IN the USA, women are reportedly forking out thousands of dollars on foot surgery, having toe bones removed or sculpted so they can squeeze into "sexy" open-toed high heels.

Foot experts in the UK fear it can only be a matter of time before the trend reaches here - where Posh Spice is already said to be developing bunions (enlarged, painful toe joints) through her liking for fashionable footwear.

It must be one of the great ironies of life that, despite all the advances of feminism over the last 40 years, early 21st century shoe designers are still trying to force women into footwear that is not only uncomfortable, but also potentially damaging to their health.

High heels undoubtedly elongate legs and create the illusion that the feet are smaller, but they also throw out the natural alignment of the body. In high heels, women have to take smaller steps for stability, producing what one American podiatrist (chiropodist) memorably describes as the "bondage gait".

Big heels also make the lower legs look more shapely, but over a period of a few months, the calf muscles shorten, causing discomfort when the wearer reverts to flatter shoes.

Nikki Grenville-Cleave, a senior podiatrist with Bournemouth Primary Care Trust, said: "Shoe manufacturers insist that people want high-heeled, very narrow shoes, so they make them, but you can't buy a more sensible type of shoe, especially for the younger generation.

"Feet have got wider and bigger with the generations but shoe manufacturers seem to be a bit slow in catching up."

She admitted that wearing high heels occasionally should not cause too many problems, but warned: "It's not something we would encourage on a regular long term basis, particularly with young feet, because they are so easily damaged."

FOOT FACTS

Early Greek and Oriental actors used platform shoes so the main character would be taller than the supporting cast.

In 16th-century Britain, male dandies wore very pointed shoes to show their higher social position.

Upper class Chinese women used to have their feet bound so they could wear tiny shoes.

Women suffer from 80 per cent of foot problems.

Seventy per cent of women at 60 will have some arthritic changes because of footwear damage.

Among foot problems that can be caused or made worse by footwear are corns, callouses, bunions, claw and hammer toes, Achilles tendonitis, bone spurs and neuromas, where a nerve is pinched by wearing tight shoes.

Nikki runs children's clinics and sees an increasing number of problems relating to footwear. "Children grow up so much more quickly these days and are much more impressionable with fashion from an earlier age," she said.

"They're getting toes that are crossing over because they are forced into abnormal positions; and tight muscle groups from wearing high-heeled shoes that cause aches and pains in their legs and feet.

"The higher the heel, the less stable the ankle joint and the more likely people are to sprain their ankles. As they go up on a high heel, the centre of gravity shifts. They end up sticking their bottom out and their shoulders forward. They can end up with back, shoulder and neck ache which affects the ankles, knees and hips."

She stressed the importance of buying shoes that fit properly and are comfortable from the outset. "You shouldn't ever have to wear shoes in. If they don't feel right, don't get them. They shouldn't rub, feel tight or slip off the heel. A leather upper is better because moisture can evaporate."

Completely flat shoes are not recommended - ideally they should have a heel of half an inch to an inch to help absorb the shock of walking on hard surfaces such as pavements.

Nikki advises adults to have their feet measured professionally at least every two to three years. "Feet tend to get slightly larger as you get older. They tend to lengthen and possibly widen a little bit," she said.

But she emphasised that the measurement should only be used as a guide, as the size you will need will depend on the style and make of shoe. Slip-ons, court shoes and flip-flops are not recommended as you have to claw your toes to keep them on.

"The ideal is a trainer-type shoe, with a thick comfortable sole, soft inner sole and rounded toe box to fit all the toes in sufficient depth as well as width," said Nikki.

"The best time to get shoes is mid-afternoon, when your feet have expanded a little bit, and there should be enough room to wiggle your toes around. When people have two different-sized feet, the shoes need to fit the larger foot - if necessary you can use an insole on the other foot."