Cosmetic surgeries on feet taking heat

By Gardiner Harris
The New York Times

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

"I was not going to walk down the aisle in sneakers," said Reese, 60, a 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, newspapers and on television news programs.

But stories rarely note perils of the procedures. For the sake of better "toe cleavage," as it is known to the fashion-conscious, women are risking permanent disability, according to many 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 that his waiting room increasingly is filled with women hobbled by failed cosmetic foot procedures.

More than half of the 175 members of the American Orthopedic 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 soon will issue a statement condemning the procedures, said Rich Cantrall, its executive director.

The American Podiatric Medical Association also is 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., and 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 Levine, a Manhattan podiatrist who 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, of course, long have 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 serious foot problems and knee, pelvic, back, shoulder and jaw pain.

Not only the height of shoes 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 also can cause or worsen claw or hammer toes, a condition in which the smaller toes are bent downward permanently. 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 and an author of the 1993 study.

But an increasing number of doctors are performing delicate, expensive operations to allow women to wear their favorite shoes.

Levine's Park Avenue office, called Institute Beaute, is decorated with cream and rose-colored wallpaper, pictures of Levine with celebrities such as Oprah Winfrey, Katie Couric, Diane Sawyer and Joan Lunden, and framed copies of articles in which she is quoted.

Levine has medium-length blond hair, a striking resemblance to singer Deborah Harry, and often wears fashionable high heels. A public-relations firm schedules her media appearances.

Sitting with a brown Yorkie in her lap, Levine explains that she is "simply fulfilling a need, a need to wear stylish shoes." Although she would not provide specific numbers, Levine said that this year she will undertake 40 percent more cosmetic foot surgeries than she did three years ago.

Among the most common are operations to shorten toes, at a cost of $2,500 per toe, and collagen injections into the balls of the feet — to restore padding lost from years of wearing high heels — about $500 per injection, she said.

"These women come in and say, 'Listen, I just came from my other podiatrist who told me to stop wearing high heels, and I don't want to hear that,' " she said.

As for Reese, she found 2-inch heels that she could briefly wear while walking down the aisle at her daughter's July wedding. She quickly changed into a pair of ballet slippers that she had dyed black and fitted with special supports. She expects, however, that she never will be able to walk barefoot again or wear anything but specially designed shoes.

"I really regret being worried about looking good for my daughter's wedding," Reese said, "because I'll pay for it for the rest of my life."

Copyright © 2003 The Seattle Times Company