Cosmetic Foot Surgery

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Cosmetic foot surgery seems to be growing in popularity in New York City. Many podiatrists and orthopedists are against the concept of cosmetic or plastic foot surgery.
In a survey of foot and ankle surgeons, "The majority surveyed (82%) said they thought cosmetic foot surgery was inappropriate."

In late December, after media reports of an increase in cosmetic foot surgery, the American Academy of Foot and Ankle Surgeons warned that the risks outweighed the benefits, and that cosmetic foot surgery "should not be considered in any circumstances."

The American Orthopaedic Foot & Ankle Society, which is based in Seattle, issued a statement criticizing any foot surgery "performed simply to improve the appearance of the foot."

Dr. Nancy Kadel, an orthopedic surgeon at the University of Washington Medical Center stated "The danger is people are starting to view foot surgery as similar to having a pedicure. It's really a lot more involved. There are lots of little nerves in your foot, and surgery doesn't always turn out perfectly."

Yes there are "lots of little nerves in your foot." Yes the foot is functional. But there exists a similar number of nerves in ones face. And ones face is certainly functional. Does this mean that Botox injections should be stopped? Does this mean surgeries to raise a drooping eyelid should only be performed if it is interfering with the patient's vision? Of course not. We only ask that the patient is informed of the risks in an informed consent. Why should we look at cosmetic foot surgery as being any different?

The function of the foot should be a consideration. But the function of the foot is always a consideration when the procedure is planned by a competent surgeon.

 

Hello Dr. Shibu,

I can appreciate the complications of any surgical procedure but surely the foot as a weightbearing structure could potentially hold increased risk of post operative complications when compared to procedures which are both non-weightbearing & soft tissue in nature (eg. many purely cosmetic procedures.)

I understand of the many post op. complications in any surgery swelling and infection are always a consideration.

Therefore is it not plausible that as both a weightbearing & dependant structure the foot would potentially hold increased risk of this?

As nerve injury was the potential damage selected I thought it pertinant to include the following.

Seddon's classification for describing nerve injury.

Neurapraxia -- temporary paralysis of a nerve caused by lack of blood flow or by pressure on the affected nerve with no loss of structural continuity.
Axonotmesis -- neural tube intact, but axons are disrupted. These nerves are likely to recover.
Neurotmesis -- the neural tube is severed. These injuries are likely permanent without repair, and will likely only achieve partial recovery at best.

Annals of Plastic Surgery. 54(2):135-139, February 2005.
Komurcu, Fercan MD; Zwolak, Paul MD; Benditte-Klepetko, Heike MD; Deutinger, Maria MD

Regards,

 

Cosmetic foot surgery will inevitably become 'mainstream', just as all other forms of cosmetic surgery have. It is market driven.

I am sure that the if we scratched beneath the surface the majority of hallux valgus and hammertoe corrections in the last century across the world were, at least in part, driven by a cosmetic desire to improve the appearance of the foot.

Consider the outcomes of this combined orthopaedic/podiatric study from the Nuffield Orthopaedic Centre (including Grahame Lavis) in The Foot from last year:

Factors associated with satisfaction with bunion surgery in women: A prospective study

Jill Dawsona, b, , , Jane Coffeyb, Helen Dolla, Grahame Lavisc, Robert J. Sharpc, Paul Cookec and Crispin Jenkinsona

Abstract
Background
Hallux valgus is a common indication for foot surgery. Over 25% of patients are dissatisfied with the outcome.

Objective
To examine women's pre- and post-surgical characteristics, regarding satisfaction with surgery for hallux valgus (‘bunions’).

Method
Prospective cohort of 95 consecutive female patients (132 ‘foot cases’) undergoing bunion surgery. Baseline interview and questionnaire asked about attitudes to fashion and footwear, plus SF-36 general health survey. At 12 months post-surgery, patients who were ‘very pleased’ with their surgery were compared with everyone else regarding their pre-, peri- and post-operative characteristics.

Results
By 12 months, key SF-36 domains had significantly improved. The 75 foot operations (n = 75/116, 64.7%) were associated with respondents being ‘very pleased’ with their foot surgery. Following adjustment, the odds of being ‘very pleased’ were severely reduced where respondents were not ‘very pleased’ their foot's appearance (p < 0.001), or where foot pain was anything but absent (p = 0.018). There was significant interaction between pre-operative expectations of resumption of hiking/sports activities and range of footwear able to be worn post-operatively.

Conclusions
The perceived appearance of their foot and range of shoes that women can wear, are crucial to womens’ satisfaction with the outcome of bunion surgery. The (total) alleviation of pain is also important.

The Foot Volume 17, Issue 3, September 2007, Pages 119-125

Form is more important than function/pain?

 

I am, on the whole, inclined to agree. And I applaud you for the courage to express this viewpoint. At the risk of getting shot down in flames, never underestimate the power of a woman's attraction towards the elegant shoe ! I learnt this from watching some episodes of 'Sex in the City'. Certainly in the US it is a market drive inevitability. But, and perhaps to a lesser extent the same phenomenon can be see in England, at least in my practice.

Of those foot surgeons surveyed, how many are participating in elective foot surgery?

In reality there are very many cases of elective foot surgical procedures which can be considered, at least in some part cosmetic, from the get go. If the only criteria is problem solving, a great majority of cases can be cured with a well fitted shoe, albeit if this means a bespoke or custom or in some way modified shoe. A high proportion of foot surgery patients will find this, or in fact other conservative alternatives, a totally unacceptable proposition. How can you tell a young woman in her 20's she now needs an orthopaedic shoe for the rest of her life.

I work predominantly in the NHS (socialised health care). I make this distinction only because in this arena there is no pressure to chase a surgical fee. This allows the surgeon the absolute freedom to discuss issues with patients, 'warts an'all'. It is, in some ways, a luxury when compared to the more aggressive open market environment

I have been impressed by the attitude of those patients, who, when faced with a detailed account of potential risks and surgical complications, will opt for the surgery all the same. The 20 % statistic is also regularly cited to ensure the surgical patient can fully understand the issues. They want the surgery all the same. The appearance of the foot, the ability to wear a wider range of shoes and without or less pain, all are critically important issues to patients, within the context of quality of life, both in the personal and professional domain.