Since its earliest days podiatry has assailed fashion footwear for its high heels, pointed toes, tight fit, extremist styling, absence of support, etc. It has made an almost holy mantra of such terms as "crippling" or "ruining" of the feet. As an alternative, it has recommended "sensible" shoes, with low, broad heels, round or broad toes with high roof or box, Oxfords or laced up styles for "support", firm shanks, roomy fit, etc.

Generation after generation, the public, women especially, has largely ignored the warnings and recommendations. Women's fashion footwear continues to outsell "sensible" shoes by at least 15 to one. This has frustrated the podiatrists and orthopedists who invoke another mantra, charging women with being "slaves of fashion" and dominated by "vanity." This clears the medical conscience by feel-ing it has fulfilled its professional duty by warning the public about the health hazards of fashion foot-wear. This noble stance not only leaves the problem unsolved, but leaves the medical practitioners cocooned in their traditional state of innocence and unenlightenment about the foot/shoe relationship of women.

It is time for these ingenuous concepts of "fashion" and particularly fashion footwear to be exposed to the light of reality. Some of the facts presented in this paper may have a jarring effect on traditional views about the foot/shoe relationship, especially as related to fashion. But sometimes traumatic therapy is essential to create a confrontation with the untarnished facts of reality.

The Function of Fashion

Fashion has always been a misunderstood and abused term by the medical fraternity, especially when it intrudes on physical health. Fashion is usually presumed to be a shallow expression of personal "vanity"— a fickle plaything constantly evolving to keep us amused and entertained. This, unfortunately, is a gullible, ingenuous view remote from the tangible truths of human nature and everyday life.

Fashion plays an enormously influential role in our lives, often involving and affecting our health physically, emotionally, psychologically and psychosexually. And this applies particularly to fashion footwear, as you will soon see. Fashion has been with us since earliest civilization, even before, because it serves a vital role by feeding two of human nature's most powerful motivating forces: status and sex attraction.

Clothing sociologist Rene Konig comments, "To ask where the line is to be drawn between the natural and the artificial is to ask in vain . . . Fashion is what it is, grown entirely from its own roots; it embraces neither artifice nor nature, but only its own all-embracing law of sex-attraction and status."

From the earliest times tribal chieftains and the upper caste families of any given society have dressed and ornamented themselves to look different from all the rest. This "tradition" applies today no less than in primitive times. The reason: to establish visible distinctions of class, rank, wealth and authority. Fashion is an insignia of social caste, the indelible imprimatur of status. It is the ideal instrument for this because it is so visible. And it applies today universally no different than thousands of years earlier.

Some 10,000 years ago tribal chieftains wore stilts when addressing the tribal mass. No other member was allowed to wear stilts. The stilts allowed the wearer to "look down" on all the others, or require the others to "look up" to the leader. One of the fundamental attractions of high heels throughout recent centuries is that they increased physical stature, enabling the wearer to "look down" on others or have others "look up" to them.

In the late 16th century when the aristocracy of Europe, led by Catherine de Medici, queen-to-be of France, embraced the new fashion of high heels, some of the parvenu commoners, seeking to socially upgrade themselves, also adopted the high heels. The wealthy and aristocratic were incensed by this "invasion". They had a law passed prohibiting anyone below the rank of gentry to wear the heels. From this came our expression "wellheeled".

France's vain king Louis XIV, only five feet four inches tall, himself adopted the high heels to assume stature equal to or above that of the women. Soon, all the courtiers, along with the aristocracy, were sporting high heels. Determined not to be out-statured or out-statused by the women, they squeezed their feet into the same fragile, precarious footwear.

In the 17th century a new footwear fashion called "startups" appeared and was quickly adopted by elitist society. The startup consisted of a shoe with a cloth or leather legging, lavishly ornamented, to attract attention to women's legs. Again, true to human nature, some of the more ambitious commoners adopted the startup style. They were quickly assailed by the elitists who gave the name "upstarts" to these social impostors— a term still used today with the same meaning.

Because status is such an innate, deep-rooted drive of human nature, and because fashion is so visible, conspicuous display becomes an essential instrument of fashion. We assume, for example, that pointed-toe shoes are "modern" fashion. But they date back 3,000 years to ancient Egypt when upper caste women wore them to make the foot look smaller and more slender to distinguish it from the wide, splayed feet of common folk and slave women who toiled in the fields. Thus fashion, via the pointed-toe shoes, was used as a mark of class and status. Because the foot was required to adapt to the unnatural shape of the shoe, the deformed foot and shoe themselves became a mark of status.

