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Foot pain: It's often the shoes Health: Fashionable but ill-fitting shoes can look good -- and have you feeling bad.


"If the shoe fits, wear it. If the shoe doesn't fit but it looks good, wear it anyway."

This seems to be the motto of millions of American women who have suffered debilitating problems as a result of wearing ill-fitting shoes. Although shoes are meant to protect the feet from injury, for many women they do just the opposite.

The American Academy of Orthopedic Surgeons reports that more than 43 million Americans, most of them women, have trouble with their feet, usually from wearing shoes that do not fit. Surveys indicate that 80 percent of women wear shoes that hurt their feet, and more than 70 percent of women have developed painful foot deformities as a result.

Women are nine times more likely than men to develop such problems as bunions, corns, calluses, hammertoes and neuromas (a pinched and painfully inflamed nerve in the foot). As evidence of chronic injury, the incidence of foot problems rises with age in women but not in men.

Orthopedic experts say these problems result primarily from one or more of these factors: shoes that are bought too small or that become too small as the foot expands with age, pointed-toe shoes that squeeze the forefoot into an unnatural shape, and shoes with high heels that place undue pressure on the toes and forefoot.

Among people who do not wear shoes, these problems are rare. But in this country they afflict 1 person in 6 and result in medical costs of about $2 billion a year and another $1.5 billion in time lost from work for surgery and recovery, the academy estimates.

Nearly all these problems can be avoided, and there is no better time to start than now. By opting for comfort over conformity, women should begin dictating footwear design instead of leaving it up to men, who would never dream of walking around with their feet in a torture chamber.

Happily, changes in fashion have made this the best year in more than a half-century for women to find and wear shoes that are both comfortable and stylish.

More and more shoes are being sold today with rounded toe boxes that are both wide enough and high enough to accommodate a normal woman's toes and forefoot. Many styles have heels that are lower and wider. They are less likely to thrust a woman's weight unnaturally forward and cause instability that can result in twisted, sprained or broken ankles.

In a fashion trend that began years ago with a New York City transit strike and has since swept the country, millions of women nationwide now travel to and from work in sneakers and don their dress shoes only at work. That limits the time they spend standing or walking around in footwear that is harmful to their feet.

On average, each woman buys 5.6 pairs of shoes each year, for an annual total of 495 million pairs. Although probably no one has as many shoes as Imelda Marcos, most women have closets filled with ill-fitting shoes.

Throw out the uncomfortable shoes and go shopping for new pairs that more closely resemble the shape of your bare feet.

Always buy for fit, not size. There are no uniform size standards that shoe manufacturers follow. Also, foot sizes change. Feet naturally get bigger as you get older -- even if you are not a runner and have never been pregnant. Through use, the ligaments that hold together the 26 bones in the foot stretch, resulting in feet that are wider and longer. Shoe size is most likely to change if you gain weight.

In a new five-year study of 88 patients, Dr. Carol C. Frey, an orthopedic surgeon at the University of Southern California in Los Angeles, found that 64 percent of those who gained weight had an increase in shoe size.

Among those who maintained their weight, 31 percent needed a larger size five years later, but even among those who lost weight, 28 percent needed a larger size. Although such women tended to buy longer shoes as their feet grew, few bought wider ones.

It is best to buy shoes when you are not rushed or desperate to find something to wear right away. Buy shoes at the end of the day, when your feet are largest. Walk around in the shoes for at least five minutes in the store and if you are the least bit uncertain about comfort, do not buy them. Walk around in them again indoors at home, and if you doubt the fit and comfort, return them.

Never buy shoes that feel tight or that need to be "broken in" because chances are your feet will break before the shoes do. Dr. Francesca M. Thompson, an orthopedic surgeon at St. Luke's-Roosevelt Hospital in New York, suggests that before shopping for shoes, measure your feet by making an outline of each bare foot while standing. (If you cannot bend over far enough, ask someone else to draw the outline.)

Cut out the drawings and take them with you to the shoe store. Or measure both feet at their widest and longest points, and write the measurements on a piece of paper that you carry in your wallet.

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