Some doctors criticize cosmetic foot surgery

Cutting foot to fit shoes can cause permanent pain

December 07, 2003|By NEW YORK TIMES NEWS SERVICE

Days after her daughter became engaged a year ago, Sheree Reese went to her doctor and said she would do almost anything to wear stilettos again.

"I was not going to walk down the aisle in sneakers," said Reese, a 60-year-old professor of speech pathology at Kean University in Union, N.J. She had been forced to give up wearing her collection of high-end, high-heeled shoes because they caused searing pain.

So Reese, like a growing number of American women, put her foot under the knife. The objective was to remove a bunion, a swelling of the big-toe joint, but the results were disastrous.

"The pain spread to my other toes and never went away," she said. "Suddenly, I couldn't walk in anything. My foot, metaphorically, died."

With vanity always in fashion and shoes reaching iconic cultural status, women are having parts of their toes lopped off to fit into the latest Manolo Blahniks or Jimmy Choos. Cheerful how-to stories about these operations have appeared in women's magazines and major newspapers and on television news programs.

But the stories rarely note the perils. For the sake of better "toe cleavage," as it is known to the fashion-conscious, women are risking permanent disability, according to some orthopedists and podiatrists.

"It's a scary trend," said Dr. Rock Positano, director of the nonoperative foot and ankle service at the Hospital for Special Surgery in Manhattan.

Positano said his waiting room increasingly is filled with women hobbled by failed cosmetic foot procedures - those done solely to improve the appearance of the foot or to help patients fit into fashionable shoes.

More than half of the 175 members of the American Orthopaedic Foot & Ankle Society who responded to a recent survey by the group said they had treated patients with problems resulting from cosmetic foot surgery. The society will soon issue a statement condemning the procedures, said Rich Cantrall, its executive director.

The American Podiatric Medical Association is also likely to formally discourage medically unnecessary foot operations, said Dr. Glenn Gastwirth, executive director of the group.

"I think it's reprehensible for a physician to correct someone's feet so they can get into Jimmy Choo shoes," said Dr. Sharon Dreeben, an orthopedic surgeon in La Jolla, Calif., who is chairwoman of the foot and ankle society's public education committee.

But advocates for the procedures say that critics simply do not understand the importance of high heels. "Some of these women invest more in their shoes than they do in the stock market," said Dr. Suzanne M. Levine, an Upper East Side podiatrist who is widely quoted in women's magazines and has appeared on network television promoting the procedures.

"Take your average woman and give her heels instead of flats, and she'll suddenly get whistles on the street," Levine said. "I do everything I can to get them back into their shoes."

Foot fashion and function have, of course, long been in conflict. Chinese girls' feet were bound to shorten them by bending the toes backward. High heels have been fashionable in the United States for decades, even though they can cause not only serious foot problems but knee, pelvic, back, shoulder and even jaw pain.

It is not just the height of shoes that can lead to damage. A 1991 study found that almost 90 percent of women routinely wear shoes that are one to two sizes too narrow. A 1993 study found that women have more than 80 percent of all foot surgeries, primarily because their shoes are too tight.

Narrow shoes can cause the big toe to bend outward, permanently changing the shape of the bone and causing a bunion, or swollen big-toe joint. Women have more than 94 percent of bunion surgeries, the 1993 study found.

By scrunching up the smaller toes, fashionable shoes can also cause or worsen claw or hammer toes, a condition in which the smaller toes are permanently bent downward. Painful and unsightly corns or calluses often form on the tops of such toes.

Foot doctors disagree sharply over how to respond to such problems. Most advise patients to stop wearing the offending shoes. "It's far simpler to cut the shoe to fit the foot than to cut the foot to fit the shoe," said Dr. Pierce Scranton, a Seattle orthopedic surgeon who was an author of the 1993 study.

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