Fashion That's Good For The Sole.

Sandals, platforms, mules and pumps. When it comes to fashion for the business woman is foot, just about anything goes in Los Angeles. But fashion is one thing. What about foot health? Women squeeze their toes into pointed patent leather and teeter around on haute couture heels. How healthy is that for our feet?

Only a small percentage of the population is born with foot problems, the California Podiatric Medical Association believes. It's neglect, wear and tear, and a lack of awareness of proper care -- including ill-fitting shoes -- that bring on the problems.

Improper footwear can lead to a number of foot health problems. This includes relatively minor annoyances like coms and calluses, to more serious problems such as bunions, hammertoes, heel pain and heel spurs, arch pain, metatarsalgia and neuromas. A woman who wears high heels or platforms is also prone to stress fractures and ankle sprains if she teeters off those heels.

Some of these problems have been around from the time that our grandmothers were young, long before women spent so much time in business suits and heels. But even so, old folk wisdom does not necessarily give us the best way to treat them. For example, contrary to popular belief, shoes alone do not cause bunions.

* Bunions are swollen and tender big toe joints that are misaligned. They tend to be hereditary, and are aggravated by ill-fitting shoes. Folk medicine suggests that bunions will disappear on their own if you wear roomy shoes and use bunion pads. But they are actually a progressive structural deformity, and are often best treated early with arch supports or orthotic devices. In more advanced cases, a podiatrist will perform surgery to correct the misalignment.

* Hammertoes occur when the smaller toes contract too much while attempting to grip the ground more firmly. This causes the knuckles of the toes to enlarge and these prominences rub the top of the shoes causing pain, blisters or coms. High heels can exacerbate this condition. Flat shoes with more natural walking mechanics can help to alleviate discomfort.

* Heel spurs, which can be extremely painful, are caused by stress on the arch ligament where it inserts on the bottom of the heel bone. They can be treated with orthotic devices, exercises and anti-inflammatory medications. Surgery is sometimes required.

* Metatarsalgia is the clinical name for pain in the ball or front "pad" of the foot. It is caused by several factors, including high heels and callus formations. Treatments include paddings, anti-inflammatory medications and avoiding high heels.

* Neuroma is the condition wherein nerve bundles, usually between the third and fourth metatarsal or itoei bones, enlarge, resulting in pain, burning or tingling on the ball of the foot and/or the adjacent toes. Neuromas may be caused by tight shoes that force the toes sharply together and are often accompanied by cysts. Treatments involve orthotic devices, cortisone injections and removal of the neuromas.

* Infections may be caused by the heat and excessive perspiration which gets trapped by nylon pantyhose, which invite foot problems because the nylon does not breathe. A warm, damp area is an ideal place for the encouragement of fungal infections such as athlete's foot and fungal nail infections. Luckily, medications now available are very effective in treating these conditions. The cramping and pressure of the hose can also contribute to ingrown toenails and hammertoes. A better quality nylon in the right size ("one size fits all" does not fit anyone well) will provide a better fit, and the better the fit, the less likely it is that cramping and pressure will occur.

But healthy footwear does not have to mean homely footwear. Feet are entirely democratic and they do respond to a good work ethic. Pay attention to your feet and you can usually wear strappy, stiletto sandals with your pantsuit one day and snakeskin pumps with your power suit the next. Your feet can be comfortable going from your staff meeting in the morning, to a client lunch at noon, to that mixer after work.

Tips to keep your feet fit and fashionable:

1 Try not to wear high heels every day. Alternate high heels with low heels. The chunkier the heel, the better for balance and dispersing pressure on the feet. Try to stay with heels that are two inches high, or less.

2 Try not to buy shoes that crowd your toes.

3 Wear comfortable walking shoes when going to and from work, and, if you can get away with it, even in the office, especially on casual days. Save your high heels for client meetings and social activities.

4 When wearing heels, sit as much as possible.

5 Prepare like an athlete. Stretch out the front and back of the legs, particularly the calves, and loosen the ankles by rotating them. Make sure to do this before wearing heels or standing for long periods, and afterwards, too.

6 Buy shoes in the proper size. If in doubt, opt for the larger pair of shoes. Feet swell as the day goes on and shoes that start out with a perfect fit" in the morning, may have painfully "shrunk" by the end of the day. Shopping for shoes at the end of the day helps ensure you will get the best fit for your foot. (Special note to pregnant women: shoe size increases during pregnancy and a woman's foot typically remains larger after pregnancy. So plan on buying yourself some new shoes after the baby is born.)

7 Do not ignore foot pain - it is not normal. If the pain persists see a podiatrist. Podiatrists are the only medical specialist trained exclusively to provide medical care to the human foot.

Noreen Oswell, DPM, is the immediate past president of the California Podiatric Medical Association, a podiatrist and owner of the Foot Center at Cedar Sinai Medical Office Towers in Los Angeles.