Cosmetic Foot Surgery

Fashion and comfort may not be natural enemies, but when it comes to women's footwear, at the very least, they're often in opposite camps. That's one reason why orthopaedic surgeons and podiatrists at HPH have been watching an unusual phenomenon emerge: cosmetic surgery of the foot.

As a result of concern expressed by doctors at the HPH about the risk of an unfavorable outcome when foot surgery is performed for cosmetic reasons alone, there is a growing public awareness of this inappropriate surgery. As chronicled in a recent article that appeared on the front page of The New York Times, the desire to wear high-fashion designer shoes-which often have very high heels and a narrow and pointed toe-is prompting some women to ask for elective surgery. The American Orthopaedic Foot and Ankle Society and the American Podiatric Medical Association have made position statements regarding the dangers of cosmetic foot surgery.

Among those operations requested are procedures to correct the appearance of a bunion, an abnormally downward-curled lesser toe (hammer toe), shortening of a long second toe, the injection of collagen into the toes or ball of the foot to provide more padding, and removal of the baby toe. These procedures are not only inadvisable, the results can be disastrous. "Patients who undergo these procedures may do so believing that a 20-minute operation will enable them to wear more attractive shoes, when, in fact, they may be risking twenty or more years of disabling pain."

"Cosmetic surgery on a pain-free, well-functioning foot is never appropriate." The foot is a complex biomechanical structure made up of numerous bones, ligaments, and tendons designed to bear the patient's weight during walking and exercise. When this mechanism is disrupted, even with an apparently minor procedure, the patient's ability to walk comfortably may be irreparably damaged.

Because of reports in the popular media, patients who seek medical care for a painful foot or ankle may be under the misapprehension that surgery is their only option. In fact, many painful conditions of the foot-including those that may be caused or exacerbated by ill-fitting footwear-may be treated non-surgically. Among these conservative options are:

  • Physical therapy that can increase the range of motion in the joint, and decrease swelling and pain
  • Prescription orthotics-molded inserts worn in the shoes-that address structural abnormalities in the foot and help redistribute load, and
  • Ultrasound-guided cortisone injections, which allow delivery of a powerful anti-inflammatory medication in the exact area where it is needed. This treatment can also be highly effective in the treatment of problems with the Achilles tendon, and pain in the heel, toe, and mid-foot.

Prescription Orthotics

When is surgical treatment of the foot the right choice? In otherwise healthy patients, only when conservative measures have been exhausted. In the case of bunions, if the patient experiences persistent pain and is unable to fit comfortably in any kind of footwear, or if the bunion itself is not painful, but is causing other problems such as pain in the second toe or the ball of the foot. (For more on surgical treatment of bunions please see the link under Further Reading at the conclusion of this article.)

Similarly, hammer toes that remain painful after non-surgical treatment and prevent the patient from fitting into shoes, can be corrected surgically. In patients who have not had previous surgical treatment, success rates for both of these procedures is about 90%, as measured by pain relief and the ability to wear shoes.

We treat patients who have had unsatisfactory results from cosmetic surgery procedures, addressing persistent problems with bunions and hammer toes, and discomfort arising from toe-shortening procedures, toe removal, and collagen injections. This group of patients may also benefit from both non-surgical and surgical treatment, but success rates are somewhat lower.