Left, pointed toe sandal of ancient Egypt; right, popular pointed toe styles of late 19th century; bottom, modern pointed toe.

Pump fashion 1999, with pointed toe and sleek silhouette for "aristocratic" slender-foot look.

Pointed toe fashion of 11th century

Deformed position of toes inside shoe with pointed toes and faulty last.

In Colonial America, under British rule, the following law pre-vailed: "Citizens of common class, or below the rank of gentry, are prohibited from wearing boots or shoes of satin cloth or ribbons, or of bright colors, or shoes with stilted heels. All such footwear is a mark of rank and privilege. Those of lesser class who attempt to emulate those of stations above by their attire will be considered in violation of His Majesty's laws and subject to fine or jail or both."

Body Deformation

Darwin wrote "Man admires and often tries to exaggerate whatever characteristics nature may have given to him." Fashion, therefore, is an opportunity to correct or corrupt nature's bare facts. The fundamental nature of all fashion is to reshape the body form, whether actual or by illusion. The upper castes of society need to keep a pace ahead of all the rest to maintain an unbridgeable social chasm of class distinction. So when the common class begins to copy and emulate the fashions of the elitist group above, the latter move on to a new fashion. That is why members of the rich and elitist class have traditionally been called "fashion leaders". They are not so much seeking to lead as to escape being associated with the common class. We humans have always believed that Mother Nature somehow fell short in designing the ideal image for our body and its parts. We have spent most of our many centuries on this planet trying to correct Nature's mistakes. Each new generation has its own ideas of what the new shapes should be— which largely accounts for the constant evolution of fashion. German psychologist and clothing historian J. C. Flugel states, "The final form of body decoration is body deformation. It is the crown jewel of personal status and sex attraction."

In 1999 over 100,000 American women underwent snip and tuck cosmetic surgery to alter and "correct" the shape of some part of the body to enhance self-image (status) and sex attraction at a cost of $30 billion. Orthopedist Michael J. Couglin, former president of the American Orthopedic Foot & Ankle Society, has performed nearly 3,000 major foot surgeries. He estimates that American women spend $3 billion per year for cosmetic correction of hallux valgus, bunions, hammer toes and neuromas alone— conditions caused mostly by shoes.

When the "new look" of fashion concerts into a permanent deformation of the body or one of its parts, we often have a serious health problem. In the late 1900s the Gibson Girls with their extremely narrow waists became the ideal body form and dominant fashion. This was achieved by distressingly tight-fit corsets that created a narrow waist, flared hips and full bosom— together the contemporary ideal. It was common for women to experience fainting spells in public, caused by the constriction of the tight corset. The constant wearing of the corsets reformed and often permanently deformed the rib cage, imposing serious pressures on the chest and abdominal organs. Nevertheless, some women even had one or two lower ribs removed surgically to enable them to wear even smaller or tighter corsets for an even narrower waist. Any woman who appeared in public uncorseted was labeled a "loose woman," meaning uncorseted and hence of questionable morals.

Left, normal waist and rib cage; right, permanently de-formed rib cage caused by habitual wearing of corsets to conform to narrow waist fashion of 19th century.

Despite the many warnings of physicians and the many articles appearing in newspapers and magazines, all citing the hazards and dangers of corsets to the health of women, corsets lost none of their popularity. The only thing that had the power and influence to cause the demise of the corset was a major shift in the fashion cycle that proclaimed another "new look."

In the early 20th century the long hobble skirt became the dominant elitist fashion. The skirt tapered down from the hips to the ankles to give the lower half of the body a cone shape. It was impossible to take a full step or natural stride. The wearer was forced to "hobble" with tiny, precarious steps. The constricted gait became part of the elitist-look fashion, indicating that women could afford the leisure to walk slowly.

But such fashions are relatively mild examples. Severe forms of body deformation for status and sex attraction are found in all cultures throughout all history. And in most cases the deformations are permanent. Examples: front teeth filed to points, or plated with gold or silver; pendulant breasts of young women stretched long enough to be slung over the shoulder and strapped to the back; the stretched lips of the Ubangi tribe women, resembling dinner plates; the pointed heads, reshaped from infancy, of the aristocratic females of ancient Egypt, a visible status symbol demonstrating they were not common water carriers; the extremely long fingernails of upper caste men of China, extending as much as 20 inches, indicating the owners were not of common manual labor class; permanently plucked eyebrows and eyelashes of the women of Indonesia; stretched earlobes reaching the shoulders; among many African tribes, permanent body scarring or other decorative body disfigurements; nostrils or cheeks pierced with five-inch stems of bone.

