Despite sprains, foot pains and blisters, towering footwear has legions of loyal female fans.
Among them are pop stars who dance intricate choreography wearing colossal shoes. Lady Gaga wore a pair of staggering 12-inch Alexander McQueen heels in her music video "Bad Romance." The theatrical shoes she wore were unveiled by the late British designer McQueen last fall, prompting some models to decline to walk the runway for him.
"We have entered a moment of heightened impracticality in footwear," said Elizabeth Semmelhack, author of "Heights of Fashion: A History of the Elevated Shoe." Heels tend to get higher during economic recessions, she added.
During the Great Depression in 1930s, the oil crisis in the 1970s, and the dotcom bust heels went higher. Although she's not sure why, Semmelhack said, "it could also be sort of a greater need for escapism."
While high heels elongate legs and make women feel skinnier and taller, they also mean ankle injuries, hammertoes and pain, podiatrists warn.
Doctors know their patients will wear the torturous footwear anyway.
"It's partly why we have a job," said Dr. Martin Alongi, a podiatrist at Beverly Hills Podiatrist in California.
"I just figure women in their 20s are going to do it. If they take care of their feet all the other time, most people can get away with it. There's going to be an occasional person who injures themselves."
There are way to lower the pain quotient on fashion.
Being fashionable doesn't mean wearing the highest heels, said Hal Rubenstein, InStyle Magazine's fashion director. Women have a lot of options this season with platforms, wedges, solid heels and jeweled sandals.
"I think there's a wide open field of what people can select," he said. "It's not like, 'Oh my God, if I don't wear 6-inch platforms, everyone's going to make fun of me.' Those days are gone. That's the old way of looking at fashion. It's about balance. So much of it is about proportion. You can't say a certain type of heel is in. That's separating the shoes from the rest of the outfit."
If a pair of heels make a woman feel sexy and confident, she should wear them. If the shoes torture her the point she says to herself, "I wish this day was over," then don't wear them, Rubenstein said.
"Should anyone wear shoes that tortures them? No, why would you wear clothing to be miserable?" he said.
But not everyone is following that message. Megan Forlines, a 20-year-old New York City resident, said walking to classes and her internship in 7-inch Jimmy Choo heels was torturous.
"The balls of my feet would hurt, I wouldn't be able to stand," said the fashion student. "I would get blisters, because I would stand in them wrong. My foot felt like it was broken."
She wore them anyway "because they look cute and because fashion is pain."
During nights out, Forlines brought a change of shoes or spent most of the evening sitting so she could slyly remove her footwear under the table.
Women tend to ignore the advice "wear sensible shoes," because "it's a damning term" with connotations of a mousyness, said Semmelhack, senior curator at the Bata Shoe Museum in Toronto, Canada.
Dr. Kathleen Stone, president of the American Podiatric Medical Association, suggests giving the feet breaks during the day and changing into high heels at night. She advises against wearing heels that are higher than 2 inches but knows many are not likely to heed the advice. The health effects of high heels are well-known.
"It's very difficult, not only on the foot, but the knees and low back," she said. "The way the shoes put pressure on the front part on your feet, it applies compression on your toes and irritation to the nerves in the toes."
The bones in the ball of the feet, called sesimoids, can be damaged or broken. Constant pressure on the feet can result in thickening of tissues around the nerves of the toes, called Morton's neuroma, causing pain, stinging or numbness in the toes.
Recent studies have affirmed the relationship between foot problems and high heels.
-- A Harvard study published in the October issue of Arthritis Care & Research found that 29 percent of 1,900 women reported generalized foot pain. The research showed that those who chose to wear uncomfortable shoes early in life suffered with foot pain in later years, while men did not experience the same type of foot pain as women. More on this study
-- A Korean study published in January suggested that high-heeled shoes may contribute to a change of the knee joint muscles while walking. More on this study
Stone warns against straining or doing vigorous activities in heels because it could overstretch ankle ligaments, which are like rubber bands and can snap.
Forlines said she doesn't worry about such health problems. She took a high heel recovery course that trains women to walk in heels. Tim Driscoll, founder and director of Backbone and Wingspan, a New York studio, started the class that incorporates Pilates-based exercises.
Women often treat their feet like blocks to stuff into their shoes and push all their weight into the front of the feet, he said.
"Draw the heel back and get in touch with the hamstring," Driscoll advised. Driscoll's advice on walking easier with heels
Forlines changed her posture and weight distribution on her feet. They used to ache immediately after putting on her red glitter Christian Louboutins, but now they only tire after hours of standing.
It's "bearable pain," she said.