Nicholas J. Giannestras, author of the book, Foot Disorders, says "poorly-fitting shoes not only interfere with the function of the foot, but produce actual damage." Giannestras wrote that it is harder to correct foot problems in women than in men because "fashion has decreed the type of shoes to be worn by the female which, under the best of circumstances, are unphysiologically constructed." According to today’s doctors, most foot problems result from poorly fitting shoes, so it is not surprising that ninety percent of foot surgery patients are women. According to Dr. Rene Caillet, some foot problems are caused by preexisting structural defects in the foot, which are accentuated by ill-fitting shoes. Podiatrist Noreen Oswell says, "It’s not that their feet are worse. Men have the same underlying deformities, but women exacerbate them with high heels."

    A common foot problem caused by the wearing of high heeled shoes is hallux valgus, or bunion. Under this condition, the large toe angulates toward the second toe, causing a protrusion at the joint of the large toe. This condition is generally attributed to the forcing of a foot into a shoe with a pointed end and a high heel. The pointed toe box found on high heeled shoes and on some low heeled shoes as well, causes great damage to the feet. When the foot is forced into a shoe with a pointed end, the toes are not allowed to abduct, or spread out, in order to stabilize the relatively great weight of the body. An imbalance between the muscles in the foot occurs when there is not enough room in a shoe for the abductor muscles to contract. The adductors overpower the abductors, pulling the large toe in a lateral direction. The high heel itself also causes damage. This may be obvious to the women who have worn high heels and have experienced pain in walking. Medical writer Carolyn Strange stresses the point in her article Kick Off Your Heels, "Having sore feet is not normal. As in any body part, pain signals that something is wrong." The problem with high heels is that they cause the weight of the body to be concentrated on the ball of the foot, which can as much as double the pressure on this area. As shown in the picture of the foot with a four inch heel, the long foot bones are almost perpendicular to the floor and therefore almost opposite of the natural position.

    Why do women wear high heels? Strange says that some women like the way that high heels affect their posture, making the derriere and bust more prominent than normal, and the "wiggle" that high heels create. Doctor Roswell even suggests to women, "In an inch-and-a-half heel, you’ll still wiggle and look cute," and says that heels should be worn in moderation if women insist on wearing them, although flat shoes are best for the feet. Women also want to be tall, since this is the ideal in Western culture, and when the very popular platform shoes were not in style, high heels were the only means by which women could become taller. Many women and men agree that legs simply look more aesthetically pleasing when the foot is curved downward, creating a graceful line. The only problem with this is walking.

    Immobility for women has long been associated with high class. In the Middle Ages, women of the aristocracy were carried around their houses in sedan chairs and by their servants. Those who could not afford this luxury of course had to walk to get around, and therefore walking became associated with the lower classes. In sixteenth century Italy, women wore extremely high (nine inches to two feet) platform shoes called chopines, in which walking required the assistance of an escort or maid.

    Tiny feet have also been associated with high class and femininity for many centuries, and in different areas of the world. The practice of footbinding in China from the tenth century until the early twentieth century may be the most extreme case of restriction through women’s footwear. Women’s feet were bent and bound tightly with cloth so that they would eventually fit into tiny shoes. Mary Trasco, author of Heavenly Soles: Extraordinary Twentieth Century Shoes, states that for Chinese women, footbinding was an "excruciatingly painful ritual, which ultimately shaped their identities." Women who endured the painful procedure gained with high social status. Walking was very difficult after the feet had been bound, though, and women had to walk very carefully, with delicate steps. Men found this very attractive. Of course, the ultimate goal in the practice of footbinding was to gain the affection of men. In the Western world as well, women strived to fit the ideal of tiny feet. Trasco states, "Even though the practice of wearing the smallest possible shoe size caused the bones of the feet to become twisted and deformed, it appeared and reappeared from the Renaissance to the Victorian Era. In the nineteenth century, some women had one or two toes removed in order to better endure extremely narrow shoes. The uncomfortable high heeled shoes that are worn today present a similar case of bizarre, restrictive fashion.

    Nicholas Giannestras stated, "First and foremost one should remember that the shoe should protect the foot, not disturb it." He and other podiatrists and orthopedic doctors agree that the most supportive shoe is one that is shaped like the human foot, with a wide enough toe portion to fully accommodate the toes and the natural motions of the foot. A well-fitted instep and heel is also suggested. "But then," asks Giannestras, "How many women would wear such a physiologically shaped shoe in this modern age? None!" Though women are now beginning to choose shoes for comfort and function. According to results of the survey conducted by the American Academy of Orthopedic Surgeons, it is primarily young women and women with high incomes who are wearing lower heels and more comfortable styles. On the other hand, many middle-aged women and women with lower incomes (under $25,000 a year) are wearing high heels. The survey results also showed that higher education levels coincided with lower heels. It is interesting that while women of high class have always conformed to impractical fashion ideals, it is the women with higher incomes who are the first to reject these fashions. This is because women now earn their own incomes by working, just as men earn their money. Women no longer need to wear silly things in order to please their husbands and maintain social status.

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