Stretched earlobes, common custom or "fashion" of Indo-Chinese women prior to the 20th century. Each set of brass rings piercing each lobe weighs five pounds.

The upper caste of women of Burma wore a pyramid of heavy metal rings that permanently stretched the neck to twice or more its normal length; or heavy metal leg rings weighing up to 50 pounds, permanently shrinking the legs and making normal gait impossible— a visible status symbol indicating the luxury of leisure and membership in the elitist class; the common practice of circumcision; and in parts of the Middle East and Africa the practice of forced clitorectomy of young girls; the universal practice of tattooing, which has ancient origins, is simply another form of body painting and scarring. The literature is rich with hundreds of such examples of body deformation.

But such practices, you may say, are associated with primitive cultures of times past. Not so. They are as contemporary as ever. Here in America, as well as in Europe, the current practice of body piercing is seen even among the young: visible needles or long pins pierced and worn on tongues, cheeks, ear lobes, eyelids and eyebrows, nostrils, neck, arms, nipples, navels and elsewhere. All are worn as cult status symbols and insignia to identify one as a member of a select society or lifestyles apart from the mass or common class.

States Enid Schilkraut, curator of New York's Museum of Natural History, "Everybody, everywhere, does something to their body to alter its shape of look. Why? To communicate who they are or wish to appear to be. The same principal applies to the sophisticated New Yorker as to the Australian aborigine living in the bush. The latter calls it custom. We call it fashion."

The 19th century "bustle" skirt padded with pillows to create illusion of large buttocks— a popular 19th century body form fashion

We speak proudly (and often smugly) of being "individuals" with a mind of our own. That's often a presumptuous stance. To the contrary, most of us, consciously or unconsciously, conform to the contemporary "fashion" or life-style. And if the fashion decrees some kind of body deformation, actual or illusory, we go with the flow so as to fit in with the current mode and feel a sense of "belonging". Art is never a duplication of nature. The artist reshapes and redesigns the original to his own vision and perspective. Fashion, a form of art, does the same with the human form— and footwear fashion with the foot.

Foot Deformation

Of all the body's parts the foot has long been perhaps the most commonly and consistently subjected to deliberate deformation anatomically and functionally— all of it under the guise of "fashion". And our shoes, from very ancient times, have been the prime instrument of pedic deformation.

The bound foot custom of China began 1,000 years ago and continued for a millennium. The foot-shrinking process started at about age five or six when the foot was soft and malleable, and continued to early maturity, at which time the foot was grotesquely misshapen and shrunken to doll size. The young boundfoot women had now achieved elitist status, joining the other boundfoot women who were regarded as the sex goddesses of the culture. The grossly deformed "lotus" foot was no longer natural, but an object of the supernatural, in the realm of the divine. Even the fragile, precarious gait, known as the "willow walk" because the body balance was so delicate and swayed like a willow in the breeze, became a symbol of sensual status.

Flesh view of Chinese bound foot.

Left, Chinese bound foot; right, skeletal view with shaded area showing shard bowing

Skeleton foot in modern high-heel shoe with anatomical position (right) much like that of Chinese bound foot.

The long history of footwear reveals a grotesque array of boots and shoes whose shapes and forms have veered sharply from the norm of foot shape. The "chopine" fashion of the 14th century was the dominant mode of the upper caste women of Europe. This was an extremist platform-type shoe ranging in height from six to 30 inches. A natural step on them was impossible. The wearers often required a maid on either side to ensure balance and security. The higher the chopine, the higher the status of the wearer. There were constant dangers from falls, and numerous miscarriages from falls were reported. In 1324, Venice, then an independent state, passed a law prohibiting the wearing of chopines higher than six inches. The law was ignored.

Versions of the chopine, an exaggerated platform shoe varying from 6 to 30 inches in height. Popular women's fashion of 14th and 15th century Europe.

