Stilettos look great but may prevent you from kicking up your heels

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Women love high heels, but they can be the cause of myriad foot problems. (MISHA JAPARIDZE / THE ASSOCIATED PRESS)

Q: I started to have a lot of great toe pain with a new pair of high-heeled shoes and since that began, I have not been able to wear any high-heeled shoes. What can I do, as I cannot wear running shoes to work?

A: Love them or hate them, high-heeled shoes are part of the everyday lives of many women and a fashion staple. Dress shoes for women are not only big business, but they can lead to big problems for the feet, ankles, knees, hips and back. Yet, it is difficult for women in the workplace to wear a more comfortable shoe because the expectation is that professional dress attire requires shoes with a heel.

Not everyone with foot pain from wearing high-heeled shoes will have the same sore area. In fact, there are several problems that appear just in the feet from high heels. These foot troubles range from mild to more serious problems so a proper diagnosis is paramount.

Oh, those bunions!

This is really a female predicament, as 90 per cent of those who suffer from bunions are women. Tight-fitting shoes are definitely a culprit, especially in a vulnerable foot. In non-Western world countries, where high-heeled shoes are not often worn, bunions are uncommon. Bunions can also be a family trait. The great toe bears a lot of weight when we walk but even more so in high heels. In a tight shoe, the base of your great toe starts to enlarge, leading to pain, redness and swelling. Most bunion symptoms are relieved by wearing wider shoes and using bunion padding -- rarely is surgery necessary.

The compression that stings

High heels change the distribution of pressure in the front part of the foot. Sometimes, a neuroma (a growth of nerve tissue) can occur in the ball of the foot. A neuroma most commonly occurs between the third and fourth toes. It can lead to pain, numbness and a burning sensation that radiates from the ball of the foot to the toes. Certain foot types, such as a flat foot, can predispose you to the development of a neuroma. Simple neuromas can resolve with padding and a change to wider shoes. More problematic neuromas may require a cortisone injection or surgery.

Crack goes the bone

Can you really get a fracture in your foot from wearing high-heeled shoes? The answer is definitely yes, and often the diagnosis can be missed because women do not think that it is possible. These fractures are also called stress fractures, which means there may not be a crack right through the bone and the fracture may not appear in an X-ray. If your physician suspects a stress fracture, it may be necessary to have a bone scan to detect it. The second toe is a common site for a stress fracture but they also occur in the sesamoid bones of the great toe and the third toe. Stress fractures require a definite rest from high heels for at least six weeks, so there is no way to complement your work attire with this injury.

The best fit

The first thing you want to consider when selecting a high-heeled shoe is the existence of any foot problems. Whether it is a bunion or a neuroma or another problem, it will worsen in high heels. Thus, it is important to address these foot problems first and wear flat, supportive shoes. Once you are ready for a high-heeled shoe, look for heels that are not higher than an inch-and-a-half, especially if you have to wear the shoes for several hours. The area where the toes sit in the high-heeled shoes is called the toe box. You want the toe box to be as wide as possible to accommodate all the toes. You can also try wearing special support padding in your shoes, but this will not work well in shoes with a narrow toe box. It is common to have one foot larger than the other. Always fit the larger, wider foot first when buying dress shoes; inserts can be used for the smaller foot.

For more help with your foot troubles, consult your podiatrist or physician.

Readers can ask Dr. Kennedy questions, but due to the volume of requests, replies are not guaranteed. Email: askthedoctor@freepress.mb.ca

Republished from the Winnipeg Free Press print edition April 6, 2010 C3