Cosmetic Foot Surgery All Talk and No Walk


Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.

September 13 2007

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Your feet take a lot of abuse. You walk on them, run on them, dance on them, stand on them, and, adding insult to injury, you cram them into poorly fitting shoes. And after they do all that for you, you also demand that they look good.

If you think your feet don't look as pretty as they could, you might consider cosmetic surgery. Cosmetic foot surgery is a growing trend. You can go on the Internet and read about several types of foot surgery being done to improve the looks of your feet.

You can have a surgical procedure to shorten your second toe if it sticks out beyond your big toe. You can also have an unsightly, but painless, bunion corrected. You can even have injections of collagen or other substances into the ball of the foot so that wearing very high heels is more comfortable. Some podiatry centers are advertising a "foot lift," where you undergo several procedures at the same time to make your feet prettier.

Cosmetic foot surgery is plastic surgery performed on a healthy, functional foot simply to make it look better, said Steven D.K. Ross, MD president of the American Orthopaedic Foot & Ankle Society (AOFAS). Dr. Ross is Professor of Orthopaedics at the University of California, Irvine School of Medicine.

Reconstructive surgery is surgery to a foot that is not functioning properly or that is in pain, such as surgery to correct a bunion or a misshapen toe. Even if reconstructive surgery ends up improving how your foot looks, it is still reconstructive, not cosmetic, said Dr. Ross.

James R. Christina, DPM, agrees with these definitions, but added that in reality it can be hard to make a distinction. Dr. Christina is Director of Scientific Affairs for the American Podiatric Medical Association (APMA). If someone has bunion surgery because they are in pain, the surgery provides a functional improvement to the foot. But what about a person who only has pain from the bunion if they wear certain types of shoes? Is that same surgery cosmetic or reconstructive, he asks?

Dr. Ross and Dr. Christina represent the two types of health professionals who treat the foot medically and surgically. A doctor of medicine (MD), usually an orthopedist (sometimes spelled orthopaedist), can specialize in foot care. The AOFAS is the professional group for orthopedic surgeons who specialize in foot surgery.

The other health professional who treats feet is a doctor of podiatric medicine (DPM), a podiatrist. Like medical doctors, podiatrists go to graduate school for four years. They then have a year of residency training in a hospital. Their professional group is the American Podiatric Medical Association (APMA).

The vast majority of surgery on the feet performed by both medical and podiatric surgeons is done to relieve painful conditions or restore function to the foot. One very common foot surgery is the correction of a bunion (hallux valgus), which is a deformity of the joint between the foot and the big toe. The joint is pushed out of alignment and to the side, forming a bump, and the big toe is pushed inward toward the rest of the toes. Wearing tight, pointy shoes that don't give your toes enough room can cause bunions.

The first choice treatment for a bunion is usually a change in shoes or the addition of an orthotic, but severe bunion cases are often corrected surgically. Surgery can realign the toe and remove the bump, aligning the whole foot correctly and greatly reducing or eliminating pain.

As with a bunion, a hammertoe results from wearing shoes that don't fit you well or excessively high heels. The second, third, or fourth toe has become bent downward and looks like a little hammer. The result is pain and corns or blistering on the toe knuckle. Wearing shoes with more room for your toes helps, but again, surgery can correct a serious hammertoe problem, leaving you with nice straight toes.

Although the availability of cosmetic foot surgery is growing, the idea is controversial, and it divides the physician community who care for the feet. In 2003, when several articles about cosmetic foot surgery started appearing in newspapers and magazines, the AOFAS issued a statement that the risks of such cosmetic surgery outweighed the benefits. The group stated that no surgery should be done for the sake of appearance to a foot that is functioning well and is not in pain.

The risks of any surgery include infection, poor healing, and inadvertent injury. Cosmetic surgery to the face or body is very safe, with risks that are usually minor and very, very rare, which means that the benefit of looking better outweighs them.

Your feet have to withstand enormous amounts of pressure even when you are just standing. Each foot is a complex structure, with 26 bones and more than 30 joints, along with tendons, nerves, and skin that all have to interact to allow you to walk or run without pain. The risks of foot surgery are increased because of the mechanics of the foot, which means that the cosmetic benefit no longer comes out ahead.

"Every operation has risks," Dr. Ross said. If something goes wrong with cosmetic foot surgery, you still have to walk on your feet every day. Any foot problems stemming from cosmetic surgery could leave you in a lot of pain for life, he said.

However, the APMA has not come out against cosmetic foot surgery. In a position statement, the podiatry group notes the disadvantages, saying, "Surgical procedures performed solely for aesthetic purposes carry risks similar to those performed for more traditional reasons." But it goes on to state, "Patients considering surgery of the foot or ankle, whether for medical or aesthetic reasons, are advised to consult a member of the American Podiatric Medical Association." It notes that podiatrists have the training and experience to "properly perform the surgery, manage the postoperative care, and treat the possible complications."

Some podiatric surgeons perform cosmetic foot surgery, Dr. Christina said. In his practice in the Washington, DC, area, he performs such surgery occasionally as long as the patient is fully informed about the risks. "I take the same approach I take to all my surgical patients. I explain the procedure and go over risks involved. I tell them that if it were myself or a family member, I would not do this because risks outweigh benefits. But if they understand the risks and understand the recovery period involved, and want to proceed with it, I let them make that decision."

One risk of cosmetic foot surgery that Dr. Christina warns his patients about is scarring. "It is very hard to hide a scar on a foot because you have to make your approach based on the anatomy and what you are trying to protect," he said.

People have come to Dr. Ross seeking surgery to make their healthy feet look prettier. "I don't do cosmetic foot surgery," he said. He notes that he goes into the risks and benefits of cosmetic surgery with the patient. "On the balance of risks and benefits, the surgery does not hold up." He also noted that shortening a longer second toe is making a problem out of a natural condition. About one-third of people have a second toe that is longer than their big toe, which means that it is a normal type of foot, he noted.

However, although the subject of cosmetic foot surgery gets a lot of attention, in actuality, it may be talked about more often than it is performed, Dr. Christina said. He said that he is asked about purely cosmetic foot surgery only rarely. "In the Washington area, I have not seen a big push nor have I heard from my colleagues that a lot of patients are looking for it." And although there are rumors of women having their littlest toe removed so that they can wear very narrow shoes, he has no knowledge of anyone who has actually done it. It might be an urban legend, he added.