Fashion and Foot Deformation - RonJones.Org

Building YourFOOTWEAR PRACTICEFashion and FootDeformationThe need for podiatrists to deal with human nature.By William A. Rossi, D.P.M.Since its earliest days podiatry hasassailed fashion footwear for itshigh heels, pointed toes, tightfit, extremist styling, absence of support,etc. It has made an almost holymantra of such terms as “crippling”or “ruining” of the feet. As an alternative,it has recommended “sensible”shoes, with low, broad heels, roundor broad toes with high roof or box,Oxfords or laced up styles for “support”,firm shanks, roomy fit, etc.Generation after generation, thepublic, women especially, has largelyignored the warnings and recommendations.Women’s fashion footwearcontinues to outsell “sensible” shoesby at least 15 to one. This has frustratedthe podiatrists and orthopedistswho invoke another mantra,charging women with being “slavesof fashion” anddominated by“vanity.” Thisclears the medicalconscience by feelingit has fulfilledits professionalduty by warningthe public aboutthe health hazardsof fashion footwear.It is time for theseingenuous concepts of“fashion” andparticularly fashionfootwear to be exposedto the light of reality.This noblestance not only leaves the problemunsolved, but leaves the medicalpractitioners cocooned in their traditionalstate of innocence and unenlightenmentabout the foot/shoe relationshipof women.It is time for these ingenuousconcepts of “fashion”and particularlyfashion footwearto be exposedto the lightof reality. Some ofthe facts presentedin this papermay have a jarringeffect on traditionalviewsabout the foot/shoe relationship,especially as related to fashion. Butsometimes traumatic therapy is essentialto create a confrontationContinued on page 104Left, normal waist and rib cage; right, permanently deformedrib cage caused by habitual wearing of corsetsto conform to narrow waist fashion of 19th century.Stretched earlobes, common custom or “fashion” of Indo-Chinesewomen prior to the 20th century. Each set of brass rings piercingeach lobe weighs five pounds.www.podiatrymgt.com OCTOBER 2001 • PODIATRY MANAGEMENT 103

Fashion...intrudes on physical health. Fashionis usually presumed to be a shallowexpression of personal “vanity”—afickle plaything constantly evolvingto keep us amused and entertained.This, unfortunately, is a gullible, ingenuousview remote from the tangibletruths of human nature and everydaylife.Fashion plays an enormously influentialrole in our lives, often involvingand affecting our healthphysically, emotionally, psychologicallyand psycho-sexually. And thisapplies particularly to fashion footwear,as you will soon see. Fashionhas been with us since earliest civilization,even before, because it servesa vital role by feeding two of humannature’s most powerful motivatingforces: status and sex attraction.Clothing sociologist Rene Konigcomments, “To ask where the line isto be drawn between the naturaland the artificial is to ask invain...Fashion is what it is, grownentirely from its own roots; it embracesneither artifice nor nature,but only its own all-embracing lawof sex-attraction and status.”From the earliest times tribalchieftains and the upper caste familiesof any given society have dressedand ornamented themselves to lookdifferent from all the rest. This “tradition”applies today no less than inprimitive times. The reason: to establishvisible distinctions ofclass, rank, wealth and authority.Fashion is an insignia ofsocial caste, the indelible imprimaturof status. It is theideal instrument for this becauseit is so visible. And it apwiththe untarnished facts of reality.The Function of FashionFashion has always been a misunderstoodand abused term by themedical fraternity, especially when itThe 19th century “bustle” skirtpadded with pillows to create illusionof large buttocks—a popular 19thcentury body form fashionplies today universally no differentthan thousands of years earlier.Some 10,000 years ago tribalchieftains wore stilts when addressingthe tribal mass. No other memberwas allowed to wear stilts. The stiltsallowed the wearer to “look down”on all the others, or require the othersto “look up” to the leader. One ofthe fundamental attractions of highheels throughout recent centuries isthat they increased physical stature,enabling the wearer to “look down”on others or have others “look up” tothem.In the late 16th century when thearistocracy of Europe, led by Catherinede Medici, queen-to-be of France,embraced the new fashion of highheels, some of the parvenu commoners,seeking to socially upgrade themselves,also adopted the high heels.The wealthy and aristocratic were incensedby this “invasion”. They had alaw passed prohibiting anyone belowthe 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, himselfadopted the high heels to assumestature equal to or above that of thewomen. Soon, all the courtiers, alongwith the aristocracy, were sportinghigh heels. Determined not to be outstaturedor out-statused by thewomen, they squeezed their feet intothe same fragile, precarious footwear.In the 17th century a new footwearfashion called “startups” appearedand was quickly adopted byelitist society. The startup consistedof a shoe with a cloth or leather leg-Continued on page 105Traditional geta or platform shoe of Japan,centuries old and still worn today.Versions of the chopine, an exaggerated platform shoe varying from 6to 30 inches in height. Popular women’s fashion of 14th and 15th centuryEurope.104 PODIATRY MANAGEMENT • OCTOBER 2001www.podiatrymgt.com

