. Regina Viotto, director of the Paul Labrecque Salon on the East Side of Manhattan, said the recent expansion of the foot-care department had helped accommodate the growing numbers of male customers, but catered particularly to women who were committed to their high-fashion high heels. "We are aware of women's obsession with their Jimmy Choos and their Manolos," she said, mentioning two high-end shoe designers. "We know these shoes are hard on the back and the body, so we have focused on creating relaxing treatments that alleviate the stress that women are putting on their feet." Dr. Novella held out hope for at least some women and their favorite shoes. He said that his goal was always to keep patients in "asymptomatic equilibrium," and that the formula was highly individual. "There are certain ways to test a person's calf tightness, as well as using other parameters which help you determine the degree of heel height the person should wear," he said. "The fact is some women are more comfortable in high heels." He added that jumping suddenly from stilettos to flats - or from daily flip-flops to high heels - was not a good idea. "Human tissues can adapt, and the best way to allow your tissues to adapt is to make no rapid changes," he said. "I tell my patients that changes in footwear and training should always be gradual - evolutionary, not revolutionary." Simon Doonan, the creative director of Barneys New York, had a simpler explanation for women's ability to wear the shoes they love. "Women have a higher pain threshold," he said. "Men would not do this." Copyright 2004 The New York Times Company

[genebujold]

Removed toes?

What woman on this board who's a fanatic about high heels would have toes removed to continue wearing heels?

That's simply insane!

If you can wear high heels comfortably, without pain, even subtle, or joint aggravation, then by all means do so.

If not, then get a clue as to what your body is trying to tell you and give it up!!!

[JeffM]

Interesting article.

"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,"

I dont know about the rest of you but I was born with no shoes on my feet. And I believe that mankind used to be like this and run and walk across all sorts of terrains with out shoes.

"are totally flat, soft and squishy, "

Then

like the leather versions common in many

high-quality shoes, can impede the foot's mechanical function by

limiting toe and ankle flexibility, said Dr. Thomas Novella,

So we shouldnt use sponge rubber too soft and we shouldnt use leather too hard. And atheletic shoes should be designed to our feet.

So we should all be back bear footed with the soft squishy underside of our feet on the ground.

You know, the ones I was born with.

Jeff

[Nova]

I totally agree with JeffM on that. Except for public restrooms. And sharp rocks. Otherwise, barefoot! Jen

[Jaral2]

Removed toes? This sounds like people loossing to much weight in order to be able to wear fhasion dresses. The question is similar, manufactures should make available fashion shoes for everybody. On the other hand there will be people trying to go not one but many step ahead of the rest of the people. If it is their choice, It is OK.

[BobHH]

Translation: Don't wear shoes that are too uncomfortable or that hurt your feet or that fall off or get caught on things. A lot of words to say that. I notice all these women's foot "specialists" are men. What do women say?

[Bubba136]

Awww, common, Bob......you know that men know a lot more about wearing heels than women do..... :rofl:

[JeffM]

Stirrer

[TXT-1]

sounds like they are loosing weight, especially..... in the brain! later, TXT-1

[onyourtoes]

I heard of having toes amputated (let's call it what it is) in the 1960's and I'm sure it was done long before that; however, chopping off a toe or two seems mild compared to the mutilation and pain endured by the Chinese with their foot binding. Other than the obvious dangers of exposing your toes to dropped anvils and such, I think flip-flops are no less (or more) healthy than any other style. Any time someone starts talking about "support" is the time to doubt their credibility. As was stated earlier, we were born unshod and you can be sure shoes weren't invented to give us support. The business of small feet is certainly an odd though pervasive notion. I personally am infected with it, too. I wear men's 10, and if I try on shoes and the one that fits right is 10 1/2, then I don't want to buy them because I'll always think they look big -- and this is just one stupid half size! Anyways, what the heck am I doing in the men's department...

[Bubba136]

I seem to remember the subject of "toe amputation" has already been thoroughly discussed. Several years ago on Jenny's site with a person that actually was thinking about having the operation performed and a year or so later on this site (I wonder if these posts are in the archives?). However, I can't even think about this without cringing. I think any person contemplating toe surgery for cosmetic purposes is "threshold" psychoneurotic and the person in need of some serious therapy.

