I read that Fred Astaire and Ginger Rogers needed 47 takes to perfect the “Never Gonna Dance” number in the movie Swing Time (1936), and that by the end of the shoot, Ginger’s feet were bleeding.

I get that. I’ve worn high heels since the age of 13 and these days, my feet hurt. Not just in stilettos, either. It’s from bearing normal bodyweight across hard surfaces day after day. Yes, I walk a lot, but humans are meant to walk. That’s why we’re called bipeds. It shouldn’t be painful.

“By age 50, a normally active person will have walked or run about 75,000 miles [more than three times around the Earth’s equator!], primarily on hard, unnatural surfaces, and will have lost as much as half of the fat pad protection on his or her feet,” says the Institute for Preventive Foot Health.   Well, there you go.

Years ago I heard about fat pad replacement surgery and stored the information away in the “someday you’re gonna get old” lobe of my brain. A podiatrist can detect fat pad atrophy by using ultrasound imaging. Surgery is risky because an implanted fat pad can migrate or disappear entirely, just like the original, natural one, rendering it useless and causing scar tissue to form.

One recent invention is the Graft Jacket from Wright Medical Technology. It’s an implant made of freeze-dried human collagen (cadaver skin) secured to a “matrix” of fibrous other stuff. Supposedly you get this thing surgically inserted, then stay off your feet for two weeks, and voila!—you can tiptoe through the tulips again. I’m not so sure.

On Jan. 7, 2011, Georgia Peeples posted this lukewarm report in Foot Health Forum:

[Five] months after surgery…I can shop for groceries (on the hard cement floor)…. I use a cane for walks, but I can now ‘gimp’ around the park for half an hour or so. And I’m finally able to ride my exercise bicycle, which I had been unable to do prior to surgery.

A year later (Feb. 27, 2012), the same Ms. Peeples posted this comment in MD News:

I did have this procedure, and, about a year and a half later, I’m no better. The Graftjacket implant, although it sounded quite promising, has not appreciably increased the padding under my metatarsal heads, and now, unfortunately, I have scar tissue, too. I have very limited walking, and I’m a formerly active 58-year-old woman. A very qualified orthopedic surgeon … told me that there’s really not much that can be done for this condition. He noted that my implant really hadn’t helped at all, confirming what I knew already.

This post by “lmbh” in the Foot Health Forum earlier this month (Jan. 24, 2013) is more encouraging:

My feet are not 100% of what they were before fat pad atrophy—a little scar tissue makes them feel a little lumpy and not good barefoot on hard surfaces. However, I have recently walked 4 miles without pain, whereas before I couldn’t walk 1 block without burning pain. I had surgery almost 2 years ago and do not regret it at all.

Today’s foot surgery darling appears to be the dashing Doctor Ali Sadrieh  in Beverly Hills. He offers a procedure called “foot-tuck fat pad augmentation” but his website doesn’t say where the fat comes from. (Two-for-one with a tummy tuck?) “There is no down time and no pain,” claims the doctor. Sounds too good to be true. I won’t be heading for the home of the Hillbillies any time soon.

Other treatments are available, but nobody seems any happier with those. Several posts on Foot Health Forum warn against steroid injections in the feet because they diminish the fat pad and make the pain worse. Some cosmetic surgeons suggest injectable collagen or fillers, but those last for less than a year. And then, of course, there are custom-made and shelf brand orthotics.

What surprises me is that I haven’t found much online about prevention of fat pad loss. The Institute for Preventive Foot Health suggests padded socks, but there goes my entire wardrobe of sandals and heels. Wearing flats would help, I suppose, or staying home with my feet up all the time. (Peel me another grape, sweetheart?)

For now I’m opting for gel pads, and they help. I’ve been shopping for cute low-heeled boots to give my bones a break between higher-altitude outings. Alas, I’ve also started wearing athletic shoes in public, not just in the gym.

Foot pain sufferers posting on the web recommend shoe brands for those who are willing to choose comfort over fashion: Speedo’s Wavewalker and the Keen brand are favorites for both women and men. Reader Olof, who kindly left a comment about feet on this Aging Bodies   in December, recommends Dr. omfort.

While I’m not going to say how many equatorial miles I’ve completed on foot, I hope I’ve got at least one lap to go, and I’d rather take that last turn in Jimmy Choos or Stuart Weitzmans than in Nikes or Crocs. So I’ll go comfy to preserve my fat pads when I can, but I’ll be wearing high heels sometimes, too—and watching for the latest in surgical solutions, just in case.

Anne Nicolai  is an American writer and editor living in San Miguel de Allende, Mexico.