Although we are all the same species, our diverse genetic expressions are limitless. Add to this fact that ‘beauty is in the eye of the beholder’, and you arrive at the controversial and complicated arena of cosmetic foot surgery. The truth of the matter is that there really is no perfect Cinderella story for everyone. For every patient I am able to help with this type of surgery, there is another patient who is not the right candidate or ‘fit’. Ultimately the procedure(s) were either too high risk for overall normal foot function or the outcome from a better procedure simply did not meet the patient’s expectations. That being said, this blog is not denouncing the growing popularity of these Cinderella foot surgery procedures. It is merely to clarify both the connotation of this surgical genre as well as a more realistic view of the ‘foot slimming’ promises out there.
Top 5 Questions Your Surgeon Should Ask You
And that is where the corrective portion comes into play. Again, every patient and their feet are not the same, but there are basic questions that need to be asked each time.
Exactly what structural problem does the patient have?
What is their aesthetic goal or is there a ‘perfect outcome’ expectation?
What is the best procedure and equipment for them? And most importantly, will their foot function and/or pain improve?
Does their overall health and medical profile meet the criteria for anesthesia, healing, and recovery?
Will they have proper care after surgery at home and will either work, shoe type, or exercise affect the procedure outcome longevity?
Toe Straightening, Lengthening, Shortening, and Corn Removal
Digital procedures inherently have a low risk due to the fact that they are not the main weight bearing portion of the foot. But is the patient more interested in a corn or discoloration removal? Is their focus on the infamous ‘hammertoe surgery’? They may want to shorten a long toe that hits the end of their shoe or lengthen a short toe that is forced upward, pressing on the top of their shoes. Performed correctly with some of the better fixation devices today, these surgeries have better long term outcomes and of course, look better as well.
The PUMP BUMP
Another popular procedure is a removal of the “Pump Bump”. The bone prominence at the back of the heel can cause pain and a very unsightly, red area in confined shoes like high heels. The most common area of the back of the heel is more to the outside and not in the center. A surgical removal and sculpting of this bone is quite simple and recovery is only dependent upon the incision healing time. Patients can partially weight bear after surgery and back in shoes in approximately 3 weeks. A problem directly in the back of the heel is a more complicated surgery since it involves the Achilles tendon attachment. The healing time can be extended another 3-6 weeks and complete non-weight bearing is mandatory.
The infamous BUNION
The infamous “Bunion” is by far the most common and sought after correction due to the pressure this deformity places on the nerves and other soft tissue structures against the inside of the shoe. The problems increase with a higher heel dress shoe and aesthetically they prevent many patients from wearing sandals or other open toed shoes. Like the Pump Bump there are a variety of surgeries to correct this problem. Some very simple with small incisions, others with more complexity, longer healing times and larger incisions. Metallic staples, screws and pins may be necessary for some of these procedures, but now we are using dissolvable products as well as natural autographs (bone pins). Smaller incisions and sutures under the skin are also available and non-weight bearing times after surgery average only 3 weeks.
Splaying toes, Toe Spreading, and “Crooked Toes”
Digital spaying or spreading of the toes can be a challenging problem to correct surgically. More than least, the problem involves the side to side instability of the metatarsal-phalangeal joints. Pinning the toes and joints are the preferred methods if joint implants or fusions are not indicated (joint degeneration or dislocation). Recently the plantar plate repair systems that relocate these joints are being used to correct this type of side to side dislocation. Releasing the tight contracted side of the joint and then using the ligament repair kit to reinforce and reattach the dislocated side straightens this joint and can withstand weight bearing forces if performed correctly (WARNING, this procedure contains graphic material).
Foot Slimming and Shortening
As for the ‘slimming procedures’, the mere vagueness of the title puts me on edge. If the aforementioned procedures give the patient a slimmer appearance, then this term is appropriate. The truth of the matter is that removing the prominent bone does not change the size or circumference of the foot. There are more aggressive procedures that involve risky osteotomies (bone cuts) or use cable material to pull the metatarsal bones close together, but they usually do not last. Unfortunately the forces or torque that the foot receives every day with every step are stronger that the materials that ‘bind’ the foot together. However, digital shortening procedures do decrease the length (sometimes a half size or full shoe size in length) of the forefoot depending upon what toe is shortened and how much bone is removed.
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