It was near the end of " Sex and the City," after the starlets had worn high heels in the snow, at the pool, to the beach, in the rain (is this sounding like Dr. Seuss?) and, of course, to bed. It was after the one who got pregnant went jogging and we were not allowed to see what she was wearing on her feet, and after the only visible shoes I remember spotting other than high heels had made their appearance (flats worn by an office intern and sneakers worn by two guys throwing rose petals during a photo shoot).
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That's when I started wondering: What are their feet going to look like in another 10 years, after being crammed down a drainpipe? Because those women look as if they've been stuck in heels since before they could walk, their little bronzed baby spikes forgotten in some horrible box of memories.

It made me wish Jack Valenti were still alive, so we could start a campaign against debilitating footwear in Hollywood and make it as taboo as smoking.

Probably it was not planned that way, but "SATC" coincided with what became the Year of Evil Shoes at the American College of Sports Medicine's recent annual meeting, at which two featured research studies discussed how different types of footwear -- flip-flops and high heels -- might adversely influence fitness.
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There is a long trail of evidence on the problems caused by high heels, including bunions, deformities such as hammertoe, a shortening of the Achilles tendon and stress fractures. There are several other problems listed on the Mayo Clinic's Web site.

To that list, the ACSM conference added a new worry when Louisiana Tech University researchers noted that as people in high heels walk down stairs, the dynamics of their gait shift markedly from how they would descend barefoot or in low-heeled shoes. Force is transferred away from the heel (which normally carries the weight of the stride but in this case has little to balance on) and toward the toe.

How does that affect the rest of the foot and lower body? Would you want to be in an airplane that was landing nose first?

Flip-flops also came under scrutiny, with new research showing that they, too, alter the way people walk. People shorten and slow their stride and scrunch their toes in a way that increases the angle of the ankle as the foot goes through its gait.

Auburn University researcher and doctoral student Justin Shroyer said the departure point for his study was the sense that people wearing flip-flops for extended periods -- to work, for example -- experience lower leg pain. His research does not show what might cause that, but it does suggest that tooling around a city on half an inch of molded plastic might not be the best idea.

"The way we think about it is that anything that deviates from normal and you do it for a prolonged period of time, it may cause problems," Shroyer said.

After all, fitness is not just about the gym. We worry about the ergonomics of office seating and computer keyboards for a good reason: Small stresses can compound into major problems.

Why not pay the same attention to what's on our feet?

Since the invention in the late 1950s of what came to be known as the Earth Shoe, a number of footwear designs have come along claiming to mimic the state of nature -- walking barefoot.
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The Earth Shoe did it with a "negative heel" that gave wearers a slightly backward tilt and, according to the company's claims, made them burn more calories and engage more muscle in standing and walking.

More recently, shoes such as those from Masai Barefoot Technology and Chung Shi have made similar claims for footwear the companies say mimics the natural health of African tribesmen or the "natural massage" Chinese peasants enjoy by walking barefoot on bamboo mats. Both use rounded soles that create a slight imbalance and force a different sort of stride that -- again, according to the companies -- tones muscles, eases pressure on joints and improves balance.

Studies of the MBT have shown that the shoes do increase muscle activation, and some therapists will prescribe them for patients who need to rehabilitate muscles or joints stiffened or weakened by disease or injury.

A colleague in my aikido class swears by her Chung Shis (which I believe were recommended to help with a problem that began with flip-flops . . . hmmm).

"It definitely helps the feet if there are certain weaknesses," Stephen Paulseth, a physical therapist in Los Angeles and head of the American Physical Therapy Association's foot and ankle group, said of the MBTs and similar shoes.

The MBTs definitely change the way you walk. I have been using a trial pair for the past two weeks, and they are bouncy and fun to wobble around on. I am not sure how much difference they would make, day to day, to anyone in reasonable shape. My sense is that you'd adapt to them pretty quickly.

MBT marketing executive Monica Riehl said the company is working on more-aggressive uses for the shoe: exercises and applications for athletes and others that would add that same bit of rocking and instability to running or other workouts. And, she noted, there are plenty of people in sedentary jobs for whom a bit of extra muscle activation (and a bit less stress on the joints) would be beneficial.

For me, I am thinking high heels on the treadmill.

Now that might make a difference.

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