The platform shoe itself dates back to the sixth century BC, introduced by Aeschylus, the Greek dramatist, who used it for his actors on stage. The higher the platform the more important the actor and his role. Hence platforms began as status shoes. They have continued throughout the centuries to the present day. All platform shoes are functionally foot-deforming, especially if frequently worn. A natural gait is impossible with them, and the foot itself acts more hoof-like than the flexible organ it naturally is. Nevertheless, because they add body height and hence status value, they retain their popularity century after century. In the late 19th and early 20th centuries women's laced and button boots were the dominant fashion. It was also the era of "trim ankles", a sex symbol of the times. Many women wore their boots so tightly laced or buttoned that their ankles shriveled to half their natural size to become permanently atrophied and deformed. The irony was that the deformed ankles, much like the shriveled foot of the boundfoot Chinese, became a prized sexual asset.

Traditional geta or platform shoe of Japan, centuries old and still worn today.

Men's platform shoe of 1970s, with 2-1/2-inch heel. Normal gait is severely altered with such footwear.

Modern platforms, 1990s. Foot is largely immobilized in gait with no foot flex action.

In 1971, Dr. Paul Steele reported in the Journal of the American Medical Association about the rising incidence of what he called "boot leg phlebitis" caused by the wearing of popular knee-high, leg-hugging fashion boots, especially by young women. Dr. Steele warned that the blood constriction in the legs and the resulting phlebitis could be fatal. The media publicized this report. But not the slightest dip in boot sales occurred. For status and sex attraction women made it clear that they were willing to die with their boots on.

Leg-hugging boots constricting lower limb blood flow.

Women frequently say "I love shoes" They rarely use that expression with such consistency about any other article of apparel— handbags, hats, gloves, dresses, sweaters, etc. And they are referring not to "sensible" shoes (sneakers, comfort casuals, walking shoes, loafers, etc.) but only to the pretty "fashion" shoes. Which is why we refer to such women as "shoe freaks"— the tens of thousands of women who own 100 or more pairs and continue to buy more of the very shoes that give them the most distress.

There is a significant message seeking to get through here: Fashion is not a modern invention. It has been with us since the earliest civilizations. There is no mystery or "mystique" about fashion. Nor is it flighty or frivolous or fickle or shallow. And least of all is it associated with "vanity". It is, instead, a vital force of human nature and essential to our state of well-being and self-image. To be "properly dressed" means to be dressed in the current fashion to suit the occasion. And perhaps the single most important role of fashion: It must reshape and deform the body or some particular part of it, actually or in an illusory manner. Further, if achieving the "new look" requires some physical distress, that is acceptable. The hurt is tolerable. This applies especially to women. It is a simple quid pro quo arrangement: the personal gratification rewards of new form fashion in exchange for a tolerable amount of distress.

Female Masochism and "Pedalgolagnia"

An understanding of fashion-related foot distress demands an understanding of the psyche of female masochism. Without it, full-fledged "foot doctoring" falls short of maximum levels of diagnosis and therapy. Psychotherapist Seymour Fisher writes in his book, Body Consciousness, "Women seem to tolerate very well any physical distress caused by revisions of body form if it is done within the framework of social approval and admiration. Such practices are not only tolerated but eagerly sought after in the name of 'fashion'."

The medical term "algolagnia" combines the Latin algo (pain) and the Greek lagnia (pleasure). Together they become pain borne with pleasure— a form of masochism. And here we can coin a fresh and appropriate term: pedalgolagnia, or foot distress tolerated with a subliminal pleasure— an everyday condition experienced by tens of millions of women. This psychological or psychosexual reality, nevertheless, is little understood by podiatrists, orthopedists and other foot-related professionals. Understanding the psychology of fashion is really an insight into the psychology of algolagnia and pedalgolagnia and their close link to masochism— physical pain borne with sensuous pleasure.

We tend to associate the pain-pleasure principle with the S-M culture and the nether world of sexual extremisms. But, to the contrary, masochism is an everyday fact of life, particularly with women when associated with fashion. British psychiatrist and sexologist Clifford Allen, M. D., states, "Masochism in women is more a way of life than a neurosis."

New York psychologist Bernard Rudofsky, who has written extensively about the link between fashion and masochism (The Unfashionable Human Body) etc., writes, "Physical distress is accepted by women if it is a constitutional part of the pleasure of courtship and mating. . . . Women will furiously defend their high heels because any distress to their feet is in itself a form of attraction for men, many of whom feel it is a sacrifice made for them."

