By Eleni Gage, April 2007

Why three in every four South African suffer from foot problems – and how to get back on your feet

"My feet are a size 10," says Athena Tsembelis, 40. "For a long time, they were eight and a half, then they started swelling from all the years I've spent trying to stuff them into shoes made for Cinderella. I wanted to be the belle of the ball and wear dainty glass slippers, so I continued to buy shoes that were too narrow, too high and cost too much money." Tsembelis's choice of shoes cost her more than money: she eventually needed surgery to remove a painful bunion from her left foot. And she may need surgery for her other foot as well.

It's not just Cinderella wannabes whose feet are aching. Men suffer, too. Noah Tannen, 33, for example, recalls a painful plantar wart that grew to the size of a coin. He had to have it frozen and shaved off.

According to the South African Podiatry Association, an estimated 75% of South Africans will experience foot problems at some point in their lives, caused mostly by ill-fitting shoes. And overweight men and women put added strain on their feet simply by walking. What's worse, pain that starts with the feet may not end there. "Your feet to your knees to your hips to your back to your neck – it's all part of the same thing," says Dr Johanna Youner, a podiatric surgeon who warns that high heels, for instance, can throw the spine out of alignment. She adds that flip flops or flat shoes that don't offer arch support can cause knee pain, because "your knees will sag inward, your hips will be problematic and other parts of your body will not be in great alignment". And that can lead to even more serious orthopaedic problems later on.

So how you treat your feet can mean the difference between tripping the light fantastic and chronic conditions that require more than an over-the-counter remedy.

In style, out of step
Some people care more about how a shoe makes them look than how it makes their body feel. In fact,42 percent of women say they'd wear shoes that are uncomfortable in order to look more stylish, says an American Podiatric Medical Association study. Even Dr Youner admits that high heels not only make a woman look taller and thinner, "they stick out your chest, make your butt stick out, they make you look sexier, curvier and slimmer". But, she warns, "the downsides are huge". After all, "It's nice to be able to walk."

Wearing high heels can also cause blisters, corns, bunions and hammertoes, which can be painful as well as unsightly. In a bid to prettify their feet, a few women are even opting for controversial surgeries such as the "toe tuck" to slim the pinkie toe, "toe shortening" to downsize toes, and "toe slimming" to remove fat deposits on the tips of toes and fight so-called toe-besity.

But even those who would never dream of having surgery to improve the appearance of their feet continue to choose shoes with looks in mind. Sought-after beauties have always been associated with perilous footwear, whether it's the ill-fitting glass slipper that helped Cinderella nab a prince, or the high Manolo Blahnik stilettos that had Carrie teetering around Manhattan in Sex and the City. Today's sky-high wedges, espadrilles and platform shoes are just as perilous. While these styles may seem more stable and easy to walk in than stilettos, warns Dr Youner, "the higher the platform, the further you fall".

Men are subject to some of the same foot problems from the stiff, tight leather shoes they wear for work. And weekend warriors often pound the ground in athletic shoes designed for walking or crosstraining – not scoring the winner or sliding into third base. "Men aren't forced into high heels with points in the front – unless they are cowboys," says Dr Youner. "So when men have foot trouble, it tends to be plantar fasciitis caused by inadequate support of the arch, sports-related heel pain, or bunions from trauma, like running too much or other weightbearing exercise."

Many soldiers experience plantar fasciitis, too. "It's the most common problem we see," says Lieutenant Colonel Patrick G. Sesto, a podiatry consultant to the US army surgeon general. The painful condition – an inflammation of the plantar fascia, a thick band of tissue along the sole of the foot – can be caused by a genetic predisposition or, in the case of soldiers, by exertion. Says Sesto, that means "overuse from running, marching and carrying extra weight like a rucksack".

So how much damage can a pair of shoes (and other foot abuse) really do? A lot. (Read 'The Perfect Fit' and 'Common Foot Troubles & Ways to Help Them'.)

Foot fixes
Most experts agree there's no miracle cure for foot problems. Prevention is the key. Buying good quality, breathable leather shoes is a start. Sweaty feet can cause more than just smelly shoes. Our feet contain a high concentration of the body's sweat glands (over 19 000 of them per square centimetre). "If moisture collects in the shoe," warns Dr Robert Baglio, a foot and ankle surgeon in Virginia, US, "it could lead to a number of skin issues, including athlete's foot." And wearing synthetic shoes that don't breathe puts you at risk for developing foot fungi.

For women, the right shoe is crucial. Heels that are five centimetres or less keep your ankle from being much higher than the ball of the foot, a better bet than stilettos or pumps. It's not just heel height that's a concern for women – the shape of the shoe plays a part, too. Round- or squaretoed styles are easier on the feet than pointy ones. But regardless of shape, if your shoes are too small and rub against your toes, you run the risk of developing painful bunions, corns and hammertoes.

Fortunately, some new treatments are emerging. For example in the US, painful corns are now being treated with Restylane injections, an off-label use of the FDA-approved facial line filler. And minor foot discomfort can be eased with the help of orthotic devices: moleskin on blisters, heel cups to alleviate plantar fasciitis, metatarsal pads under the ball of the foot and arch supports in shoes, which are available over the counter or by prescription from a podiatrist or orthopaedist. The US army even issues foot powder and moleskin to soldiers to help them prevent foot fungi and treat blisters.

No doubt foot abuse will continue. "If everyone wore trainers, I'd lose half my business," jokes Dr Youner. But since trainers aren't acceptable, or fun, to wear at all times, she advises that women should limit the amount of time they spend in heels. She also suggests that after wearing heels, you do the "runner's stretch" to lengthen the Achilles tendon, with both hands on a wall and one foot extended behind you.

And if, on occasion, you want to feel like Cinderella at the ball, go ahead. "If you get dressed up and wear an excessively high heel, that's fine," says Dr Baglio. Just remember that the clock will strike midnight and, as he says, "we have to care for our feet, and they'll take care of us".