Is Foot Plastic Surgery Safe?

Last week it was chin implants and this week it is toe tucks.  Butt, boobs, tummy, nose, and thighs are only a few common “problem” areas.  Plastic surgery has become nearly mainstream.   From 2000 to 2006, cosmetic surgeries performed increased by 48 percent and Americans spent over 11 billion dollars a year to better their looks under the knife.  At one time it was the rich and famous who got the occasional tuck and tighten but now it seems like everyone is getting their dose of Botox and surgical “touch ups.”  I now have patients coming in asking for cosmetic foot surgery. 

More popular in Hollywood and New York, podiatric plastic surgery has become the rage among women who have to wear the towering heels.  Why buy a more comfortable pair of shoes when you can get your foot reshaped to fit into the fancy shoes you love!  Clearly justifying their decision with fashion over logic, many are subjecting themselves to the knife, removing bones and sometimes complete toes.  Yes, complete toes.  Amputation of the fifth toe is now a procedure women are asking for so they can better squeeze their feet in the highly unreasonable shoes.  Are there any serious risks to these cosmetic foot surgeries?

Every surgical procedure carries risks.  Even the best surgeon in world has had a complication.  Some are unavoidable, unpredictable or even untreatable without devastating results.  Simply said, stuff happens.  In 2009, former Miss Argentina died after butt enhancing surgery.  This young, healthy, celebrity died of a pulmonary embolism.  Blood clots that traveled to the lungs are uncommon complications after surgery and in foot surgery it occurs in less than 1%.  Still, it does happen and it can be fatal.  This is of course the worst case scenario.  Less fatal but possibly equally devastating are post operative infections.  In young healthy patients, these can typically be treated successfully with antibiotics.  Occasionally, the infection is more severe requiring more surgery, and possible amputation.   Other complications consist of nerve damage, chronic pain, recurrence of deformity, and worsening appearance.  Currently the American Podiatric Medical Association and the American Orthopedic Foot and Ankle Society both denounce cosmetic surgery to the foot due to the inherent risks of surgery far outweighing the benefits.  Many people need foot surgery but such surgical procedures are reserved for people experiencing pain or a chronic deformity.  

We have all been there.   A gorgeous pair of shoes on sale just begging you to buy them,  but they are just a size too small.  If only your foot were a little smaller, a little narrower, if you had one less toe or less toe cleavage, you could make this perfect pair of shoes fit!  Unfortunately a toe tuck or a foot facelift is not the answer.  There are some shoes you just have to walk away from.  If the shoe hurts, it doesn’t fit!!!  It’s better to find a shoe to fit the foot than make a foot that fits the shoe. 

Will I Need Pins in my Toes after Surgery?

It may look and sound crazy but pins sticking out of toes are normal!  You can imagine the disbelief on a person’s face when I tell them they may wake up from surgery with pins sticking out of their feet.  “Don’t worry, I’ll remove them in my office and you won’t feel a thing.”  It sounds crazy but I’m being serious!  Kirschner wire or k-wire is a small pin commonly used in foot and ankle surgery and is routinely used in toesurgery.

A hammertoe is a dreadful toe deformity that can cause pain, discomfort, difficulty fitting in shoe gear and appear unsightly.  Few people can ignore the annoyance of hammertoes because they often progressively get worse over time.  I’ve seen patients have to completely dismember their shoes, cutting holes to allow their toes to fit in the shoe box.  The cause can be complex and is largely attributed to a tendon imbalance caused by an abnormal foot type. The result is bones buckling up on one another causing the knuckle of the toe to stick up in the air.  Most people complain of the knucklerubbing on the shoe and forming corns.  Another common complaint is pain at the tip of the toe that is now bearing more weight.  Pain around the nail can also occurrence because the nail will often rub against neighboring toes. 

Unfortunately, little can be done to treat hammertoes conservatively.  A wider shoe with alarge toe box is the best advice.  Tapingor padding around the toes can help to relieve symptoms periodically but does not treat nor reverse the deformity.  Hammertoe is a common surgical procedure with some variability.  Depending on the flexibility of the toe, sometimes it is only necessary to remove a small part of bone to straighten the toe.  Often, it is necessary to fuse the bones to ensure the toe remains strait.  Toe surgery is performed in a step wise fashion and until the toe is strait.  First the bone is cut to allow more space in the joint.  This is then followed by surrounding soft tissue procedures to completely straiten the toe.  There are several different implants that can be placed in the bone at the joint to fuse the two bones.  These have become more popular over the years and k-wires are being used less, but still k-wires remain the gold standard of treatment.  The k-wire is drilled through the toe to keep it strait during the healing process to ensure a better recover and appearance of the toe after surgery.  The pin is pulled several weeks after surgery and is completely painless.  

It probably still sounds a little funny and maybe a bit scary, but nothing abnormal about waking up from toe surgery with some external hardware.  As I described before, toe surgery is done in a step wise fashion until the toe is strait.  Not all toes surgery needs a k-wire or joint implant.  This depends on the severity of the deformity .