A woman, returning with her husband from an evening on the town, kicks off her pretty shoes and rubs her feet for relief. Her husband shakes his head and says, "Why do you wear those pinchy shoes and silly heels?" She replies, "The shoes are fine. It's my feet that are killing me."

Artist Andy Warhol got his start in New York sketching and designing women's fashion shoes. He once said, "Women would be unhappy without a little masochism and a noble sense of suffering as a 'sacrifice' for their men. So we designers try to incorporate a little sacrificial discomfort into the fashion shoes we design for them."

Women's earrings will frequently pinch and hurt the ear lobes after a few hours of wear. Women simply remove them until the hurt eases. They do the same with their pinchy high-heel shoes, kicking them off under the table for temporary relief. But they would no more give up wearing their tight shoes and high-heels than their earrings. It is the eternal love-hate relationship that women have with their fashion footwear, as much as they sometimes do with their husbands.

None of this seems logical. But logic plays no role in the masochism of fashion or in other forms. How do we explain the Hindu holy man who spends a lifetime sleeping on a bed of nails? Or other holy men who constantly wear sandals foot-bedded with nail points into the foot's sole? Pain? What pain? It is, instead, the experience of spiritual ecstasy. You may call it mind over matter. But it may also explain the same underlying principle as masochism or algolagnia.

The slow, inexorable process of foot deformation begins in infancy with the first shoes and continues throughout adulthood. The infant will repeatedly try to pull the shoes off its feet as something alien and intrusive. This is why most infants' shoes or booties are laced. The mother, to foil the child, will tighten the laces and double-knot them, further constricting blood flow to the foot.

Feet of six-months-old infant not yet in shoes. The dexterous, prehensile toes will soon be tamed and immobilized when shoes begin to be worn.

Meanwhile, the shoe itself, because of its too-thick or heavy sole, forces the child to walk with unnatural, pancake-like steps. And the shoe upper, usually much too heavy, compresses the natural, prehensile movements of the toes and foot. Further, within four-five weeks the shoe is usually outgrown, adding to the constriction of natural growth— even with the initial "grow room" allowance. The infant's foot is undergoing the "breaking-in" process, on its way to assuming the deformed, "civilized" shape.

The deformation of the Chinese bound foot began at about age five or six, when the bones and joints were not yet fully developed and the foot was pliable and malleable. The bandages at first were mildly applied, then became increasingly constrictive as the child grew older. Hence while the child felt some annoyance with the first constriction, there was no pain or distress. And soon the child felt that the bound foot state was the norm.

This very same process in principle happens with most children in the shoe wearing societies. From infancy the child rarely feels any foot distress from the shoe and becomes adapted to the hampered gait and constrictions of the shoe. It assumes that whatever is happening to its feet and gait is normal.

Traditionally, the makers and seller of juvenile footwear, infants into early teens, promise and promote the theme of "helping the child's foot to grow strong and healthy" and to "develop in nature's way". This, of course, has been totally untrue; promise without delivery. The anatomical and functional difference between a child's shoe-wearing foot and a child's foot that has never worn shoes are enormous. Unfortunately, the podiatrist cannot discern this because he/she never sees a "natural" foot and hence can make judgements only by comparing one unnatural (deformed) foot with another.

What are the specifics about juvenile footwear that make normal and natural child foot development impossible? To cite a few of the more common ones: Soles that are too thick or heavy and prevent full foot flexion; traction soles (the majority of juvenile footwear today) that create "turf toe" and deform the toes; laced shoes, all of which, to varying degree, constrict blood circulation to the foot; shoes too heavy; non-conforming uppers (leathers unnecessarily thick or heavy); faulty lasts that create foot/shoe dimensional and shape conflict; "heeled" shoes which alter the natural 180 degree flat plane of the foot (no child's shoe should have an elevated heel of any height); hostile inside-shoe climate and thermal conditions among others.

Children's shoes. Thick, inflexible soles, heels 1 – 1-1/4 inches in height, heavy leather uppers low in conformability, laced uppers corseting the foot. Yet such shoes are medically recommended as "proper" for the growing foot, which is destined to become anatomically and functionally handicapped.

