Rami Abboud finds the latest fashions in ladies' footwear "horrible".

But his concern is clinical rather than aesthetic: he is a biomedical and rehabilitation engineer at Dundee University, and coordinator of the university's foot pressure analysis project, which aims to help patients with foot deformities without resorting to surgery.

The project has developed a series of measurements to determine the pressure of body weight on the foot when the patient is walking. This is linked to measuring muscle activity in the leg, to see if muscle dysfunction is causing abnormalities, a problem which can particularly affect patients with diabetes.

The Dundee research team has created an electronic insole, custom built for every patient, containing a set of transducers to redistribute the shoe-wearer's weight.

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Mr Abboud is currently investigating problems caused by rheumatoid arthritis. Inflammation in the joints aggravates the pain by forcing patients to put abnormal weight on the deformed foot, and Dundee has been highly successful in constructing insoles that take the pressure off the joint.

"A lot of the deformities we see, such as bunions and toe stiffness and pain underneath the ball of the foot, as well as a lot more serious complaints, are mainly caused by bad foot management and ill-fitting shoes," Mr Abboud said.

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"Shoes which are narrow or have high heels cause the most damage. Wearing these means that the entire action of the foot is changed, with tendons, muscles and joints working in ways they weren't supposed to."

Sixty per cent of patients in the foot-analysis clinic are female, Mr Abboud said, largely because of the type of shoes women wear. Body weight should ideally be distributed between the heel and the front of the foot, but high heels put pressure on the ball of the foot, which also affects the knees and the hips. Many women wear shoes that are not sufficiently wide or deep, although shoes that are too loose are just as bad, Dr Abboud said.

Trainers have the disadvantage of a base narrower than the material on top. "That's what causes most of the injuries in sports people, because they start twisting their foot while running, and there's no support," said Dr Abboud.

"I think the only type of shoes you can say are protective are boots, like army boots or Doc Martens, which support the ankle and have a broad base. Males and females can follow that trend, but I don't think they will."

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