Fashion...ral shape of the shoe, the deformedfoot and shoe themselves became amark of status.In Colonial America, underBritish rule, the following law prevailed:“Citizens of common class, orbelow the rank of gentry, are prohibitedfrom wearing boots or shoes ofsatin cloth or ribbons, or of brightcolors, or shoes with stilted heels. Allsuch footwear is a markof rank and privilege.Those of lesser classwho attempt to emulatethose of stationsabove by their attirewill be considered in violationof His Majesty’slaws and subject to fineor jail or both.”Body DeformationDarwin wrote “Manadmires and often triesto exaggerate whatevercharacteristics naturemay have given tohim.” Fashion, thereging,lavishly ornamented, to attractattention to women’s legs. Again,true to human nature, some of themore ambitious commoners adoptedthe startup style. They were quicklyassailed by the elitists who gave thename “upstarts” to these social impostors—aterm still used today withthe same meaning.Because status is such an innate,deep-rooted drive of human nature,and because fashion is so visible, conspicuousdisplay becomes an essentialinstrument of fashion. We assume,for example, that pointed-toe shoesare “modern” fashion. But they dateback 3,000 years to ancient Egyptwhen upper caste women wore themto make the foot look smaller andmore slender to distinguish it fromthe wide, splayed feet of commonfolk and slave women who toiled inthe fields. Thus fashion, via thepointed-toe shoes, was used as a markof class and status. Because the footwas required to adapt to the unnatufore,is an opportunity to correct orcorrupt nature’s bare facts.The fundamental nature of allfashion is to reshape the body form,whether actual or by illusion. Theupper castes of society need to keep apace ahead of all the rest to maintainan unbridgeable social chasm of classdistinction. So when the commonContinued on page 106Men’s platform shoe of 1970s, with 2-1/2-inch heel.Normal gait is severely altered with such footwear.www.podiatrymgt.com OCTOBER 2001 • PODIATRY MANAGEMENT 105

Fashion...class begins to copy and emulate thefashions of the elitist group above,the latter move on to a new fashion.That is why members of the rich andelitist class have traditionally beencalled “fashion leaders”. They are notso much seeking to lead as to escapebeing associated with the commonclass. We humans have always believedthat Mother Nature somehowfell short in designing the ideal imagefor our body and its parts. We havespent most of our many centuries onthis planet trying to correct Nature’smistakes. Each new generation has itsown ideas of what the new shapesshould be—which largely accountsfor the constant evolution of fashion.German psychologist and clothinghistorian J.C. Flugel states, “The finalform of body decoration is body deformation.It is the crown jewel ofpersonal status and sex attraction.”In 1999 over 100,000 Americanwomen underwent snip and tuck cosmeticsurgery to alter and “correct”the shape of some part of the body toenhance self-image (status) and sexattraction at a cost of $30 billion. OrthopedistMichael J. Couglin, formerpresident of the American OrthopedicFoot & Ankle Society, has performednearly 3,000 major foot surgeries,He estimates that Americanwomen spend $3 billion per year forcosmetic correction of hallux valgus,bunions, hammer toes and neuromasalone—conditions caused mostly byshoes.When the “new look” of fashionconcerts into a permanent deformationof the body or one of its parts,we often have a serious health problem.In the late 1900s the GibsonGirls with their extremely narrowKeep in mind thatall fashion or dressfootwear is designed notfor the natural,unspoiled foot but forthe already deformed,shoe-shaped foot.waists became the ideal body formand dominant fashion. This wasachieved by distressingly tight-fitcorsets that created a narrow waist,flared hips and full bosom—togetherthe contemporary ideal. It was commonfor women to experience faintingspells in public, caused by theconstriction of the tight corset. Theconstant wearing of the corsets reformedand often permanently deformedthe rib cage,imposing serious pressureson the chest andabdominal organs.Nevertheless, somewomen even had one or two lowerribs removed surgically to enablethem to wear even smaller or tightercorsets for an even narrower waist.Any woman who appeared in publicuncorseted was labeled a “loosewoman,” meaning uncorseted andhence of questionable morals.Despite the many warnings ofphysicians and the many articles appearingin newspapers and magazines,all citing the hazards and dangersof corsets to the health ofwomen, corsets lost none of theirpopularity. The only thing that hadthe power and influence to cause thedemise of the corset was a major shiftin the fashion cycle that proclaimedanother “new look.”In the early 20th century the longhobble skirt became the dominantelitist fashion. The skirt tapered downfrom the hips to the ankles to givethe lower half of the body a coneshape. It was impossible to take a fullstep or natural stride. The wearer wasforced to “hobble” with tiny, precarioussteps. The constricted gait becamepart of the elitist-look fashion,indicating that women could affordthe leisure to walk slowly.But such fashions are relativelymild examples. Severe forms of bodyContinued on page 107Modern platforms, 1990s. Foot is largely immobilized in gaitwith no foot flex action.Leg-hugging boots constricting lower limb blood flow.106 PODIATRY MANAGEMENT • OCTOBER 2001www.podiatrymgt.com

