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An estimated 25,000 cosmetic procedures were performed in Britain in 2002 and since 2005 there has been a 54% rise in the cosmetic surgery market in the UK year on year. Inevitably, attention becomes focussed on all aspects of the body and the foot is no exception. Cosmetic foot surgery is gaining a foothold among women who want to look better in shoes, and women’s love affair with shoes is as hot as ever, with over 30% of women wearing a 2-3 inch heel on a regular basis. Many patients with foot deformities, including men of course, remain very embarrassed to expose their feet, for example at the beach or swimming pool and the feet are certainly no less deserved of cosmetic attention than a crooked nose or a broken tooth! Recent media attention has been heightened by an article in the Times, Tatlers and ITV in June. CBS in America covered cosmetic foot surgery on The Early Show, in May, with podiatric surgeons pioneering the surgery.
Patients’ Choices
The health professional undertaking the surgery could be a plastic surgeon, orthopaedic surgeon with interest in the foot or podiatric surgeon. Some surgeons would not advocate or perform cosmetic foot surgery for any reason, but many patients want to make their own lifestyle changes and being unable to wear a fashionable shoe because of deformed feet removes that choice. “With appropriate information and counselling on risks, these patients have a good chance of achieving a satisfactory result” says Harley Street Consultant Podiatric Surgeon, Jason Hargrave. Arguments rage between various factions as to where the line is drawn between reconstructive and cosmetic procedures. It is certainly a grey area and the distinction between the two is difficult to make, for example a bunion (hallux valgus) needs reconstructive surgery to correct it but may only be painful in certain shoes. Either way there’s no getting away from the cosmetic benefit of reconstructive surgery where deformity is aesthetically displeasing for the patient. Rumours of women having their little toe removed so that they can wear very narrow shoes are widespread, although there is no knowledge of anyone having actually done this and it may therefore be just an urban myth.
Beware of your surgeon’s experience in this area!
There are certainly differences in the training and philosophy of surgeons in the sphere of foot surgery. Ultimately it’s the patient’s personal preference. Podiatric surgeons have a vocational degree and train specifically for over 10 years in the lower limb and foot surgery. Podiatric surgeons undergo mandatory reviews by fellow Podiatric Consultants appointed by The College of Podiatrists and are regulated by the Health Professions Council (HPC).
It is important to be aware of the relevant experience and specific training in foot surgery of the surgeon undertaking this work, and whether they regularly update themselves in the field of foot surgery. When did your surgeon last attend a conference in foot surgery?
The foot is a unique structure…
The foot and ankle is a biomechanically complex part of your anatomy and surgery performed on it is peculiarly unique in that it takes your full body weight, and frequently becomes structurally deformed. The use of contemporary and intelligent surgical techniques allows you to weight-bear immediately after the majority of procedures. This area of practice is important because you cannot remove the understanding of foot mechanics, unique to the podiatric surgeon’s training, from the outcome of the surgery and expect to have good results.
Classifying cosmetic foot surgery
Any congenital or acquired deformity of the foot and toes could be classified as cosmetic, although many of these deformities will either be or become painful and disabling at some stage. Painful deformities are classified as reconstructive procedures, although as stated previously, the lines are somewhat blurred. Common examples would be bunions (hallux valgus deformity); hammertoes, mallet and clawed toes; unsightly soft-tissue lumps (e.g. ganglion cyst) or bony lumps and unsightly skin lesions and nail deformities.
Making the informed choice
Most results for foot deformities will be very cosmetically pleasing for the patient but all surgical procedures carry potential risks and complications. It is possible to end up with a straighter foot that is more uncomfortable than prior to surgery! The risks and benefits are assessed by the surgeon for each individual patient, who should be given information on any potential negative side effects. The patient can then make a fully informed decision.
Is it really that simple?
Probably not! Personal decisions by patients on whether or not to subject themselves to cosmetic procedures are always complicated and of course there are always complex emotional drivers for each patient. Cosmetic controversy will always remain, and of course will become more prominent when a patient has a poor surgical result. The Consultant’s job is to provide a safe and competent service; to minimise the risks and fully inform the patient on the range of likely outcomes including the positive and negative side of such treatment.
Jason E Hargrave FCPodS
Specialist Consultant Podiatric Surgeon
www.cosmeticfootsurgery.co.uk
Faculty of Podiatric Surgery 15th-October
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