Questions & Answers features staff members of Rockhill Orthopaedics and the Health and Rehabilitation Pavilion. This Issue we interviewed Susan Bonar, MD, new fellowship-trained orthopedic surgeon and foot and ankle specialist on staff at Rockhill Orthopaedics.

What is your advice to people who stand on their feet all day?
Let's start with women. The biggest mistake women make is wearing shoes that don't fit properly. Women undergo 90 percent of all forefoot surgeries in this country. Their feet don't start out abnormally, but they treat them abnormally. The width of a woman's foot increases as she ages and with every child she bears, but most women continue to wear the same size shoes they always did. Well fitting shoes are the key to being comfortable and to preventing bunions and painful corns.

Why do so many women have those bunions that deform the front of the foot?
Again, they happen because of ill-fitting shoes, though some women are bunion-prone. The majority of bunions don't hurt and they are difficult to operate on and can create pain that wasn't there before. The first line of treatment is good shoes.

Are high heels particularly bad?
Yes. They damage the feet and also cause stress all the way up the leg because they throw the body out of natural alignment. A woman hobbles in high heels, and heels really aggravate toe problems. Women with healthy feet can tolerate a low heel as long as it has a rounded toe and is wide enough in the forefoot.

How about men who stand on their feet?
The same advice holds about being sure the shoe is a good fit. The shape of the inside of the shoe should match the foot. If a person has a defined arch, the shoe should have arch support. That allows the weight to be evenly distributed across the bottom of the foot. A big help in preventing fatigue. If a shoe-work boots, for example,-don't have arch support, you can buy soft supports to put in them.

Aren't these supports prohibitively expensive?
Not at all. You can get them at orthopedic supply stores, shoe stores, or specialty pharmacies at a very moderate cost (about $45 a pair). There's no need for the average person to get expensive prescription supports.

Some jobs require a certain type of shoe. But if people can wear what they want, is there a type of shoe you recommend?
My favorite is what's called a Birkenstock. They have a nice cork sole with a good arch that conforms to the foot. It's not necessary to buy the real expensive ones - I've found the cheap ones to be just as good. They give the foot a lot of support, and the lack of a toe covering is good for the front of the foot. I can wear them through a long day of surgery and still have plenty of energy at night.

Should people with flat feet try to get them "fixed" by wearing shoe inserts?
A lot of people have painless flat feet. This problem has unfortunately been overtreated by our society. As long as they don't hurt, they're not a problem. That goes for children as well as adults.