The Designer Foot 

The latest trend in cosmetic surgery is elective procedures to beautify women's feet.

Angela Harris' red-painted toenails peek out of her black sandals as she leads the way into her walk-in closet, where about seventy pairs of shoes are stacked neatly in Tupperware containers and shoeboxes. Harris, an Alameda insurance broker with the polished look of a TV anchor, holds up two high heels with barely-there straps covered in tiny beads. "These I'm really looking forward to wearing," she says.

Her excitement comes not because her shoes are new. Rather, she can't wait to show off her new toes. Harris recently shelled out almost $3,000 for cosmetic foot surgery to smooth and straighten her right foot's three middle toes. A self-confessed shoe fetishist, she's an example of a growing trend of women who put their feet under the knife for the sake of fashion.

"Mostly it's females whose primary request is to have some kind of surgery, usually done to the front foot, for the sole purpose of being able to fit into a certain type of shoes," says Dr. Timothy Shea, a Concord foot doctor who occasionally performs cosmetic surgery.

Some women are having their feet surgically narrowed or shaped, but the most common procedures are to shorten long toes, correct crooked toes called hammertoes, or remove unsightly but not painful bunions. Painful bunions or hammertoes can sometimes require surgery, but doctors -- and insurance companies -- consider the procedures cosmetic when patients without pain want surgery simply to beautify their feet.

The trend is new enough that it's hard to estimate how common it is, but a survey of orthopedic surgeons found that 51 percent said their patients had asked for cosmetic procedures. And according to a Web site that promotes cosmetic surgery, foot alterations are growing in popularity. "Just as more exposed midriff areas resulted in desires for tummy tucks, cosmetic foot surgery has been in response to an increase in open-toed sandals and other foot-baring trends," the Web site eBreastAug.com states.

Harris just wanted to be rid of small corns, caused by hammertoes, that she believed marred both her feet, most noticeably the right one. "I like wearing open-toed shoes, but I hate seeing unsightly feet," she says. "My toes in sandals were just ugly."

So she went to Dr. Jeffrey Niccoli, an Alameda podiatrist. After originally warning her against the unnecessary surgery, he eventually agreed to shave down the bones in her right toes. Harris removes her sandal to show off the results: toes smooth and straight enough to make any pedicure model proud.

But not all doctors would have agreed to Harris' request. "It's very controversial," concedes Niccoli, who says he performed the surgery only because it was relatively minor and Harris seemed motivated enough to follow his directions for a safe recovery. "Many doctors frown on it."

Both the American College of Foot and Ankle Surgeons and the American Orthopaedic Foot & Ankle Society have come out against cosmetic foot surgery because complications could cause patients to have trouble walking. And half of the surgeons surveyed by the society say they've treated cosmetic foot-surgery casualties.

"Your face is for show; your feet are for function," says Dr. Sharon Dreeben, chair of the society's public education committee, who opposes cosmetic foot surgery in any circumstances. "If cosmetic surgery on your face goes wrong, you'll have a scar. If you have a scar on your foot, you may not be able to walk."

For this reason, some East Bay doctors say they won't perform the surgery. "I think you're asking for trouble," says Dr. Beatrice Schmugler of Berkeley. "It's permanent once you cut into the skin -- you can never go backward. ... Some people come through surgery just fine. You're rolling the dice."

The side effects and possible complications of foot surgery vary depending on the procedure. They can include joint stiffness, swelling, scarring, infection, and temporary or long-term pain if the surgery is less successful, as well as bone problems or even instability from more serious surgery. Even without complications, doctors say patients can wait anywhere from a week to several months before they can walk regularly or wear normal shoes.

Dr. Oliver Zong is a New York podiatrist who has built his career around cosmetic foot surgery. He offers "toe tucks" to slim the pinky toe and "foot facelifts" to narrow and beautify the whole foot. They aren't cheap -- $500 to $1,500 per toe for the tucks and $7,000 to $15,000 for the full-foot fix -- but Zong says there is no shortage of women willing to pay for feet that fit into Sex and the City fashions.

Zong argues that patients can make their own decisions, once they're armed with information about the potential risks. "It's all elective surgery," he says. "If a patient is interested in it and there's a market for it, there will always be someone to fill that niche." Plus, he maintains, there's a benefit that should be weighed in the balance: the self-esteem women can gain by being able to fit into fashionable shoes.

This argument doesn't fly with Dreeben of the Foot & Ankle Society. "If somebody has a bunion and their self-image is destroyed by that bunion, do you really think the bunion is causing the problem?" she asks. "And will fixing the bunion really fix the deeper psychological problem? Probably not."

Other doctors stake out more middle ground. "If somebody's self-image is improved by straightening a toe, improving a nail, or fixing a bunion, then that's fine," says Dr. Jonathan Steinberg of Walnut Creek. But, for him, toe tucks and footlifts are going too far: "I won't take a foot that's normal but somewhat wide and try to make it narrower. I think that's a horrible thing to do. To me, that's no different than binding a Chinese child's foot."

Most East Bay foot doctors who are willing to perform cosmetic surgery say they will proceed only if patients seriously consider the possible risks. "I tend to dissuade patients from having that done," says Shea of Concord. "If you don't need to have a procedure done, you don't need to have that potential for complications."

But, as the growing legions of facelift, nose job, and breast-enhancement patients demonstrate, customers are willing to risk pain -- and worse -- for beauty.

In fact, most potential foot-surgery customers probably already suffer pain for fashion. At Nordstrom Rack in San Leandro, one of Harris' favorite shoe treasure troves, she surveys rows of women's shoes in a variety of unnatural shapes. There are three-inch heels; long, pointy toes; backless sandals balanced on splinter-thin spikes.

Wandering through this heaven for fashionistas on a budget, Harris picks up and discards pair after pair of foot-torturing beauties. Instead, she tries on shoes that mix fashion and function -- meaning high-heeled sandals with a bit of padding under the toes, or boots with a slightly wider toe.

"I don't ever want to mess up my toes again," she explains. She picks up an especially pointy pair. "I don't know why people make these shoes, now that I know what they do."

What they do is cramp women's feet, leading to corns, bunions, hammertoes, and sometimes more serious problems. Harris' hammertoes were likely brought on largely by the high-fashion shoes that she often wore a size too small. Foot experts believe that stylish shoes account for somewhere around three-quarters of women's foot problems. So it's possible to imagine a kind of nightmare cycle in which women get surgery to look good in fashionable shoes, which lead to more problems that require more surgery.

Harris is determined not to fall into such a trap. Her doctor has fitted her with shoe padding that should stave off future problems, and she resolutely avoids the most insubstantial shoes. Still, she is excited as she fingers black patent-leather sandals with a tiny strap. "I couldn't have worn these before," she muses. "I would have tried, but I would have had to put makeup on my toes."

So, for her, the dangers and the side effects were worth it. She had to keep her feet up for the first week and then wear a surgical boot for two months to control the swelling. Four months after the surgery, she still hasn't risked hitting the tennis courts. But she is pain-free and enthusiastic as she picks out two new pairs of shoes to take home.

And she says she would do it again. In fact, she's planning to. "Some time next year, I'll get the other foot done," she confides.

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