Fashion...deformation for status and sex attraction are found in allcultures throughout all history. And in most cases the deformationsare permanent. Examples: front teeth filed topoints, or plated with gold or silver; pendulant breasts ofyoung women stretched long enough to be slung overthe shoulder and strapped to the back; the stretched lipsof the Ubangi tribe women, resembling dinner plates; thepointed heads, reshaped from infancy, of the aristocraticfemales of ancient Egypt, a visible status symbol demonstratingthey were not common water carriers; the extremelylong fingernails of upper caste men of China, extendingas much as 20 inches, indicating the owners werenot of common manual labor class; permanently pluckedeyebrows and eyelashes of the women of Indonesia;stretched earlobes reaching the shoulders; among manyAfrican tribes, permanent body scarring or other decorativebody disfigurements; nostrils or cheeks pierced withfive-inch stems of bone.The upper caste of women of Burma wore a pyramidof heavy metal rings that permanently stretched the neckto twice or more its normal length; or heavy metal legrings weighing up to 50 pounds, permanently shrinkingthe legs and making normal gait impossible—a visiblestatus symbol indicating the luxury of leisure and membershipin the elitist class; the common practice of circumcision;and in parts of the Middle East and Africa thepractice of forced clitorectomy of young girls; the universalpractice of tattooing, which has ancient origins, issimply another form of body painting and scarring. Theliterature is rich with hundreds of such examples of bodydeformation.But such practices, you may say, are associated withprimitive cultures of times past. Not so. They are as contemporaryas ever. Here in America, as well as in Europe,the current practice of body piercing is seen even amongthe young: visible needles or long pins pierced and wornon tongues, cheeks, ear lobes, eyelids and eyebrows, nostrils,neck, arms, nipples, navels and elsewhere. All areworn as cult status symbols and insignia to identify oneas a member of a select society or lifestyles apart from themass or common class.States Enid Schilkraut, curator of New York’s Museumof Natural History, “Everybody, everywhere, does somethingto their body to alter its shape of look. Why? Tocommunicate who they are or wish to appear to be. Thesame principal applies to the sophisticated New Yorker asto the Australian aborigine living in the bush. The lattercalls it custom. We call it fashion.”We speak proudly (and often smugly) of being “indi-Continued on page 108Left, pointed toe sandal of ancient Egypt; right, popularpointed toe styles of late 19th century; bottom, modernpointed toe.www.podiatrymgt.com OCTOBER 2001 • PODIATRY MANAGEMENT 107

Fashion...viduals” with a mind of our own.That’s often a presumptuous stance.To the contrary, most of us, consciouslyor unconsciously, conformto the contemporary “fashion” orlife-style. And if the fashion decreessome kind of body deformation, actualor illusory, we go with the flow soas to fit in with the current mode andfeel a sense of “belonging”. Art isnever a duplication of nature. Theartist reshapes and redesigns the originalto his own vision and perspective.Fashion, a form of art, does thesame with the human form—andfootwear fashion with the foot.Foot DeformationOf all the body’s parts the foothas long been perhaps the mostcommonly and consistently subjectedto deliberate deformationanatomically and functionally—allof it under the guise of “fashion”.And our shoes, from very ancienttimes, have been the prime instrumentof pedic deformation.The bound foot custom of Chinabegan 1,000 years ago and continuedfor a millennium. The foot-shrinkingprocess started at about age five or sixwhen the foot was soft and malleable,and continued to early maturity,at which time the foot wasgrotesquely misshapen and shrunkento doll size. Theyoung boundfootwomen had nowachieved elitist status,joining the otherboundfoot womenwho were regarded asthe sex goddesses ofthe culture. Thegrossly deformed“lotus” foot was nolonger natural, but anobject of the supernatural,in the realmof the divine. Eventhe fragile, precariousgait, known as the“willow walk” becausethe body balancewas so delicateand swayed like a willowin the breeze, becamea symbol of sensualstatus.The long historyof footwear reveals a grotesque arrayof boots and shoes whose shapes andforms have veered sharply from thenorm of foot shape. The “chopine”fashion of the 14th century was thedominant mode of the upper castewomen of Europe. This was an extremistplatform-type shoe ranging inheight from six to 30 inches. A naturalstep on them was impossible. Thewearers often required a maid on eitherside to ensure balance and security.The higher the chopine, thehigher the status of the wearer. Therewere constant dangers from falls, andnumerous miscarriages from fallswere reported. In 1324, Venice, thenan independent state, passed a lawprohibiting the wearing of chopineshigher than six inches. The law wasignored.The platform shoe itself datesback to the sixth century BC, introducedby Aeschylus, the Greekdramatist, who used it for his actorson stage. The higher the platform themore important the actor and hisrole. Hence platforms began as statusshoes. They have continued throughoutthe centuries to the present day.All platform shoes are functionallyfoot-deforming, especially if frequentlyworn. A natural gait is impossiblewith them, and the foot itself actsmore hoof-like than the flexibleorgan it naturally is. Nevertheless, becausethey add body height andContinued on page 109Pump fashion 1999, with pointed toe and sleek silhouette for “aristocratic” slender-footlook.Deformed position of toes inside shoewith pointed toes and faulty last.Pointed toe fashion of 11th century108 PODIATRY MANAGEMENT • OCTOBER 2001www.podiatrymgt.com