A century or so ago the life of a child's foot was highly hazardous, especially under city life conditions. Many families struggled to survive economically, especially the large families common to the era. These were the times of hand-me-down shoes within families, or when outgrown shoes continued to be worn because there was "still good wear left in them". The growing feet of many children were severely handicapped upon reaching maturity. The children of rural families were more fortunate. They were equally poor, but living in isolated areas they commonly went barefoot. But when these same farm children with healthy deformity-free feet reached maturity and migrated to the cities, they donned shoes and the foot-deforming process began. It became the time of lost pedic virginity. The abrupt switchover from barefoot to shoe wearing at maturity became a severe ordeal. Graphic examples of this are on record.

When South African natives were "exported" from the interior to work in the diamond mines near Johannesburg, they were furnished with the required miner's boots. The boots so compressed and distressed the pristine native feet that the natives rebelled. But martial law prevailed and they were forced to wear the boots despite severe pain. But over the succeeding months the pain gradually subsided as the feet acquired deformed shape matching that of the boots. Like newly captive horses, the feet were "broken in" and made submissive. Civilization had triumphed over nature.

During World War II, the British drafted the Sikhs of India into the British army. The barefooted Sikhs had long been famed as fighting men. They were assigned British uniforms, including the regulation boots. During training routines the foot casualty rate skyrocketed, disabling most of the Sikhs whose feet could not adapt to the boots. The British were forced to concede, allowing the Sikhs to return to the barefoot state. The Sikhs went on to post a remarkable record for valor in military performance during the war.

Foot of 80-year-old Japanese woman who has worn only the traditional simple zori sandal all her life.

Feet of 9-year-old Uganda boy unspoiled by shoes. Note straight toes with spaces between. Low arch is genetic and fully functional.

Top Left, Natural foot of shoeless native. Note spread of toes. Right, Footprint of shoeless native. Note natural spread pattern of toes. Bottom, View of same foot.

Similar experience happened in the U. S. Army during World War II. Some of the young recruits or draftees from the rural or mountain regions of states like Arkansas, West Virginia, Tennessee and Kentucky arrived at the registration centers barefoot, as they always had been since childhood. When they arrived at the training camps they were assigned uniforms and boots. But despite numerous and patient fitting trials, the boots and feet were hopelessly mismatched. Throughout the training exercises and marches many of these recruits became severe casualties, their feet badly bruised, swollen and in excruciating pain. The numerous extreme cases were given medical discharges.

There is a pronounced difference between crippling and deformation. Crippling is physical disabling; a permanent laming that prevents full and normal functioning. Deformation is a body disfiguring or altering usually self-imposed, of normal or natural shape and appearance, though seldom disabling.

Has fashion "crippled" or "ruined" our shoe-wearing feet? These are extremist labels. The shoe-wearing foot clearly has been dramatically reshaped and deformed by our shoes, yet most people assume they have a "normal" foot. And, disturbingly, even most podiatrists assume that the average shoe-wearing foot, free of any distress or visible lesion, is normal and with natural form. Thus the ironic reversal of standards: the abnormal becomes the norm, the unnatural the natural.

Foot ills are rarely fatal. Even the most severe ones are not life threatening. This has seriously handicapped podiatry's efforts to educate the public about foot health and foot care. This applies especially to younger people under 25 years. They look at their mothers and grandmothers who wore the fashion shoes of their day, yet escaped any "crippling" consequences. They conclude that the risks are minimal. And when the risks are measured against the numerous present benefits and gratifications, it becomes a no-contest choice.

Women profess to want "comfort" in their fashion or dress shoes. But it's largely self-deception. A survey by Carol Frey, M. D., chief of the Foot and Ankle Care Department at the University of California, and involving several hundred women, found that 80 percent were wearing shoes one to three sizes too narrow.

According to shoe industry surveys based on responses from shoe stores, two-thirds of women's shoe sales are on B or "medium" width. That is absurd. An estimated 52 percent of women's shoe stores and departments carry only one width, B, in women's dress shoes. Another 37 percent offer two widths (out of a "standard" run of 12 widths, AAAAA to EEE). So it's inevitable that if stores are asked what is their best-selling width, it will be B— which will be a misfit for at least half the women.

Keep in mind that all fashion or dress footwear is designed not for the natural, unspoiled foot but for the already deformed, shoe-shaped foot. It has become the captive serf of the shoes. It frequently winces and sometimes agonizes from the abuses of its master. And from this constant mistreatment has risen a huge complex of "industries" providing products and services promising relief, remedy or even cure. Yet the incidence of foot ills has not changed in a century.

