Women’s Footwear: When Fashion Hurts

Close-up image of lady legs standing next to red moto scooter

By Dr. Alexis E. Dixon,

Orthopedic Surgeon/Foot

and Ankle Specialist



According to Jonathon Wolford’s History of Women’s Shoes, the stiletto heel, first fashionable in the 1950s, paired with a sharp pointed toe, is still “the most aesthetically complimentary shoe style ever designed. The pointed toe visually narrowed the foot and the high heel tightened the calf muscle, slimming the ankle.”

Never mind that walking in such shoes, for many women anyway, can pose numerous challenges. As a woman who is both fashionable and an orthopedic surgeon specializing in foot and ankle injuries, I can attest to the fact that wearing and walking in these fashionable designs can be a risk to your health.

A study conducted by The American Orthopaedic Foot and Ankle Society (AOFAS), which examined 356 women, found that 88 percent were wearing shoes that were too small for their feet; most had not had their feet re-measured in over a decade; and, not surprisingly, over 50 percent reported experiencing daily foot pain from their shoes.

As we age, our feet grow wider and flatter, and the fat pad that sits under the bones in the ball of our foot begins to thin. This diminishing protective cushion of fat can cause significant pain while walking, as the shock absorption from the fatty tissue is no longer there. Add to that the discomfort of wearing shoes that are too tight, and high heels that push our feet forward into a pointed shoe that bunches up our toes, and we’ve got a perfect recipe for bunions, hammertoes, corns, calluses, and myriad other foot and ankle issues.

The easiest way to prevent these problems is to wear properly fitted shoes. The American Association of Orthopaedic Surgeons recommends that people get their feet measured for length AND width while standing and that these measurements are done at the end of the day when feet are their largest. You should also have your feet measured regularly, as the size of your feet changes as you age; and have both feet measured as most people have one foot that is larger than the other. Fit your shoes to the largest of your feet.

I also recommend to my patients that they go shoe shopping later in the day, to ensure a proper fit, and I caution them that if a shoe is too tight, don’t buy it, as there is no such thing as “breaking in” a shoe. It either fits or it doesn’t. I suggest avoiding narrow, pointed shoes that squeeze the toes and look for low-heeled (less than one inch in height), wide-toe box shoe styles. Do not select shoes by the size marked inside the shoe. Sizes vary among shoe brands and styles. Judge the shoe by how it fits on your foot. You should also stand during the fitting process and check that there is adequate space (3/8″ to 1/2″) from the end of your longest toe to the end of the shoe. Make sure the ball of your foot fits well into the widest part (ball pocket) of the shoe. Your heel should fit comfortably in the shoe with a minimum amount of slippage. And, lastly, walk in the shoe to make sure it fits and feels right, as every style, even from the same manufacturer, will vary in fit and comfort.

Fashionable shoes can be comfortable, too. Look to shoe manufacturers such as SAS, Born, Easy Spirit, New Balance and my personal favorite,  Attilio Giusti Leombruni (AGL) shoes, which are quite fashionable, albeit pricey.

If your previous footwear choices are now causing you foot pain, you may be suffering from:

Bunions: Bunions are often caused by wearing poorly fitting shoes, in particular, shoes with a narrow, pointed toe box that forces the toes into an unnatural position. High heeled shoes also put more pressure on the forefoot and increase the likelihood of foot problems or injury. Some people inherit feet that are more likely to develop bunions due to their shape and structure; and bunions are also more common in those with inflammatory conditions, such as rheumatoid arthritis.

In most cases, bunion pain is relieved by wearing wider shoes with adequate toe room and using other simple treatments to reduce pressure on the big toe. But a bunion is not just a bump that can be shaved off! There is usually no excessive growth of the bone, so any surgery that would simply remove the bump will not work. The bunion will either come back, or the toe will angle the other direction.

Surgery, where the bone is cut and the joint tightened, is usually the most successful remedy, with 90 percent reporting they’re happy with surgery if the pain is relieved.

Hammertoes: Hammertoes occur as a deformity of the smaller or lesser toes, are usually due to muscle imbalance and tight shoe wear, and are sometimes related to arthritis. Those with neuromuscular conditions, such as Charcot-Marie-Tooth disease, are more likely to develop hammertoes. With this happens, the skin on the deformed toe(s) can rub against the shoe, and can also lead to painful calluses at the ball of the foot.

Like bunions, the first step in treating hammertoes is to avoid tight fitting shoes. Shoe inserts that cushion the ball of the foot or toe spacers that alleviate pressure may provide some relief. But sometimes, hammertoes can become so severe that even shoe wear modification is ineffective. In this case, outpatient surgery can be used to straighten the toes.

For those of you who are already experiencing foot pain, changing your shoes may not solve the problem, in which case you should consult with a physician or orthopedic surgeon.

Dr. Alexis E. Dixon is an Orthopedic Surgeon/Foot and Ankle Specialist at DISC Sports and Spine Center (DISC.) For more information head to: discmdgroup.com.