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Can A Passion For Fashion Cause Foot Problems?

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Choosing shoes with lower heels and a wider, rounder toe box may help alleviate some foot problems.

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By MICHAEL J. SHEREFF, M.D. Tribune correspondent

The Tampa Tribune

Published: March 25, 2009

Updated: 03/25/2009 11:56 am

If fashion shoes are your passion, you already may know those stylish stiletto heels and pointy toes can feel pretty awful.

Even worse, poorly fitting shoes - high heels or shoes that are too narrow or short for your feet - could lead to a whole host of unsightly foot problems, including bunions, hammer toes and neuromas.

Among the most common foot deformities are painful, aching bunions - bony protrusions that form on the side of the foot when the first joint of the big toe slants outward. High heels can aggravate bunions by pushing the foot forward into a shoe's toe box, putting excessive pressure on the front part of the foot and constricting the toes. You may have difficulty finding shoes that fit without aggravating the bump and, if left untreated, swelling and eventually arthritis may develop in the misaligned big toe joint.

Choosing shoes with lower heels and a wider, rounder toe box may help alleviate bunions. Splints may be prescribed, and various protective pads can be used to reduce pressure over bony prominences. If a bunion causes frequent pain and interferes with daily activities, surgery may be needed to remove the bunion, narrow the foot and correct the deformity.
Hammer toes and claw toes are deformities of the four smaller toes that result when pressure applied to the tips of the toes causes them to buckle. Hammer toes, often associated with bunions, bend down toward the floor at the middle toe joint and up at the end joint. This condition occurs most frequently with the second toe. Claw toes, which may occur in all four smaller toes at the same time, bend in such a way that causes the toes to curl downward.

High heels and shoes that are too tight can cause the toes to bend unnaturally, leading to the development of hammer toes and claw toes. You are likely to experience painful corns and calluses, hardened layers of skin that form in areas where the shoe rubs against your foot. At first, hammer toes or claw toes may lie flat when you're not wearing crowded footwear, but eventually the toes will contract and become permanently stiff.

If your toe is still flexible, splinting devices may help reposition the toe, and wearing roomier shoes and protective padding can help prevent a recurrence. Surgery may be needed to straighten the toe and relieve pain once it becomes inflexible.
Neuromas are caused by inflammation of one or more digital nerves providing sensation to your toes - most commonly the nerve between your third and fourth toes. Tight-fitting shoes, high heels and prolonged walking on hard surfaces may contribute to this abnormal growth of nerve tissue. Patients describe burning pain in the ball of the foot that shoots to the tips of the toes accompanied by numbness or tingling in the toes. Treatment includes wearing a metatarsal pad (soft, heart-shaped pad) under the forefoot to spread the bones away from the injured nerve.

Anti-inflammatory medications or cortisone injections may help relieve swelling around the nerve. If conservative measures do not alleviate symptoms, surgical removal of the neuroma most often solves the problem.

Dr. Shereff is professor and director of the Division of Foot and Ankle Surgery, Department of Orthopaedics and Sports Medicine, at USF Health.

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