Fashion...hence status value, they retain theirpopularity century after century.In the late 19th and early 20thcenturies women’s laced and buttonboots were the dominant fashion. Itwas also the era of “trim ankles”, asex symbol of the times. Manywomen wore their boots so tightlylaced or buttoned that their anklesshriveled to half their natural size tobecome permanently atrophied anddeformed. The irony was that the deformedankles, much like the shriveledfoot of the boundfoot Chinese,became a prized sexual asset.In 1971, Dr. Paul Steele reportedin the Journal of the American MedicalAssociation about the rising incidenceof what he called “boot legphlebitis” caused by the wearing ofpopular knee-high, leg-hugging fashionboots, especially by youngwomen. Dr. Steele warned that theblood constriction in the legs and theresulting phlebitis could be fatal. Themedia publicized this report. But notthe slightest dip in boot sales occurred.For status and sex attractionwomen made it clear that they werewilling to die with their boots on.Women frequently say “I loveshoes” They rarely use that expressionwith such consistency about anyother 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 onlyto the pretty “fashion” shoes. Whichis why we refer to such women as“shoe freaks”—the tens of thousandsof women who own 100 or morepairs and continue to buy more ofthe very shoes that give them themost distress.There is a significant messageseeking to get through here: Fashionis not a modern invention. It hasbeen with us since the earliest civilizations.There is no mystery or“mystique” about fashion. Nor is itflighty or frivolous or fickle or shallow.And least of all is it associatedwith “vanity”. It is, instead, a vitalforce of human nature and essentialto our state of well-being and selfimage.To be “properly dressed”means to be dressed in the currentfashion to suit the occasion. Andperhaps the single most importantrole of fashion: It must reshape anddeform the body or some particularpart of it, actually or in an illusorymanner. Further, if achieving the“new look” requires some physicaldistress, that is acceptable. The hurtis tolerable. This applies especiallyto women. It is a simple quid proquo arrangement: the personal gratificationrewards of new form fashionin exchange for a tolerableamount of distress.Female Masochism and“Pedalgolagnia”An understanding of fashion-relatedfoot distress demands an understandingof the psyche of femalemasochism. Without it, full-fledged“foot doctoring” falls short of maximumlevels of diagnosis and thera-Continued on page 110www.podiatrymgt.com OCTOBER 2001 • PODIATRY MANAGEMENT 109

Fashion...This psychological or psychosexualreality, nevertheless, is little understoodby podiatrists, orthopedists andother foot-related professionals. Understandingthe psychology of fashionis really an insight into the psychologyof algolagnia and pedalgolagniaand their close link tomasochism—physical pain bornewith sensuous pleasure.We tend to associate the painpleasureprinciple with the S-M cultureand the nether world of sexualextremisms. But, to the contrary,masochism is an everyday fact of life,particularly with women when associatedwith fashion. British psychiatristand sexologist Clifford Allen,M.D., states, “Masochism in womenis more a way of life than a neurosis.”New York psychologist BernardRudofsky, who has written extensivepy.Psychotherapist Seymour Fisherwrites in his book, Body Consciousness,“Women seem to tolerate verywell any physical distress caused byrevisions of body form if it is donewithin the framework of social approvaland admiration. Such practicesare not only tolerated but eagerlysought after in the name of‘fashion’.”The medical term “algolagnia”combines the Latin algo (pain) andthe Greek lagnia (pleasure). Togetherthey become pain borne with pleasure—aform of masochism. And herewe can coin a fresh and appropriateterm: pedalgolagnia, or foot distresstolerated with a subliminal pleasure—aneveryday condition experiencedby tens of millions of women.ly about the link between fashionand masochism (The UnfashionableHuman Body) etc., writes, “Physicaldistress is accepted by women if it is aconstitutional part of the pleasure ofcourtship and mating....Women willfuriously defend their High heels becauseany distress to their feet is in itselfa form of attraction for men,many of whom feel it is a sacrificemade for them.”A woman, returning with herhusband from an evening on thetown, kicks off her pretty shoes andrubs her feet for relief. Her husbandshakes his head and says, “Why doyou wear those pinchy shoes and sillyheels?” She replies, “The shoes arefine. It’s my feet that are killing me.”Artist Andy Warhol got his startin New York sketching and designingContinued on page 111Flesh view of Chinese bound foot.Left, Chinese bound foot; right, skeletal view with shaded area showing shardbowingSkeleton foot in modern high-heel shoe with anatomical position (right) much like that of Chinese bound foot.110 PODIATRY MANAGEMENT • OCTOBER 2001www.podiatrymgt.com

