Is there an adult female who doesn't shudder at the story of Chinese women having their feet bound in childhood to conform to an idea of beauty that horribly deformed them?
Along with that story has always come the implication that we're more civilized because we don't do that.
Now comes a national survey by a group of orthopedic surgeons that charges we're not so pure after all. Its main finding: Shoes are responsible for the majority of foot deformities and problems that physicians encounter in women.
"It's a real problem; shoe wear has its impacts on women's feet," says Seattle's Dr. John E. McDermott, incoming president of the American Orthopaedic Foot and Ankle Society, the study's sponsor.
It's also a problem that results in women being by far the majority of patients visiting orthopedists with foot complaints, McDermott says.
Some 80 percent of the study's 356 women reported foot pain. Count their agonies: bunions, hammertoes, pinched nerves, corns and calluses.
And all this from individuals, ages 20-60, who reported no previous foot trauma or surgery and no medical conditions that may affect foot health, like arthritis or diabetes.
"There's always been a lot of suspicions and accusations that women's footwear causes a lot of problems, but there were no studies to back up those accusations," says the report's primary author, Dr. Carol Frey, a professor at the University of Southern California School of Medicine.
Although Frey denies feminism was at work, she does acknowledge that the six physicians who took part were women and "biased from the start," she jokes.
The study found enough blame to go around, spreading it among shoe manufacturers, retailers, and women themselves.
To begin with, when doctors measured the subjects' feet, they found 88 percent were wearing shoes too small. But the problem wasn't in the length so much as the width. While the average woman in the study said she was an 8B, in fact she was an 8C.
The crunch comes when women try to find dress shoes that fit their heel snugly but leave room for their toes. Although most women have narrow heels, manufacturers commonly give wide shoes wide heels.
"For a shoe to give support or help, it has to give you heel control," McDermott says. To get this, many women buy shoes too tight across the base of their toes.
In addition, shoe manufacturers commonly buy their dress-shoe lasts the form upon which the shoe is modeled in Asia, where women have narrower feet. The result is a slender shoe, which manufacturers believe U.S. women find more appealing.
Style also conspires to cause problems. Is there a woman alive who hasn't painfully regretted buying a pair of cruel shoes, those high-heeled killers that thrust her weight into pointed toes?
"The shoe should be longest at the great toe not in the center of the shoe," McDermott says. "That's one of the big problems of design. The big toe is pushed over toward the other toes by the shape of the shoe, and you end up with a deformed foot."
According to McDermott, high price doesn't necessarily buy better-fitting shoes because big bucks often equate to a stylishly higher heel and more pointed toe. Nor will flats guarantee against damage.
Commonly this damage is done gradually, over years and sometimes painlessly, resulting in a bunion at the base of the big toe, a misshapen big toe, and smaller toes that have clawed under and developed calluses on top. These are called hammertoes.
"Women start having problems in their 20s and 30s," McDermott says. "Then we see them in their 40s and 50s when their big toe slips out of place and they need surgery.
"If you have a serious problem, it's hard to get over it," he says. "Bunion surgery is very difficult; there are about 10 ways to do it. Doctors see bunions recur all the time, especially with women who wear ill-fitting shoes after surgery."
Men rarely have these problems, study physicians found, because their shoes conform more naturally to the shape of their feet, and are generally better made of higher quality materials. Thus they get more support and cushioning, especially important when walking on hard surfaces.
The average American woman owns 15 pairs of shoes and expects to replace dress shoes after about a year. Men, on the other hand, wear theirs three times as long.