Women and high heels. Can't live with 'em, can't live without 'em.

Just as Sarah Jessica Parker wouldn't step out in anything but high-heel pointy-toe stiletto pumps as Carrie Bradshaw in TV's Sex And The City, women everywhere are voting with their feet and heading for the heels.

But while soaring arches are the height of fashion, they can be a downfall for your feet.

Tottering about in 4-inch (10cm) heels - de rigueur now that 3 inches no longer measures up - is painful after a few hours. And the niggling aches you feel at the end of the day might be more serious than you think.

In fact, here's some sole-crushing news for all you spike sisters: Common foot problems related to high heels are toe pain, pain in the balls of the feet and blisters, says a 2003 study by the American Podiatry Medical Association.

You can also get painful corns and calluses over the toes and balls of the feet, says Adriaan Erasmus, principal podiatrist at the department of rehabilitation medicine in National University Hospital.

Worse: In some cases, your heels can cause fractures in the small bones of the feet.

Worse still: Those are just short-term injuries. In the long run, regular high-heel wearers may develop bunions, osteoarthritis - a type of arthritis caused by the inflammation, breakdown and eventual loss of cartilage in the joints - of the first and second toes, ankles and knees, as well as toe deformities, says Erasmus.

And treatment for such foot problems could require surgery that cost thousands of dollars.

Wearing high heels has been associated with pain in the lower back and hip as well.

According to Kin Ismail, a senior podiatrist at Tan Tock Seng Hospital, the most frequent injuries to result from wearing heels are ankle sprains. And it isn't surprising.

"Walking about in high heels can be wobbly, especially in stiletto heels," says Kin. Dancing or dashing for a bus means an increased risk of toppling over, too.

"Wearing heels becomes even more dangerous when the speed of movement is higher," adds Chelsea Law, a senior podiatrist at the rehabilitation centre in Alexandra Hospital.

And slipping into a pair of shoes with thicker heels - like trendy wedges and funky clogs - won't make much difference.

According to Erasmus, a study by Dr D.C. Kerrigan from Harvard Medical School in 2001 to compare the effects of stiletto and wider high-heel shoes on the knees, showed that it's the height and not the width of the heel that matters.

While a chunkier heel might just reduce your risk of an ankle sprain, high heels in general remain bad for your feet.

"The incidence of osteoarthritis of the knees was higher in the wider heel group. Chunky heels tend to give a false perception of comfort and stability, so women wear them for longer periods of time," says Erasmus.

Judging by historical trends, women aren't going to come down to earth and wear flats anytime soon.

Heels were first designed to address the problem of horse riders' feet slipping through stirrups, but women soon started wearing them as a fashion statement. High heels took off among men and women of the French court, and the shoe business has never been the same, despite the pain.

Fazillah Abdul Gaffa, 21, a fashion stylist, who goes as far as squeezing her size 12 feet into shoes a size or two smaller, says: "My heels make me feel like I'm in control. I'm 1.73m tall and I'm usually in heels that are 4 inches
high. Towering over everyone helps to boost my confidence."

Part-time dance instructor Samantha Hu, 24, also gets a lift from 4-inchers, saying: "I wear high heels because they make me look good. My legs appear longer and I feel better."

Lawyer Sharmini Selvaratnam, 26, echoes that sentiment. "High heels make my legs look as if they go on for miles when they really don't, and that's going to make anyone feel sexy."

The opposite sex seems to agree.

"Women in high heels are definitely sexy. When women wear heels, their calves look more defined and their legs are accentuated. But not all heels are sexy. Chunky heels just look cute. Stilettos are sexy," says Marc Das, 25, a business development executive.

Others find the notion of hazardous heels crazy.

"I don't understand how women can put themselves through so much pain. It isn't good for your back in the long run. It's a lot of trouble just to look good," says civil servant Gerald Teo, 27.

However, doctors are not completely down on the uppers. They reckon heels that are 1-inch-high or less are okay.

"I recommend women don't wear high heels, but I know that will never happen, so the trick is to strike a balance," says podiatrist Tye Lee Tze of The Podiatry Centre at Tanglin Place.

"Wear them when you think you need to, such as during meetings at work or at dinner functions; stick to low heels the rest of the time."

Alexandra Hospital's Law recommends shoes with broader fronts for easier toe movement - this will prevent excessive pressure to the sides of the foot that causes calluses and corns.

Also, chunkier heels provide more stability than thinner ones, while shoes with straps, buckles and backs give more support.

Erasmus warns though: "The longer you wear your high heels, the greater the risk of developing foot problems. Deformities might start to become significant only later in life, but then the damage has already been done."