It is frequently contended that if women wore "sensible" shoes the problems of foot deformation and foot distress would be largely reduced. This is more illusion and assumption than reality. Many women with conservative tastes and lifestyles have for most of their lives worn so-called "sensible" shoes, yet many have experienced the same problems as the wearers of fashion/dress footwear.

It is an established fact: all footwear— sensible, dress/fashion or other— is designed for the deformed "civilized" foot, not for the natural, normal foot. A shoe designed for the natural foot would not suitably fit the "civilized" foot, and vice versa.

Men Are Not Excluded

We usually associate "fashion" with women and "style" (a more conservative version of fashion) with men. Hence we assume that men are much less exposed to foot ills. Statistics would seem to bear this out, with women visits to podiatrists outnumbering those by men four to one. This would seem to indicate that men are much more "sensible" about their footwear. But the only fundamental difference between men's and women's footwear is the height and design of the heel. Otherwise the male foot is as much a captive of the shoe as is the female foot.

Male vanity surpasses that of women. "Bastard" boot with ornate, colorful lace-lined top, a popular fashion with male dandies of 15th and 16th century Europe.

Men's pointed-toe shoes. Top, 13 century; center, 19th century; bottom, 1970s.

In any shoe-wearing society it is as impossible to find a fully natural or normal male foot as it is to find a comparable female foot. The toes of the male shoe-wearing foot have lost as much as 60 percent of the natural prehensibility. Though not as frequently, men nevertheless develop bunions, hallux valgus, hammer toes, nail lesions, heel and arch problems, etc.— and quite aside from sports or work injuries of the foot. Just as with women, the foot deforming process of men begins in infancy. By age 12 or 13 the boys' feet, like those of the girls, have lost their natural form and full functionality— a process that will intensify through the adult years.

The difference in heights and styles of heels in men's and women's shoes does not allow escape from foot deformation for the male foot. Men's shoe heels are usually one inch in height, though heights of 1-1/2 – 2-1/2 inches are not at all uncommon. But even a one-inch height alters the foot's natural 180-degree flat plane and affects tread and gait. Most men wear laced footwear, which keeps the foot constantly "corseted" and inevitably affects foot circulation (women's feet, by contrast, usually escape the corset effect and permit fuller circulation and foot freedom). The corseting of men's laced shoes also restricts the functional freedom of the arch and the natural exercising of the tarsal/metatarsal joints. Men's shoes often have the same pointed or narrow toes as women's shoes. And the shoes are much heavier, with heavier, less comfortable leathers. They also have rigid shanks, restricting natural elasticity of the arch. The soles are heavier, more rigid, and hence less flexible. The shoes are made on the same crooked, foot-conflicting lasts as women's shoes. A quick glance at a men's shoe that has had several weeks of wear will almost always reveal a running over of the upper on the lateral border of the forefoot— clear indication that foot and shoe are in anatomical and functional conflict. And most men's shoes, like most women's shoes, are purchased and worn with widths too narrow for a "glove fit"— another aspect of corseting that prevents full expansion of the metatarsal span on weightbearing.

Shoes made on common faulty last design. Runover effect clearly reveals conflict between foot and shoe with consequent foot deformity and functional impairment.

Footwear fashion actually began with men, not women. Today, each year over a million "new" footwear fashions are introduced in the United States and Europe. But all are based on only seven basic shoe styles. Style and fashion are not synonymous. A style, from the Latin stylus, a pointed instrument to draw an outline, is a one-of-a-kind design. A fashion is a variation or adaptation of a style. There are only seven basic shoe styles: the pump, oxford, boot, sandal, clog, moccasin, and mule. The millions of shoe "fashions" that emerge from the basic seven shoe styles is a tribute to the creativity and imagination of the shoe designers.

Now comes a surprise. Of those seven basic shoe styles— the oldest of which is the moccasin dating back some 14,000 years, and the youngest being the oxford dating back some 400 years— all were originally designed by and for men, not one by or for women. That's because in centuries past women were subordinate to men in just about everything. But beginning in the 16th century with the introduction of the high heel in Europe, women began to "feminize" shoe styles, which gave birth to footwear "fashion", a burgeoning industry still spreading its wings. It thrives because of the innate female need for status and sex attraction, of which the "pretty foot" is an important part of the arsenal of provocative allure. Hence to attempt to invoke "common sense" into this scenario is both unrealistic and futile.

