If the Cinderella story were a modern-day reality show, the evil sisters might win the day by undergoing cosmetic foot surgery to fit into the dainty glass slipper. Nipping and tucking has now reached the nethermost region of the body, with procedures like laser spider-vein removal and surgical toe shortening becoming more prevalent.
"The population is aging, and people are concerned about their feet looking good," says aesthetic podiatrist Dr. Suzanne Levine, Institute Beauté, New York.
Today's shoe styles are open-toed or have cutouts that expose the feet. And heel heights have "gotten out of hand," Levine says. That's one reason she invented a trademarked procedure called "Pillows for Your Feet," which restores padding beneath the skin.
Our natural padding breaks down with age. "People complain about burning under the balls of their feet," says Levine, vice president of the International Aesthetic Foot Society.
The procedure consists of injecting polylactic acid to plump up the foot, oftentimes so patients - mostly women - can wear "fabulous" footwear, Levine says.
Meanwhile, on the opposite coast, people with abnormally long toes come to Dr. Joshua Kaye's Los Angeles practice from as far away as Asia to have them shortened. It's not about tolerating fashionable shoes but kicking them off without embarrassment.
"The primary motive is usually cosmetic, but oftentimes there are psychological reasons - they're too embarrassed to remove their shoes, or they won't go swimming or take part in beach activities."
Kaye operated on a bride who still hadn't revealed her feet to her husband two months after their wedding.
The American Podiatric Medical Association neither endorses nor condemns cosmetic foot surgery but takes the position that surgical procedures generally be performed to relieve pain, restore functionality and reconstruct deformities.
"This is not different than plastic surgery on any other part of the body," though it is "complicated by fact that it is being performed on a weight-bearing functional structure," says James R. Christina, director of scientific affairs for the APMA, based in Bethesda, Md.
Pillows for Your Feet costs $500 per foot and lasts up to nine months.
Polylactic acid and other dermal fillers typically used for facial treatments are not FDA-approved for feet, so Pillows is a legal but off-label use of the product. Polylactic acid is a material that the human body naturally tries to get rid of, but absorption can take a year or more, says Dr. Saul Trevino, clinical professor of orthopaedic surgery, University of Missouri, Columbia.
"Injections done to the face are less of a problem than if you are actually walking on" the injection site, he says.
The benefits of toe shortening, sometimes called a toe tuck, should be carefully weighed against risks. "The most unpredictable of all podiatric surgeries is minor toe surgery," Trevino says.
Other cosmetic foot procedures that are gaining in popularity include liposuction to reshape chunky ankles, or "cankles"; laser whitening of yellow, polish-stained or fungal toe nails; and "foot facials" that involve skin-softening salicylic acid peels. Medical insurance does not cover these procedures.
Still, some people are willing to pay a princely sum for pretty, fashionably clad feet. Both Levine and Kaye have had patients request foot-narrowing surgery, which neither performs. Levine has been asked to perform liposuction on toes, which she feels is "absurd," and Kaye has turned down requests to remove the entire baby toe to fit into a slimmer shoe.
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