Fashion...women’s fashion shoes. He once said,“Women would be unhappy withouta little masochism and a noble senseof suffering as a ‘sacrifice’ for theirmen. So we designers try to incorporatea little sacrificial discomfort intothe fashion shoes we design forthem.”Women’s earrings will frequentlypinch and hurt the ear lobes aftera few hours of wear. Women simplyremove them until the hurt eases.They do the same with their pinchyhigh-heel shoes, kicking them offunder the table for temporary relief.But they would no more give upwearing their tight shoes and highheelsthan their earrings. It is theeternal love-hate relationship thatwomen have with their fashionfootwear, as much as they sometimesdo with their husbands.None of this seems logical. Butlogic plays no role in the masochismof fashion or in other forms. How dowe explain the Hindu holy man whospends a lifetime sleeping on a bed ofnails? Or other holy men who constantlywear sandals foot-bedded withnail points into the foot’s sole? Pain?What pain? It is, instead, the experienceof spiritual ecstasy. You may callIn any shoewearingsociety it is asimpossible to finda fully naturalor normal male footas it is to finda comparablefemale foot.it mind over matter. But it may alsoexplain the same underlying principleas masochism or algolagnia.The slow, inexorable process offoot deformation begins in infancywith the first shoes and continuesthroughout adulthood. The infantwill repeatedly try to pull the shoesoff 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 thelaces and double-knot them, furtherconstricting blood flow to the foot.Meanwhile, the shoe itself, becauseof its too-thick or heavy sole,forces the child to walk with unnatural,pancake-like steps. And the shoeupper, usually much too heavy, compressesthe natural, prehensile movementsof the toes and foot. Further,within four-five weeks the shoe isusually outgrown, adding to the constrictionof natural growth—evenwith the initial “grow room” allowance.The infant’s foot is undergoingthe “breaking-in” process, on itsway to assuming the deformed, “civilized”shape.The deformation of the Chinesebound foot began at about age five orsix, when the bones and joints werenot yet fully developed and the footwas pliable and malleable. The ban-Continued on page 112www.podiatrymgt.com OCTOBER 2001 • PODIATRY MANAGEMENT 111

Fashion...dages at first were mildly applied, then became increasinglyconstrictive as the child grew older. Hence whilethe child felt some annoyance with the first constriction,there was no pain or distress. And soon the child felt thatthe bound foot state was the norm.This very same process in principle happens withmost children in the shoe wearing societies. From infancyFeet of six-months-old infant not yet in shoes. The dexterous,prehensile toes will soon be tamed and immobilizedwhen shoes begin to be worn.Children’s shoes. Thick, inflexible soles, heels 1 – 1-1/4inches in height, heavy leather uppers low in conformability,laced uppers corseting the foot. Yet such shoes aremedically recommended as “proper” for the growing foot,which is destined to become anatomically and functionallyhandicapped.the child rarely feels any foot distress from the shoe andbecomes adapted to the hampered gait and constrictionsof the shoe. It assumes that whatever is happening to itsfeet and gait is normal.Traditionally, the makers and seller of juvenile footwear,infants into early teens, promise and promote thetheme of “helping the child’s foot to grow strong andhealthy” and to “develop in nature’s way”. This, ofcourse, has been totally untrue; promise without delivery.The anatomical and functional difference between achild’s shoe-wearing foot and a child’s foot that has neverworn shoes are enormous. Unfortunately, the podiatristcannot discern this because he/she never sees a “natural”foot and hence can make judgements only by comparingone unnatural (deformed) foot with another.What are the specifics about juvenile footwear thatmake normal and natural child foot development impossible?To cite a few of the more common ones: Soles thatare too thick or heavy and prevent full foot flexion; tractionsoles (the majority of juvenile footwear today) thatcreate “turf toe” and deform the toes; laced shoes, all ofwhich, to varying degree, constrict blood circulation tothe foot; shoes too heavy; non-conforming uppers(leathers unnecessarily thick or heavy); faulty lasts thatcreate foot/shoe dimensional and shape conflict;“heeled” shoes which alter the natural 180 degree flatplane of the foot (no child’s shoe should have an elevatedheel of any height); hostile inside-shoe climate and thermalconditions among others.A century or so ago the life of a child’s foot was highlyhazardous, especially under city life conditions. Manyfamilies struggled to survive economically, especially thelarge families common to the era. These were the times ofhand-me-down shoes within families, or when outgrownshoes continued to be worn because there was “still goodwear left in them”. The growing feet of many childrenwere severely handicapped upon reaching maturity.The children of rural families were more fortunate.They were equally poor, but living in isolated areas theycommonly went barefoot. But when these same farmchildren with healthy deformity-free feet reached maturityand migrated to the cities, they donned shoes and thefoot -deforming process began. It became the time of lostpedic virginity. The abrupt switchover from barefoot toshoe wearing at maturity became a severe ordeal. Graphicexamples of this are on record.When South African natives were “exported” fromthe interior to work in the diamond mines near Johannesburg,they were furnished with the required miner’sboots. The boots so compressed and distressed the pristinenative feet that the natives rebelled. But martial lawprevailed and they were forced to wear the boots despitesevere pain. But over the succeeding months the paingradually subsided as the feet acquired deformed shapematching that of the boots. Like newly captive horses,the feet were “broken in” and made submissive. Civilizationhad triumphed over nature.During World War II, the British drafted the Sikhs ofIndia into the British army. The barefooted Sikhs hadlong been famed as fighting men. They were assignedBritish uniforms, including the regulation boots. DuringContinued on page 114112 PODIATRY MANAGEMENT • OCTOBER 2001www.podiatrymgt.com

