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By New You Editorial
Posted On Aug 23, 2012

In one of his cheeky Ciroc vodka ads, Diddy (as in Puff Daddy) directs his gaze toward the camera and the women of the world, swirls his drink in his glass and states: “Ladies:  Open-toe shoes…if your feet are hanging over the front…your feet are too big.” Well, the ladies are listening. Rather than upsizing their shoes, however, many are shockingly downsizing their feet.

The Foot Facelift, as it has fast become known, involves surgical procedures from shortening or lengthening the toes to shaving off bunions and slimming the feet, and a new guard of podiatrists say there’s growing demand for it. “Everyone wants toes that form a perfect parabola,” says New York City podiatrist Oliver Zong, MD, describing the pretty effect of toes that graduate down from biggest (big toe) to smallest (pinky toe).

Ali Sadrieh, MD, founder of Beverly Hills Aesthetic Foot Surgery in Studio City, California, agrees. He claims he is inundated with requests from women seeking cosmetic surgery on their feet. “A lot of women are embarrassed by their feet, they want them to look better in sandals, to fit into designer shoes, or just to be more comfortable,” he says. Sadrieh estimates that he turns away about 40% of patients because their perceived flaws are too nominal, but he helps scores of others. “We have the technology to do these surgeries now at reduced risks.” But should you?

For Roxanne Marks, 48, a pharmaceutical brand consultant from New York, the answer was yes. Thanks to bunions and a painful pinky toe, the mother of three couldn’t wear her favorite designer heels—Manolo Blahniks—until Manhattan podiatrist Suzanne Levine, MD, fixed both with surgery to narrow her feet. “I knew the bunions were genetic, because even my 10 year-old daughter has one,” she says. “The first two doctors I met with told me to buy bigger, wider shoes, which is just not a good solution. When I found Dr. Levine, I felt like she was the first doctor who ‘got’ it.”  After surgery, Marks wore surgical boots for two weeks and was back in her heels at two months. “The pain is gone, it’s miraculous,” she says. Clearly, some procedures fix real issues and encouraging women to just live with pain and size up in the shoe department isn’t the best approach. Indeed determining what’s a necessary operation and what’s overkill is at least a subjective call.


Some of these popular procedures seem quite extreme, while others (bunion removal, foot augmentation) have been around awhile. Clinics like Sadrieh’s assign treatments clever names, such as Perfect 10, The Cinderella Procedure, and Model T (patients reportedly came up with some of the catchy monikers) while Zong has dubbed his toe slimming procedure the Pinky Tuck. But make no mistake, all (save for Foot Augmentation) require going under the knife. This is how they’re done:

For toe shortening (about $3700), a segment of bone is removed near the joint and then titanium is added to fuse it in the correct position. “This can prevent a too-long toe from buckling and becoming a claw-like hammertoe,” says Zong, referring to the clamped and buckled toes often seen on women in sky-high sandals and actresses striding the red carpet.

Toe lengthening (about $4000) involves releasing ligaments and fusing a custom silicone implant to the bone to extend it, says Sadrieh. It can stretch stubby digits or correct toes that were over-shortened by previous surgery. Toe slimming or straightening (about $1500) is the new answer to little toes rubbed raw by shoes. This procedure differs among doctors but it can include removing calloused skin, scar tissue, or a small piece of bone or fat and straightening the pinky so it fits better in shoes.

Bunion correction (about $4700) involves shaving bony protrusions off inner and outer sides of the feet and sliding angled toe bones back into place. “Over time the toe will angle and point in the wrong direction, spreading the foot, so removing the bunion narrows it,” says Levine. “An osteotomy or controlled cutting of the bone is performed to reduce that angle and then a very small titanium screw is placed behind the metatarsal to hold it in place,” explains Sadrieh. All the above surgeries can be performed under local with twilight anesthesia rather than general; scars are usually hidden between toes; and recovery time is roughly 6-8 weeks (with some of the time spent on crutches or in a surgical boot). For Foot Augmentation (about $1000-1700), doctors inject fat or a filler traditionally used for the face into the balls of the feet to cushion them. Levine pioneered the treatment and trademarked it Pillows for the Feet. She favors the filler Sculptra (made from absorbable suture material), because it helps the injected area re-build its own collagen. “Fillers can also cushion heel spurs and lubricate arthritic joints,” she says, noting that rheumatologists now frequent her teaching seminars, further evidence of how the field is evolving.


Walking on injected “pillows” sounds divine, but look-pretty-in-sandals surgery is best approached cautiously—particularly since there’s no formal training for it.

“The primary function of your foot is to get you around,” says podiatrist Keith L. Wapner, MD, former president of the American Orthopaedic Foot and Ankle Society (AOFAS). “I don’t think you can justify doing surgery on someone who’s asymptomatic in terms of pain and possibly putting them at risk.” The very real risks for these types of surgeries include nerve damage, stiffness, infection, post-surgical pain, scar formation, and potentially losing a toe.
Doctors performing these surgeries are aware that there’s some dissent among the ranks. “They may not agree with it, but women aren’t going to stop wearing heels. It’s a social norm that’s not changing and they want and need these new options,” Sadrieh says, adding that he’s always seeking to improve the patient experience. In addition to giving out post-surgical concierge kits with his cell number, he’s just launched an iPhone app (evofoot) that provides patients with educational videos and quick access to him through email should they have questions pre- or post-surgery.

For Marks the risk was worth it. “Heels make your legs look so much sexier,” she says. “I’m thrilled to be back in them.” The choice for surgery isn’t so surprising, since many women aren’t willing to give up pretty shoes. Maria Sanderson, a 35-year-old Californian who works in the not particularly glamorous field of law enforcement, isn’t immune to the lure either but pain and self-consciousness prevented her from strapping on sexy sandals in her off hours.

“My second toes on each foot were so much longer that they would hang off of the edges of shoes or rub and form calluses in close-toed shoes,” she says. “They’d turned into painful hammertoes, but wanting prettier feet was also part of my decision for surgery, because I live in California where we wear sandals year round.” She elected for toe shortening with Sadrieh, whom she says went out of his way to explain the process. “It took about 45 minutes to an hour for each foot. Recovery wasn’t difficult and the scars between my toes are nearly invisible now. I’m happy beyond belief!”

But what if you don’t want—or truly need—surgery? How can you remain pain-free in heels? In an effort to make high heels more comfortable for more women, Levine has developed a new home-use version of Pillows for the Feet (see sidebar). Other tips: Since feet swell during the day, Wapner recommends shopping for new shoes later in the day. “Also, take time to study the toe box of the shoe—it’s more important than heel height in terms of comfort,” he says. “Choose rounded or squared toe boxes over pointy.”

Dr. Levine advises learning which designer shoes work for your particular feet. “Jimmy Choos and Louboutins run narrow, so they’re good if your feet do the same. But since YSL’s are cut wider, they’re better if you’ve got bunions. And Manolos and Pradas have a particularly comfortable last,” she states. A platform will lessen the incline, but with the skyscraper heights they’ve recently climbed to wearing them is risky business. The ankle is a tri-plane joint, explains Levine. It moves up, down, in, out, and around in circles which can lead to lateral ankle sprains when you’re elevated off the ground. Lastly, don’t ever buy sandals a size too small, no matter how good the sample sale. (Diddy, you’re loud and clear).