Hostess Geraldine Scarlett greets clients in a downtown Vancouver restaurant — in flats. The 26-year-old shuns spikes to save her bad knees.

"Wearing heels is completely foreign to me in all senses," said Scarlett, who noted that her co-workers are actually discouraged from wearing heels higher than two inches.

But Vancouver podiatrist Jaspaul Riar said some of his patients still do eight-hour shifts in spikes, despite a recent ban on mandatory high heels in the workplace that came about as the result of a private members' bill introduced by Green Party Leader Andrew Weaver and championed by Liberal Leader Christy Clark.

Riar said more is needed than amendments to the Workers Compensation Act to save women's feet from the ravages of full shifts in stilettos.

While Riar is thrilled some females are ditching heels for high tops, he said social pressure to don pumps remains strong.

Canadian women have four times as many feet problems as men, and heels are to blame, says the Canadian Federation of Podiatric Medicine.

Heel-related injuries — ranging from ankle sprains to concussions — have doubled in U.S. women in the past decade, according to the Journal of Foot and Ankle Surgery.

FILMFESTIVAL-CANNES/

Cannes Film Festival high heels-only dress code earned protests last year after women were ousted from the red carpet for wearing flats, prompting actress Emily Blunt to espouse her love of sneakers over spikes. (Regis Duvignau/Reuters)

But prying feet out of heeled shoes will require a shift in social mores. And Canada's $48-billion clothing and footwear industry is a powerful market force.

"I wouldn't say women are forced to wear heels. It's a complicated situation," said Riar. He often counsels young women to switch shoes but gets pushback, even from injured patients who fear being the only girl in flats.

 "And it's certainly a controversial one.They are worried about how they will look and how they will fit in — it's only human.

"And they feel that peer pressure from their colleagues," he said.

Shifts in U.K.

Worldwide, attitudes are changing in shoe choices.

B.C. was applauded in Britain for the move to ban mandatory heels after images of an Edmonton restaurant worker's bloodied feet went viral.

But sport shoe sales had already eclipsed heels in 2015 — a first in the U.K., according to Mintel Global Market Research.

U.S. retailers are seeing similar spikes with sales of athletic footwear beating dress shoes even in the under-34 age range, according to Mintel.

Comfort has shifted to the top shoe-selling point, say Canadian vendors.

In Vancouver, Lord's Shoes and Apparel manager Carly Jackson said the top question from customers is: "What do you have in a high heel that's comfortable. And I'm like 'well… that's kind of tricky.' "

Jackson's top selling shoes are mid-height heels — under three inches.

Runners that can be worn with frocks also move well, she said.

But she's not convinced spikes will ever die.

"I don't think high heels will ever go away. The French will never let a pointed toe go out of style. Let's be honest," she said.

Christine Chandler of Miz Mooz Boutique in Kitsilano spent her 20s in stilettos, but applauds young female staff and customers opting for lower shoes.

"I see a lot of women saying 'I can't live my life uncomfortable all the time. I work on my feet 12 hours a day.' Whereas, in the past it was like, 'Is it cute? I'll take it.' "

Joey's heels

An Edmonton woman said she was required to wear heels by a restaurant dress code. A training session left her feet (above) bloody. The restaurant said she misunderstood the dress code, which permits flats. (Facebook)

Podiatrists say those comfier choices will spread the weight of their body over the whole foot and help them avoid everything from bunions to hammer toes, and even help relieve arthritis.

But Chandler shivers when she sees girls still enduring spikes to look "sexy."

"I see the men in their comfortable loafers and I look at women in their heels and tight skirts and I just don't see how that's equal."

Perhaps one way to permanently shift shoe-buying habits is to print pictures of hammer toes and head injuries on stiletto shoe boxes to drive home the reality of the price that may be paid for a life in heels.

Suffice to say — it's not pretty.

Britain High Heels

B.C. employers can no longer require female staff to wear high heels. (The Associated Press)