The $745 price tag on that gorgeous pair of peep-toed leopard-print sling-back stiletto Christian Louboutins may be just the initial cost women pay for high-heeled fashion.

No matter what the total value of your shoe closet, it can't touch the potential for medical bills later in life that stem from prolonged high-heel wear.

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"The overall cost of people wearing ... restrictive shoewear is about $3 billion a year," said Dr. Lori Reed of the Nebraska Medical Center.

Vanity fuels the bottom line of not just shoe retailers, but podiatrists, massage therapists and pedorthists. Pedorthists are foot-care experts trained to manufacture and modify both footwear and orthotics.

The toll of the fashion statement isn't just monetary -- it's also physical. Omaha podiatrist Dr. David Cornell said he does countless bunion operations, callus and corn removals, and consults on generalized foot pain. Cornell said one of the big culprits that sends women screaming into his office is high-heeled shoes.

"It changes the way you walk, putting your center of gravity on the ball of your foot. The higher the heel, the worse it is," Cornell said.

Shoes Hurt Backs, Too

The discomfort can radiate up into the lower back, too.

"I can usually tell by the pelvic alignment whether a woman wears heels," said Douglas Lee-Regier, a massage therapist. "The (hip bones) will be pushed up and the client will complain of sore neck and shoulders."

Why?

There are four parts to the step. First, the heel hits the floor, then the foot falls flat, then the heel lifts off and that leg swings through to prepare for the next step. Cornell said that between the second and third pieces of the puzzle, there's a series of small bones that allow the arch to go down and absorb shock.

"What the (high-heeled shoe) does is puts you directly into the third phase of gait. The rest of the body hasn't caught up, so those bones aren't locked (as they should be) and this is what causes bunions and hammer toes," Cornell said.

But rather than lecture women to deposit much of their shoe closet into the nearest Dumpster, Cornell counsels caution.

"As a doctor, my job is not to make you feel guilty. My job is to support your lifestyle but provide info," Cornell said. "I don't complain, because it makes me a lot of business.”

Deniz Seran, owner of Omaha shoe boutique Deniz, said that in eight years in her shop, she doesn't see the trend moving away from tall shoes any time soon.

"There are times when, if somebody has a great outfit or party or event ... most women will break down and do a high heel," Seran said. "We don't have any customers who are 5 feet 2 that are scared of heels."

How To Heal

Women can take steps to ease their pain.

Start by letting your heel hit the floor for a few hours each day.

"Alternate your shoe gear," Cornell said. "Spend two hours a day in a low shoe."

Women who live in heels eventually can't wear flats.

"It's not unusual for career women who regularly wear high heels to find themselves in pain when they switch over flat shoes. Years in high heels causes the Achilles tendon to shorten, making it too short for flats," said Dr. Douglas Albreski, director of Podiatric Dermatology Services at UConn Health Center. "With the regular wear of flat shoes and stretching exercises, it should return to resolve itself."

Daily calf stretches can help, too.

Perhaps the best way to combat high-heel aches and pains is to spend a little time on shoe and padding selection.

"Most of those high heels -- the front part of the soles are very thin, even if it seems cushy," Cornell said.

He provides patients with specially-made gel insoles, but said there are some mail-order and over-the-counter products that can act as shock absorbers for the ball of the foot, too.

Fashion Adapts

Luckily, Seran said fall's fashions account for comfort. She said her store is full of round- and square-toed varieties, which doctors recommend for maximum comfort, and she said she's noticed that manufacturers are now taking a more walk-friendly approach to high fashion.

"A lot of vendors are taking the time to try and come up with (soles that are) comfortable. They're trying to do things that are more wearable," Seran said. "Vendors with Web sites get feedback from clients, which has changed the way they do some things."

Cobbler and pedorthist Di Mauro customizes shoes with bars across the bend of the foot that provide more support and spread out a woman's weight. He charges $13 and said many flex spending plans will pay for bars ordered with a doctor's prescription.