High heels can be murder on the feet, but some women can't kick the habit.

High heels can be murder on the feet, but some women can't kick the habit.
By DAWN FALLIK
KNIGHT RIDDER NEWSPAPERS
PHILADELPHIA -- Dawn Joslin's feet hurt so much last week that she wore sneakers to work for the first time. But there she was at lunchtime, despite corns, bunions and three major foot surgeries, sitting at Lord & amp; Taylor's trying on high-heeled slingbacks.
Would they hurt her feet? Yes. Would she wear them anyway? Of course.
"I just like the look of them," says the 50-year-old comptroller. "I used to wear the stilettos, but gave those up in my 30s. No doctor has ever told me not to wear heels."
Blame Sarah Jessica Parker and her Manolo Blahnik obsession (and her ability to run in the four-inch nightmares). Despite an excess of anatomically correct, cushioned-soled support, women won't be separated from their power spikes and pointy toes. Some are demanding cosmetic surgery -- cutting off toes and lengthening others -- to make their shoes fit.
"Even though we have this incredible choice -- sophisticated flats, and Prada sneakers that can cost as much as a pair of Manolo Blahniks, it's interesting that women continue to wear high heels," said Elizabeth Semmelhack, curator of the Bata Shoe Museum in Toronto.
"High heels bring status and sex appeal and that's why they're not going to go away."
Large numbers
An estimated 72 percent of women wear high heels -- 39 percent on a daily basis, according to the American Podiatric Medical Association -- and they are paying for their addiction with bad backs, sore knees and aching feet.
"About 90 percent of my patients are women between the ages of 25 and 65 with foot pain from heels," says Joseph N. Daniel, an orthopedic surgeon at Albert Einstein Medical Center in Philadelphia. Most of them wear shoes at least a size too small and so pointy that toes jam and blister and bunion.
Three issues contribute to podiatric pain: support, pressure and space.
Completely flat shoes can fail to cushion heels or give arch support. High-heels shorten the calf muscle, which pulls on the lower back. Pizza shapes squish and rub toes.
At the Sheer Gait and Motion Analysis Lab at MossRehab Center in Elkins Park, Pa., Daniel often sends problem patients for gait analysis and pressure tests. Sensors are placed in their shoes, and then they take a slow 10-step stroll to the end of a runway.
The sensors show movement, pronation (leaning to one side or the other), and pressure placed on the soles.
As a tester walks on her 3-inch rubber-soled platforms, a multicolored image on a computer screen shows the red disaster zone -- a circle of potential pain appears right on the ball of the foot. The red areas reflect the centers of highest pressure on the foot at 6 kilograms of pressure per square inch, compared with 2 kilograms at the rest of the foot.
Another walk down the aisle in a sensible shoe and there's not a splash of red in sight. The rocker bottom -- low in the front and back, higher in the middle -- and thick sole spread the pressure away from any particular area of the foot.
Early detection
Doctors use the data to detect where problems are happening, to create special insoles for problem feet, or ward off problems that could arise. But Daniel says he rarely tells patients to stay off the heels altogether. Moderation, he says -- once or twice a week -- is fine. Every day running around, not so much.
The problem is that women these days are starting to ask doctors to fix their feet -- not to correct problems caused by the shoes but to make their feet match their shoes.
"About three years ago, maybe 20 women called me for cosmetic surgery for their feet, and now I get about 150 calls a year," says Daniel. "There's just a greater awareness of their bodies and people are striving to achieve perfection from head to toe."
In some cases, women are actually having their toes, particularly the second toe, shortened so as to enhance their "toe cleavage."
Sean Ravaei, a Philadelphia podiatrist who performs cosmetic foot surgeries, said he's received 20 calls from high schoolers, just wanting to have perfect feet for the prom.
"They want toe-lengthening, toe-shortening, they want their foot wider or narrower -- you'd be surprised at what people ask," he said.
Several other podiatrists and surgeons said they would not perform cosmetic surgery on feet because of the risk of complications with the 26 bones, 33 joints, 107 ligaments and 19 muscles that make up the foot.
"I'm completely against cosmetic surgery on feet," said Tracey Vlahovic, a podiatrist at Temple University. "The foot takes all your weight and there's a precise biomechanical action that takes place."