Fifteen years ago, Andrew Goldberg would have rejected the idea outright. He believed that most foot problems were inherited and that shoes played little role in causing long-term damage. That view changed after he began examining detailed 3D scans showing how feet behave inside footwear.

Goldberg, a consultant orthopaedic foot and ankle specialist at the Wellington Hospital in London, described in The Guardian how comparing scans of the same person standing barefoot and then in high heels transformed his thinking. The difference was immediately clear. In heels, the toes were pushed tightly together, the big toe angled inward to form a bunion, and the smaller toes curled into a clawed position as they tried to maintain balance.

While such changes may appear temporary after a short period of wear, prolonged use can lead to lasting damage. Goldberg explained that wearing heels for several hours each day over many years encourages the foot to adapt permanently to that distorted shape. Soft tissues stretch, toes stiffen into unnatural positions, and conditions such as bunions, hammer toes and, eventually, wear-and-tear arthritis can develop.

The influence of footwear is not limited to high heels alone. As Goldberg noted in the report, all shoes affect foot shape to some degree by gradually narrowing the foot and drawing the toes closer together. Tight or pointed designs make the problem worse, and many people unknowingly wear shoes that are too small.

For those who regularly wear heels, Goldberg recommends simple daily exercises to counteract the strain. Picking up small objects with the toes or walking barefoot on tiptoes for a short time can help keep the feet flexible and strengthen supporting muscles.

Moderation, he stresses, is the most effective safeguard. Wearing heels occasionally for social events is unlikely to cause serious harm. Problems arise when they are worn all day, every day. The aching feet many people experience at the end of an evening, he says, are a natural response to the sustained stress placed on the foot.