[Arno]

There are many things wrong with the article which recycles uncritical views of the podiatric establishmant but the most galling is the attempted explanation of shin splints by doctor Novella: "... because tendons in the toes attach to the tibia, when the toes tug, it can register in the shins.' This man just has no knowledge of foot anatomy and poses as an expert. Tendons do not connect bone to bone, they connect bone to muscle. The tendons in question connect to Flexor longus digitorum and Flexor longus hallucis, two muscles in the thigh that power the toes as you walk. The article also does not mention the most basic fact that high heel problems are not caused by heel height but by narrow shoes because most high heels are made in only one width called "medium" which is actually narrow.

[Arno]

Not thigh, calf!!! (sorry)

[Bubba136]

I've seen high heel manufactured in several different widths. My wife wears a 8½, AAA shoe with a AAAAA heel. That's sure not "medium" by any stretch of anyone's imagination, even yours, Arno. (And yes, they are expensive but are not difficult to find. Most shoe stores carry that shoes in that width)

[jo]

This new article (in the New York Post this time) advises on seasonal injuries: http://nypost.com/style/34744.htm

[Bubba136]

Interesting article. However, the only positive news in it relates to the increased popularity of high stiletto heels.

[BobHH]

Following is an excerpt from an article from Scripps Howard news service. Is an "inversion injury" where you wind up upside down? Wearing 3 in. platforms in and old Spanish restaurant would seem a bit of a risk. Anyway, here's the article: One moment Regina Gonzales was enjoying a free evening on a business trip to Spain, making her way down the narrow steps of an old and elegant restaurant in Barcelona while admiring the fine art displayed on the walls. The next she was sprawled upside down on the staircase, her head split open, her tailbone severely bruised, and her conservative companion's face as red as the underwear Gonzales revealed when her skirt flew up above her waist. The culprit? Her 3-inch platform high heels. "I caught one of my heels and ended up doing a 360, hitting three or four steps and landing with my feet straight up in the air," says Gonzales, 44. The fall required eight staples in her head and multiple subsequent chiropractic appointments. Gonzales still grimaces when she recalls the episode - and yet she hasn't sworn off wearing heels. "I do still wear them," she says, "but I'm very much more careful. And I certainly do not look at the art anymore." High heels might be the most glaring example of dangerous fashion, but they're not the only one. Platforms, flip- flops, oversized earrings and clothing so loose or lengthy it invites tripping or tangling - all present the potential for peril. "There's a low risk to these things - we don't see them that often - but there's always a possibility," says Dr. Leon Deprest, medical director of urgent care at an Albuquerque, N.M., hospital. Deprest says sprains from falling off high heels are probably the most common type of injury, followed by secondary infections from body piercings. Most are minor and temporary inconveniences. "High heels put you at risk for sprains, and platforms cause a lot of inversion injuries," says podiatrist Steven Wrege of Foot and Ankle Specialists of New Mexico, whose own wife disregards his recommendation of not more than a half-inch heel. "As for the extremely pointy toes that are so popular now ... well, I think I'm going to have a job for a while." The American Podiatric Medical Association has determined that high heels are the main reason women have four times as many foot problems as men. The most common complaint is metatarsalgia (pain in the ball of the foot), but the association says heels can cause everything from knee and back pain to shortened ham string muscles and an unnatural gait. Their Web site recommends a heel height of not more than 2 inches. But no heel is not necessarily more healing. Flip-flops, which offer no support and leave the foot vulnerable to trauma, are dangerous to both sexes, Wrege says. Paris, a 6-foot-3 dancer (using her stage name) trying on a pair of 8-inch heels at an Albuquerque boutique specializing in high heels and exotic clubwear, sees no imminent danger. "I was wearing low ones," says the 18-year-old - meaning the 5-inchers she is forsaking. "But these are so cute! It's just like anything. You adapt. When I was 9 years old I was jumping rope in heels." Jacob Park, who owns the boutique with his wife, Cherif, says there are plenty of women besides "entertainers and body builders" who try on the extremely high heels and boots at his shop. "I've even had women buying these heels because their wedding dress is too long," he says, holding up a 7-inch white patent leather model with a 3-inch Lucite platform. "The major comment I hear is, 'I'll break my neck!' but I've also seen girls who can run in them." Even if you choose sensible footwear, other extreme fashions might place you in harm's way.

[JeffM]

This sort of stuff has been published before by various forms of media.

And I ask the same question as before when this is said.

Flip-flops, which offer no support and leave the foot vulnerable to trauma,

Just what did man kind do before the invention of foot ware, that is when he went about bare footed?

He must have come close to extinction with all the foot problems encounted.

So maybe we can say that foot ware was the savior of the human race.

And high heels enhance the propagation of the species.

Jeff