Feet of 9-year-old Uganda boy unspoiledby shoes. Note straight toeswith spaces between. Low arch is geneticand fully functional.Fashion...training routines the foot casualtyrate skyrocketed, disabling most ofthe Sikhs whose feet could not adaptto the boots. The British were forcedto concede, allowing the Sikhs to returnto the barefoot state. The Sikhswent on to post a remarkable recordfor valor in military performance duringthe war.Similar experience happened inthe U.S. Army during World War II.Some of the young recruits or drafteesfrom the rural or mountain regions ofstates like Arkansas, West Virginia,Tennessee and Kentucky arrived atthe registration centers barefoot, asthey always had been since childhood.When they arrived at the trainingcamps they were assigned uniformsand boots. But despite numerousand patient fitting trials, theboots and feet were hopelessly mismatched.Throughout the trainingTop Left, Natural foot of shoeless native. Note spread of toes. Right, Footprint ofshoeless native. Note natural spread pattern of toes. Bottom, View of same foot.exercises and marches many of theserecruits became severe casualties,their feet badly bruised, swollen andin excruciating pain. The numerousextreme cases were given medical discharges.There is a pronounced differencebetween crippling and deformation.Crippling is physical disabling; a permanentlaming that prevents full andnormal functioning. Deformation is abody disfiguring or altering usuallyself-imposed, of normal or naturalshape and appearance, though seldomdisabling.Has fashion “crippled” or “ruined”our shoe-wearing feet? Theseare extremist labels. The shoe-wearingfoot clearly has been dramaticallyreshaped and deformed by our shoes,yet most people assume they have a“normal” foot. And, disturbingly,even most podiatrists assume that theaverage shoe-wearing foot, free of anydistress or visible lesion, is normaland with natural form. Thus the ironicreversal of standards: the abnormalbecomes the norm, the unnatural thenatural.Foot ills are rarely fatal. Even themost severe ones are not life threatening.This has seriously handicappedpodiatry’s efforts to educatethe public about foot health and footcare. This applies especially toyounger people under 25 years. Theylook at their mothers and grandmotherswho wore the fashion shoesof their day, yet escaped any “crippling”consequences. They concludethat the risks are minimal. And whenthe risks are measured against the numerouspresent 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 surveyby Carol Frey, M.D., chief of theFoot and Ankle Care Department atthe University of California, and involvingseveral hundred women,found that 80 percent were wearingshoes one to three sizes too narrow.According to shoe industry surveysbased on responses from shoestores, two-thirds of women’s shoesales are on B or “medium” width.That is absurd. An estimated 52 percentof women’s shoe stores and departmentscarry only one width, B, inwomen’s dress shoes. Another 37 per-Continued on page 115114 PODIATRY MANAGEMENT • OCTOBER 2001www.podiatrymgt.com

Fashion...of “industries” providing productsand services promising relief, remedyor even cure. Yet the incidence offoot ills has not changed in a century.It is frequently contended that ifwomen wore “sensible” shoes theproblems of foot deformation andfoot distress would be largely reduced.This is more illusion and assumptionthan reality. Manywomen with conservative tastes andlifestyles have for most of their livesworn so-called “sensible” shoes, yetmany have experienced the sameproblems as the wearers offashion/dress footwear.It is an established fact: all footcentoffer two widths (out of a “standard”run of 12 widths, AAAAA toEEE). So it’s inevitable that if storesare asked what is their best-sellingwidth, it will be B—which will be amisfit for at least half the women.Keep in mind that all fashion ordress footwear is designed not for thenatural, unspoiled foot but for the alreadydeformed, shoe-shaped foot. Ithas become the captive serf of theshoes. It frequently winces and sometimesagonizes from the abuses of itsmaster. And from this constant mistreatmenthas risen a huge complexwear—sensible, dress/fashion orother—is designed for the deformed“civilized” foot, not for the natural,normal foot. A shoe designed for thenatural foot would not suitably fit the“civilized” foot, and vice versa.Men Are Not ExcludedWe usually associate “fashion”with women and “style” (a moreconservative version of fashion) withmen. Hence we assume that men aremuch less exposed to foot ills. Statisticswould seem to bear this out.,with women visits to podiatrists outnumberingthose by men four toContinued on page 116Foot of 80-year-old Japanese woman who has wornonly the traditional simple zori sandal all her life.Male vanity surpasses that of women. “Bastard”boot with ornate, colorful lace-lined top, a popularfashion with male dandies of 15th and 16th centuryEurope.Men’s pointed-toe shoes. Top, 13 century; center, 19th century;bottom, 1970s.www.podiatrymgt.com OCTOBER 2001 • PODIATRY MANAGEMENT 115

