"More and more women are saying, ‘We’re tired of being tortured,’" says Dorothy Twining Globus, director of the museum at New York’s Fashion Institute of Technology.

There are still plenty of fashion slaves who will jam their feet into shoes that are too short, narrow and pointy and whose heels are too high. But a small rebellion has started and is growing, say a number of shoe designers and manufacturers and doctors. Some women are sacrificing vanity for feet that don’t hurt.

At her job as development officer at the Cheney Cowles Museum in Spokane, Wash., Jan Wigen only wears Birkenstocks, a flat German sandal with an insole molded to the shape of the foot. They "are not beautiful," she concedes (an understatement), "but they feel beautiful." Besides, adds Ms. Wigen, "I never felt we lost a donor because of what I wear on my feet."

The demand for a more comfortable shoe is partly the result of the growing popularity of athletic shoes, which now account for some 40% of the U.S. shoe market. "Because young people were born in softies [athletic shoes] , they will continue to look for comfort as they grow," says Howard Davis, professor of footwear design at New York’s parsons School of Design.

Middle-aged and older women have their own reasons for demanding more comfortable dress shoes: 80 million of them suffer from foot problems, says the American Orthopedic Foot and Ankle Society. And no wonder: The average American woman’s foot size is 8 wide, yet the best-selling shoe size is 7 ½ medium. Do the math.

Women "try on a size 6 that fits too tight, so they go to the next size up, a 6 ½," says Josh White, medical director for Eneslow, a New York dealer in "comfort" shoes. "But that’s too loose, so they go back to the 6 and hope it stretches; it doesn’t."

Although men wore shoes with high heels and pointy toes in earlier centuries, today the typical man’s shoe has relatively round toes and low heels, which means that far and fewer men have problems with their feet. Michael J. Coughlin, an orthopedic surgeon in Boise, Idaho, says 94% of his patients who have foot operations are women.

Dr. Coughlin is co-author of a study showing that the annual cost of foot ailments in this nation alone is $3.5 billion for surgery and 15 million lost work days.

A simple pump for women is a feat of engineering: It consists of a leather upper that wraps around the foot, a lining of leather or other material and a sole, which includes a sock of leather or synthetic, a foam insole, an outsole of leather, rubber or synthetic, and a heel of rubber, stacked leather or plastic covered with leather. A textile toecap and a plastic shield wrapped around the heel add stiffening, Stitching is of nylon. The best shoes have uppers – inside and out- made of soft glove leather, which can breathe, not of synthetics or patent leather.

Women’s dress shoes are often uncomfortable because of their narrow toes and high heels. A narrow toe makes a woman’s foot look daintier than it really is, and high heels – some high-fashion shoes have heels that are 6 inches high – make legs look longer, thrust the body forward and shorten the gait.

Athletic shoes are usually more comfortable than dress shoes because, according to Jeffrey Cosgrove, senior vice president for marketing at Rockport, a division of Reebok International Ltd., they are made of lighter materials, have insoles that are more flexible, are molded to conform to the foot and support the arch and are designed to wick away water and heat and fight microbes. Their bottoms are a rubber compound that provides better traction. Rockport is a pioneer in trying to introduce athletic-shoe technology into dress shoes.

Whether for dress or athletics, the fit of the shoe can also make or break a pair of feet. Shoes used to come in 11 widths, from AAAAA to EEE. But an increasing number of stores, trying to reduce inventory, carry no more than three widths and as few as one. An estimated six million women need size 10 or larger, but the average shoe store stocks only sizes 5 ½ to 10. And fewer than 10% of shoe salespeople have had even basic training in foot anatomy or shoe sizing. To make matters worse, feet change size during the day; they’re biggest at the end of the day. Feet also get larger as people get older. Shoe makers aggravate the situation by not agreeing on uniform sizes.

The best-made shoes in the world come from Italy and Spain. Although making a good shoe is not rocket science, it is very difficult to automate the production of good shoes, which both these countries have done. Italy specializes in business shoes, Spain in evening shoes.

There’s a continuing debate about the maximum height a heel should be. The American Podiatric Medical Association recommends that heels be no higher than ½ to ¾ of an inch. Other groups set the limit at 2 ¼ inches. There’s no debate about the width of heels; they should be broad to spread weight, not spiky.

To help people find kinder, gentler shoes, the Foot and Ankle Society plans in February to announce a new seal of approval that it will bestow on shoes that have passed 15 rigorous tests for comfort and safety. The tests will cover things like shock absorption, breathability, fit and sole friction.

There is little agreement on how much one must pay for comfort and good looks. A female managing director at a big New York investment bank says she has to spend between $200 and $500 to get what she wants in business shoes with 2-inch heels.

Another professional woman, Andrea Robinson, president for department store marketing at Revlon Corp., New York, says her $500 Manolo Blahniks with 4-inch heels are not only the latest in chic but are super-comfortable. "In any beautifully made shoe, where the leather is so good and pliable, comfort really isn’t an issue," says Ms. Robinson, who admits to riding a limousine to work.

If women must wear heels, experts advise them to switch to low heels as much as possible. "Make it a very limited treat," says Glenn Pfeffer, a San Francisco orthopedic surgeon. "Have yourself dropped off in your high heels in front of the restaurant. Take them off when you get back in the car.