A woman showing up to an orthopedic appointment wearing high heels is asking for a lecture from her doctor. Orthopedic surgeons say that increased high heel wearing can lead to bunions, a condition where the largest toe points toward the second largest toe and causes a bump on the outside edge of the foot. High heels contribute to the problem by being tight on the foot and not conforming to the foot’s natural shape. These shoes often have a sloping foot bed and narrow toe box, squishing toes together and out of shape.

It’s easy to diagnose a bunion because it’s obvious by looking at the toe. It makes the toe look deformed and out of shape. Bunions may be a common sight gag in movies and television but they’re no laughing matter. Bunions are associated with sharp pains in the foot, even when not walking. Severe cases can make it difficult to fit regular shoes and walk around at all.

Bunions are also permanent, requiring the help of an orthopedic surgeon to correct. Surgery can be both expensive and painful. The process involves removing swollen tissue, removing bones from the foot and permanently joining the joints in the big toe. Without surgery, they just get bigger and more painful. If ignored, bunions can cause inflammation and swelling in the joints associated with the big toe.

Although high heel shoes aren’t the only cause of bunions, it’s one of the avoidable ones. According to the Mayo Clinic, it’s best to avoid shoes with a heel over two and a quarter inches and to avoid tight shoes altogether. If bunions do occur, use a non-medicated pad over the bump to avoid further trauma to the foot. For situations where the foot is inflamed or in pain, try an ice pack two or three times a day to reduce swelling. Overall, it’s far easier to avoid bunions than to deal with the consequences of them. So instead of wearing yet another pair of uncomfortable, foot deforming high heels, remember that high fashion has consequences.