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Since ancient times, a small, dainty foot has been a symbol of femininity and status. Cinderella got her prince because her feet fit into tiny, glass slippers. Until recently, the wealthy Chinese bound the feet of little girls to keep them from growing to their natural size. Even in this era of more liberated (and comfortable) footwear, women continue to torture their feet by wearing narrow, high-heeled shoes.

The human foot is made up of some 30 small, flexible bones that are bound together by a web of ligaments and muscles. This structure gives the foot its flexibility and amazing strength. Of all the body structures, the foot takes the most punishment. When a person runs, for example, the foot bears up to a ton of force.

As a person ages, ligaments and tendons lose some of their strength. In the foot, this natural process results in gradual spreading and a change of shape. Bunions may form, and arches flatten. As a result, a person of 50 may require shoes that are a full size or more larger than when he or she was 20 or 25. Even during the course of the day, the feet change. A shoe that is comfortable in the morning may be too small by evening because of a natural swelling. In addition, many medical conditions cause foot swelling or enlargement.

Causes of enlarged feet

Allergic reactions
Many allergic reactions cause widespread swelling due to changes that allow fluid to pass more easily through the cell walls. This excess fluid tends to collect under the skin and in the extremities, producing swelling of the hands and feet. Such swelling is temporary and is usually harmless. In some instances, however, it may be a warning sign of an impending anaphylactic reaction that can result in shock and death.

Bunions
A bunion is a painful deformity of the first joint in the big toe. It develops with age and is more common among women than men. As the joint becomes more deformed, the big toe is pushed inward and crowds the other toes. A smaller deformity may then develop on the little toe. A bunion usually necessitates wearing larger shoes that are wide enough to accommodate it.

Edema
Edema is characterized by the presence of excessive fluid in tissue spaces. It occurs when fluid that is normally held inside the cells or within blood vessels escapes through the cell or capillary walls, resulting in flooding of body tissue. This excess fluid tends to collect, or pool, in the extremities, resulting in swollen, puffy feet. The feet may appear normal in the morning, but as the day progresses, they balloon, most noticeably on top. This type of edema is most common in heart failure, a condition in which the heart muscle is too weak to circulate the blood adequately. It may also occur in kidney failure and various circulatory disorders, especially of the lymph channels.

Growth disorders
Growth is controlled by hormones secreted by the pituitary gland. Abnormal production of pituitary hormones can result in excessive growth, especially of extremities, or end (acral) structures such as the feet, hands, jaw, nose, and ears. Paget's bone disease is one of the most common examples of this type of abnormal growth. More extreme but less common growth dis­orders that may result in enlarged feet include acromegaly and gigantism.

Lymphedema
The lymphatic system is often referred to as the body's second circulatory system. It addition to its vital role in defending the body from disease-causing organisms, the lymphatic system helps maintain proper fluid balance by draining excess fluid from body tissues. When lymph channels in the leg are blocked or damaged, the lower leg, ankle, and foot may become greatly enlarged, a condition sometimes referred to as fatty leg. The swelling may appear to be fat, but it actually is fluid.

Pregnancy
By the end of pregnancy, most women find they need shoes that are a size or so larger than normal. Several factors combine to produce this increased foot size. Hormonal changes late in pregnancy cause ligaments throughout the body to soften somewhat. This allows the pelvic structure to widen so that the baby can pass into the birth channel. In the foot, however, the softened ligaments are unable to hold the many foot bones firmly in place, so it enlarges as they spread out. In addition, the enlarged abdomen creates pressure on blood vessels and lymph channels in the legs, resulting in swollen ankles and feet. Swelling problems usually can be minimized by a program of rest and exercise. Although a certain amount of swelling and foot enlargement is normal, excessive fluid accumulation may be a warning of pre-eclampsia or toxemia of pregnancy, a serious condition requiring prompt treatment.