Crossroads

Back to the main premise: the feet of all shoe-wearing people— men, women, children— are anatomically deformed and functionally deficient to some degree. The only natural or "normal" feet are those of shoeless people. Footwear and fashion have seduced the foot and molded it to the shoe's own form. And if the shoes have abused our feet it has been with our own permission and even our encouragement. We have submitted because the "new form" via fashion has pleased the eye, the emotions, the psyche, the sense of upgraded status and sex attraction. "The Devil," wrote Shakespeare, "hath a pleasing manner".

Podiatry, therefore, should cease referring to fashion footwear as "crippling" and "ruining" the feet, and women being "slaves of fashion" and victims of "vanity". Such terms are tired cliches that are both outmoded and unrealistic. As self-anointed reformers, the critics of fashion are whistling against the wind. Women will have their cake and eat it too. They will have their fashion footwear and tolerate the distress and deformities that go with it.

This, of course, ensures that podiatry has a long and promising future, because shoe-abused feet will always be in need of medical care. Despite the fact that all the technology is already available to produce trouble-free, foot-friendly fashion footwear, it will never become a commercial reality. Such footwear would threaten the prime premise of fashion itself: to create a constant parade of "new looks" by altering body shape. And in this sense the foot has long been a prime target because it is so easily moldable to make it appear smaller and more slender and more sensuously provocative. Which is why we will always have shoes with pointed toes, slender shapes and high heels— and will always squeeze your feet into shoes too small or narrow.

Podiatry's future as a medical need and a public health service is assured. Some 80 percent of all foot ills are shoe-related or shoe-caused. There is little likelihood that the footwear industry will change its centuries-old tradition of producing attractive fashion shoes that deform and defunctionalize the foot. Hence the essential need of podiatry serving as the medical repairmen to fix the damages repeatedly done.

It is like the economist who discovered the solution for full and permanent employment and prosperity for all. Half the population would be employed making and blowing up balloons, the other half sticking pins in them. The footwear industry and podiatry are perfectly mated with a very similar symbiotic arrangement.

But pedic medical repairing has its limits of personal gratification for the practitioner. After a while it becomes a matter of re-hammering and re-bandaging the same finger. Podiatry needs to spread its wings and apply its skills and talents to new territories. And fashion provides podiatry with a huge opportunity: the still-virginal field of pedacosmetics via pedacosmetic surgery and dermatology. Except for a few specialists, this is a field begging for attention and development.

Leonardo Da Vinci once wrote: "The human foot is a work of art and a masterpiece of engineering." Podiatry has largely dedicated itself to engineering— the mechanics and therapies of foot repairing. But it has gravely neglected the esthetics of the foot— the restoration of its natural beauty and sensuous character of which all women are acutely aware. Throughout the many centuries the foot— especially the feet of women— has been praised and extolled in ballads, fable, poetry, story, painting, sculpture and other art forms. Women are constantly reiterating this same message via their fashion footwear designed to draw attention to the sensual attributes of their feet. They are using the foot and shoe as both a sex lure and a status instrument.

Ironically, everyone seems to be aware of this except the podiatrists. The message is further echoed by the hundreds of millions of dollars spent by women for over-the-counter products designed to "beautify" the feet, along with cosmetic services provided by pedicurists and others. Cosmetic surgery and dermatology is a multi-billion dollar industry with physicians. For podiatry, a miniscule amount. We read and hear about all kinds of cosmetic therapy applied to all parts of the body— but very little about the foot. What is obviously needed is the development and public exposure of the medical specialty of pedacosmetic surgery and dermatology. If women are so obviously foot-aware from an esthetic, sexual and status standpoint, they will quickly take notice if alerted to the availability of medical services focused on restoring the natural beauty of the foot.

We can coin another term: pedoesthetics. It belongs in the everyday terminology of podiatry and is waiting for the pedacosmetic surgeons and dermatologists to bring it to life. It may be argued that pedacosmetic surgery and dermatology are not "essential" segments of podiatric practice. Quite to the contrary. For generations women have sought the idea of "pretty feet", which automatically makes it essential for women. The M. D.'s, along with the dentists, have made cosmetic surgery essential and respected branches of their professions. Podiatry is the last holdout.

Footwear fashion is going to be with us far into the future. And so are the consequent foot deformities and esthetic scars. What women are waiting for is the opportunity to restore their pretty feet to match their pretty shoes.

The author, a shoe industry consultant, has written eight books and over 400 articles, including extensive articles on leather and footwear in Encyclopaedia Brittanica.