Women who regularly wear high heels can expect to suffer heel pain as they age, according to a study from a Harvard-affiliated institute.

Yet even the lead researcher admitted she would not likely stop wearing heels, despite the mounting evidence against them.

"I thought about it after I started doing all this research and seeing pictures of feet disfigured by wearing bad shoes, but no, I haven't given anything up," said lead author Alyssa B. Dufour, a graduate student at the Institute for Aging Research of Hebrew Senior Life.

"That's because fashion is so much more important to us [women]," said Dufour, laughing at the contradiction.

Past studies have shown women who wear high heels are more likely to fall or develop a variety of painful, degenerative muscle and joint diseases.

According to this newest study, it's not just high heels. The flattest of the flat shoe, the flip-flop, is one of the worst shoes a woman can wear, said Dufour.

"Flip-flops are terrible for your feet. There's nothing to hold your foot in."

The study analyzed data from 1,900 women and nearly 1,500 men enrolled in the Framingham Foot Study between 2002 and 2008. Researchers found one-quarter of participants reported generalized foot pain on most days, with 19 per cent of men and 29 per cent of women falling into this category.

The study is one of the first to examine the association between footwear beyond just high-heel use and foot pain.

Eleven shoe types were considered. High-heels, pumps, sandals and slippers were classified as "poor." Hard- or rubber-soled shoes and work boots were "average," and athletic and casual sneakers were "good." More than 60 per cent of women reported wearing "poor" shoes in the past, compared to only two per cent of men.

The researchers say past shoe-wear among women is a key factor for hind-foot, or heel, pain. They found no significant link between foot pain and the types of shoes men wear, something that did not surprise Dufour.

"There's not a whole lot of different shoes that men can wear that aren't flat," she said.

High heels need not be so damaging, said Dufour, but sadly, good high heels — those that offer good padding and strong support — are very expensive. She would like to see her research used by shoe designers and manufacturers.

"The real issue is designing a good high heel that is affordable."

The study offered one unexpected finding in that women reported pain only in their hind foot.

Dufour said she and her researchers had expected more reports of pain all over the foot. In her own experience, she finds the ball of her foot become sore when she wears heels.

The study will be published in the October issue of the journal Arthritis Care & Research.