Fashion...one. This would seem to indicatethat men are much more “sensible”about their footwear. But the onlyfundamental difference betweenmen’s and women’s footwear is theheight and design of the heel. Otherwisethe male foot is as much a captiveof the shoe as is the female foot.Shoes made on common faulty last design. Runover effectclearly reveals conflict between foot and shoe with consequentfoot deformity and functional impairment.In any shoe-wearing society it isas impossible to find a fully naturalor normal male foot as it is to find acomparable female foot. The toes ofthe male shoe-wearing foot have lostas much as 60 percent of the naturalprehensibility. Though not as frequently,men nevertheless developbunions, hallux valgus, hammer toes,nail lesions, heel and arch problems,etc.—and quiteaside from sports orwork injuries of thefoot. Just as withwomen, the footdeforming processof men begins ininfancy. By age 12or 13 the boys’ feet,like those of thegirls, have lost theirnatural form andfull functionality—a process that willintensify throughthe adult years.The differencein heights andstyles of heels in men’s and women’sshoes does not allow escape from footdeformation for the male foot. Men’sshoe heels are usually one inch inheight, though heights of 1-1/2 – 2-1/2inches are not at all uncommon. Buteven a one-inch height alters thefoot’s natural 180-degree flat planeand affects tread and gait. Most menwear laced footwear, which keeps thefoot constantly “corseted” and inevitablyaffects foot circulation(women’s feet, by contrast, usually escapethe corset effect and permitfuller circulation and foot freedom).The corseting of men’s laced shoesalso restricts the functional freedomof the arch and the natural exercisingof the tarsal/metatarsal joints. Men’sshoes often have the same pointed ornarrow toes as women’s shoes. Andthe shoes are much heavier, withheavier, less comfortable leathers.They also have rigid shanks, restrictingnatural elasticity of the arch. Thesoles are heavier, more rigid, andhence less flexible. The shoes areContinued on page 117116 PODIATRY MANAGEMENT • OCTOBER 2001www.podiatrymgt.com

Fashion...imagination of the shoe designers.Now comes a surprise. Of thoseseven basic shoe styles—the oldest ofwhich is the moccasin dating backsome 14,000 years, and the youngestbeing the oxford dating back some400 years—all were originally demadeon the same crooked, foot-conflictinglasts as women’s shoes. Aquick glance at a men’s shoe that hashad several weeks of wear will almostalways reveal a running over of theupper on the lateral border of theforefoot—clear indication that footand shoe are in anatomical and functionalconflict. And most men’sshoes, like most women’s shoes, arepurchased and worn with widths toonarrow for a “glove fit”—another aspectof corseting that prevents full expansionof the metatarsal span onweightbearing.Footwear fashion actually beganwith men, not women. Today, eachyear over a million “new” footwearfashions are introduced in the UnitedStates and Europe. But all are basedon only seven basic shoe styles. Styleand fashion are not synonymous. Astyle, from the Latin stylus, a pointedinstrument to draw an outline, is aone-of-a-kind design. A fashion is avariation or adaptation of a style.There are only seven basic shoestyles: the pump, oxford, boot, sandal,clog, moccasin, and mule. Themillions of shoe “fashions” thatemerge from the basic seven shoestyles is a tribute to the creativity andPodiatry has gravelyneglected the esthetics ofthe foot, the restorationof its natural beauty andsensuous character ofwhich all women areacutely aware.signed by and for men, not one by orfor women. That’s because in centuriespast women were subordinateto men in just about everything. Butbeginning in the 16th century withthe introduction of the high heel inEurope, women began to “feminize”shoe styles, which gave birth to footwear“fashion”, a burgeoning industrystill spreading its wings. It thrivesbecause of the innate female need forstatus and sex attraction, of whichthe “pretty foot” is an important partof the arsenal of provocative allure.Hence to attempt to invoke “commonsense” into this scenario is bothunrealistic and futile.CrossroadsBack to the main premise: the feetof all shoe-wearing people—men,women, children—are anatomicallydeformed and functionally deficientto some degree. The only natural or“normal” feet are those of shoelesspeople. Footwear and fashion haveseduced the foot and molded it to theContinued on page 118www.podiatrymgt.com OCTOBER 2001 • PODIATRY MANAGEMENT 117

