Foot Pain: A Podiatrist’s Take on Stylish Shoes

I love shoes as much as any fashion-conscious woman– spring sandals with skinny straps, stiletto heels and ballet flats.

But I also know the dangers of the latest styles.

In my podiatry practice at Wake Forest Baptist Health, I see patients every week – men and women – with foot injuries caused by the shoes they wear.

So when I give in to temptation and buy that pair of pointy-toed flats, I make a simple promise to myself. I’ll wear them for that special evening out, but the rest of the time, especially when I know I’ll be standing on my feet for long periods, I stick to sensible shoes.

Sensible shoes fit your heel snugly, provide plenty of room for your toes, have a firm sole and arch support. Running shoes and other shoes designed for walking are probably the best all-around supportive shoes, but most of us can’t wear running shoes to work. Fortunately, a number of shoe companies now make stylish shoes that provide the support you need to protect your feet from injury.

In many cases, foot injuries heal by switching to better shoes and adding arch support, padding and other orthotic devices. But some injuries require treatment by a podiatrist or an orthopaedist who specializes in feet and ankles.

We all know that high heels and tight shoes make your feet ache. But they can also damage the nerves that run from the ball of the foot to the toes. High heels and tight shoes put pressure on the ball of the foot and the nerve: the higher the heel, the greater the pressure. That pressure irritates the nerve, causing inflammation or abnormal nerve growth called a neuroma.

Symptoms include tingling, pain and swelling between the toes. In many cases, a wider, more supportive shoe with a low heel helps the nerve heal itself. We can also use steroid injections to reduce the inflammation. And if that fails, I can remove the nerve. Neuroma is more common among women, but I see male patients with neuromas too. Many are cyclists who put extra pressure on the ball of their foot when they pedal a bike.

High heels and pointy-toed shoes can also lead to a condition called hammer toes. Simply put, high heels, especially in shoes with a pointy toe, or small ballet flats don’t leave enough room for all of your toes.

At first, the toes accommodate to the small space by bending into a contracted-like shape.

Over time, the ligaments in the toes become rigid and the toes no longer flatten, even when the high-heeled, glamorous shoes are removed. Corns on the top and tip of the toes often add to the pain. In some cases, wider shoes with enough room for all 5 toes reduce the pressure on the toes and correct the problem. But when the contraction on the toe ligament is permanently rigid, surgery is the only treatment for hammer toes.

In addition to neuromas and hammer toes, spiky heels and pointy-toed shoes can also lead to painful bunions and ingrown toenails.

A bunion is a prominent bone on the big-toe joint. Some people are born with bunions, but others develop them in their 30s or 40s – usually from shoes that rub against the joint. Once they start, bunions only get worse. We can slow the rate of growth of a bunion with wider shoes and orthotics that help align the foot better. Usually a painful bunion requires surgical treatment.

Many people are born predisposed to ingrown toenails. Their nails are simply wider than the nail bed. High heels and narrow shoes irritate already painful ingrown nails. Often the best solution is for me to cut the nail away down to the nail bed. Again, a “sensible” shoe will help prevent a recurrence.

Ballet flats, flip flops and other flat shoes also cause injuries because they offer little to no support for the arch and no cushion for the bottom of the foot. Shoes that provide no support or cushion can lead to inflammation of the thick tissue on the bottom of the foot known as the plantar fascia. Even walking long distances barefoot can irritate the tissue. Inflamed tissue, or plantar fasciitis, is also common in men, usually active men who exercise in worn out shoes that no longer provide arch support or padding. In most cases rest, ice, stretching and arch support help. Some cases of plantar fasciitis require surgery.

I’m not against flimsy shoes and spindly heels. And even if I were, I know that my female patients would still want the latest sandals. But women need to be smart about the shoes they wear and realize that if they start wearing heels in their 20s without a break, by the time they reach their 40s they may very well be paying the price.

Remember, your feet shouldn’t hurt. And when they do, your shoes may be causing real injury.