Women have been wearing high-heeled shoes since the 1800s, when shoes were made to match the outfit.

Today, women wear high heels to make their legs look longer and their ankles thinner and, yes, sexy.

As a podiatrist, I see women every day complaining of pain in their feet. Often, they attribute their pain to an exercise regimen or athletic shoes.

After a thorough exam of their feet, I often find the shoes they are using for athletic activities are not the problem. It's the shoes they wear to work every day!

It's unrealistic for me to expect women not to wear fashionable, trendy shoes, but you may want to think twice about wearing them every day. You could be causing more damage to your feet than you know.

Wearing high heels changes the biomechanics of walking, and can have an impact on the entire structure of the foot and the relationship of the knee to the ankle, as well as your lower back.

It puts more pressure on your feet per square inch. This means if you are overweight and wearing high heels, you will put a lot of added pressure per square inch on your feet as you walk.

High-heeled shoes have been linked to many foot ailments like bunions, hammer toes, neuromas, metatarsalgia, Achilles tendonitis, ingrown toenails, corns and calluses. It also affects the veins in your legs by effecting the blood circulation.

If you wear a heel that is more than 1½ inches high every day, your calf muscle will not effectively pump blood out of the leg.

You can try this at home. Feel how the calf contracts when you walk in lower heels and then switch to high heels. The foot simply moves forward in high heels without your calf contracting.

This can lead to the development of varicose veins.

So, what is a fashion-conscious woman to do? Try these simple steps to minimize the damage to your feet from high-heeled shoes:

- Get your shoes fitted to your feet properly.

Most women wear shoes that are a half-size too small.

Measure your feet with a brannock device every time you go shoe shopping to make sure your shoe size hasn't changed. Even a few extra pounds will cause your foot size to increase.

Remember that different shoe manufacturers will size differently. Don't be a slave to your shoe-size number.

Always make sure the shoe is the correct width. The shoes will not stretch that much when you "break it in." Most of my patients buy shoes that are too narrow.

- Buy shoes in the afternoon or at the end of the day.

Your feet swell throughout the day, so you will get a better, more realistic fit if you buy in the afternoon.

- Buy leather shoes, not synthetics.

Leather is a natural material that conforms to your foot more easily then synthetic materials.

- Wear heels that are no higher than three inches and beware of the pointy-toed, high-heeled stiletto shoe. These are a double-whammy.

Try to avoid the severe point and go for more of a taper or square-toe box and a chunkier heel.

I've seen women who surgically alter their feet to accommodate the severe taper of high heeled shoes.

Also, try to wear a consistent heel height as variations can cause pain in your Achilles tendon. Chronic wear of high-heeled shoes

Causes a shortening of the Achilles tendon. This shortening can lead to tendonitis and heel pain. To combat this, stretch your Achilles tendon and calf muscles at least every day if not twice a day.

- Wear your heels less than three hours a day.

Giving your feet a rest from the constriction of high heeled shoes is important.

If your feet are swollen and painful after wearing your heels, that's an indication you're wearing them too long.

This can cause severe problems including bunions and hammering of the toes. Bunions are bony growths at the base of the big toe.

Your large toe separates from your foot and can cause excruciating pain when it gets into advanced stages.

The big toe will angle inward toward the other toes and the bump can become swollen, inflamed, painful and unsightly.

Hammertoes will develop because the shoes will force the toes to crumple up. This shortens the muscles inside and leaves them permanently bent.

You may also experience the "pump bump." This is where the straps and the rigid backs of pump style shoes cause a bony enlargement on the heel.

It can also cause plantar (ball of foot) fasciitis, which, over timeas it develops can become extremely painful and require treatment by your podiatrist including surgery.

If you have bunions or hammertoes, a silicone protective sleeve can help alleviate the pain and rubbing in your shoes.

Hammertoes and bunions have to be corrected surgically to stop the pain it causes when you wear shoes, especially heels.

- If you have constant knee pain, avoid heels all together.

One study showed a 26 percent increase in stress on the knee joint in heels higher than two inches. Osteoarthritis in the knee has been linked to chronic wearing of high heel shoes.

- If you have two different-sized feet, and most people do, shoe stretchers can be used to stretch the toe box if one foot is only a little bigger than the other.

Remember though, you can only stretch 100-percent leather.

If you have significantly different sized feet, some stores and web sites will sell you two different sized shoes.

- If you have to wear heels and have a flexible flat foot, try custom orthotics made especially for dress shoes.

They can distribute weight off the ball of the foot back to the heel. This weight shift improves body alignment and balance dramatically, reducing leg and lower back fatigue while reducing pressure on the ball of the foot.

It also helps relieve forefoot pressure from painful metatarsal heads, Morton's neuroma and calluses.

- Always have a pair of comfortable casual or athletic shoes handy at your desk or in the trunk of your car.

Change into these shoes if you are sitting at work for long periods of time.

- Core strengthening exercises can help stabilize your feet and decrease the stress from high heeled shoes.

Every woman should do core exercises at least three times a week. They help with back pain, knee pain and foot pain caused by instability.

It's important to realize that your feet were never designed to wear high heels.

Think before you wear the latest trend-setting style. A few aches and pains are normal with high-heeled shoes. If you have pain that lasts more than five days see your podiatrist. It could indicate you're damaging your feet.

If caught early, simple solutions are available at your podiatrist, but if you delay treatment then more expensive surgical treatments may be needed to correct the damage to your feet.

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