Fashion...shoe’s own form. And if the shoes have abused our feet ithas been with our own permission and even our encouragement.We have submitted because the “new form” viafashion has pleased the eye, the emotions, the psyche,the sense of upgraded status and sex attraction. “TheDevil,” wrote Shakespeare, “hath a pleasing manner”.Podiatry, therefore, should cease referring to fashionfootwear as “crippling” and “ruining” the feet, andwomen being “slaves of fashion” and victims of “vanity”.Such terms are tired cliches that are both outmodedand unrealistic. As self-anointed reformers, the criticsof fashion are whistling against the wind. Womenwill have their cake and eat it too. They will have theirfashion footwear and tolerate the distress and deformitiesthat go with it.This, of course, ensures that podiatry has a long andpromising future, because shoe-abused feet will alwaysbe in need of medical care. Despite the fact that all thetechnology is already available to produce trouble-free,foot-friendly fashion footwear, it will never become acommercial reality. Such footwear would threaten theprime premise of fashion itself: to create a constant paradeof “new looks” by altering body shape. And in thissense the foot has long been a prime target because it isso easily moldable to make it appear smaller and moreslender and more sensuously provocative. Which iswhy we will always have shoes with pointed toes, slendershapes and high heels—and will always squeezeyour feet into shoes too small or narrow.Podiatry’s future as a medical need and a publichealth service is assured. Some 80 percent of all foot illsare shoe-related or shoe-caused. There is little likelihoodthat the footwear industry will change its centuries-oldtradition of producing attractive fashionshoes that deform and defunctionalize the foot. Hencethe essential need of podiatry serving as the medical repairmento fix the damages repeatedly done.It is like the economist who discovered the solutionfor full and permanent employment and prosperity forall. Half the population would be employed making andblowing up balloons, the other half sticking pins in them.The footwear industry and podiatry are perfectly matedwith a very similar symbiotic arrangement.But pedic medical repairing has its limits of personalgratification for the practitioner. After a while it becomesa matter of re-hammering and re-bandaging the same finger.Podiatry needs to spread its wings and apply its skillsand talents to new territories. And fashion provides podiatrywith a huge opportunity: the still-virginal field ofpedacosmetics via pedacosmetic surgery and dermatology.Except for a few specialists, this is a field begging forattention and development.Leonardo Da Vinci once wrote: “The human foot is awork of art and a masterpiece of engineering.” Podiatryhas largely dedicated itself to engineering—the mechanicsand therapies of foot repairing. But it has gravely neglectedthe esthetics of the foot—the restoration of itsnatural beauty and sensuous character of which allwomen are acutely aware. Throughout the many centuriesthe foot—especially the feet of women—has beenpraised and extolled in ballads, fable, poetry, story, painting,sculpture and other art forms. Women are constantlyreiterating this same message via their fashion footweardesigned to draw attention to the sensual attributes oftheir feet. They are using the foot and shoe as both a sexlure and a status instrument.Ironically, everyone seems to be aware of this exceptthe podiatrists. The message is further echoed by thehundreds of millions of dollars spent by women for overthe-counterproducts designed to “beautify” the feet,along with cosmetic services provided by pedicurists andothers. Cosmetic surgery and dermatology is a multi-billiondollar industry with physicians. For podiatry, aminiscule amount. We read and hear about all kinds ofcosmetic therapy applied to all parts of the body—butvery little about the foot. What is obviously needed is thedevelopment and public exposure of the medical specialtyof pedacosmetic surgery and dermatology. If womenare so obviously foot-aware from an esthetic, sexual andstatus standpoint, they will quickly take notice if alertedto the availability of medical services focused on restoringthe natural beauty of the foot.We can coin another term: pedoesthetics. It belongs inthe everyday terminology of podiatry and is waiting for thepedacosmetic surgeons and dermatologists to bring it tolife. It may be argued that pedacosmetic surgery and dermatologyare not “essential” segments of podiatric practice.Quite to the contrary. For generations women have soughtthe idea of “pretty feet”, which automatically makes it essentialfor women. The M.D.’s, along with the dentists,have made cosmetic surgery essential and respectedbranches of their professions. Podiatry is the last holdout.Footwear fashion is going to be with us far intothe future. And soare the consequentfoot deformitiesand estheticscars. Whatwomen are waitingfor is the opportunityto restoretheir prettyfeet to match theirpretty shoes. ■The author, ashoe industryconsultant, haswritten eightbooks and over400 articles, includingextensivearticles on leatherand footwearin EncyclopaediaBrittanica.118 PODIATRY MANAGEMENT • OCTOBER 2001www.podiatrymgt.com