Cosmetic foot surgery to wear high heels has been reported in the New York Times newspaper, television and other media. I do have an opinion about cosmetic foot surgery, especially for podiatrists who are performing this surgery, those who regulate the practice of podiatry, and individuals who have gotten or are interested in getting this surgery.
In regards to
Cosmetic Toe Amputation Surgery :
There was an article titled "If Shoe Won't Fit, Fix the Foot? Popular Surgery Raises Concern" by Gardiner Harris in the New York Times on December 7, 2003,
that reported on new cosmetic toe amputation surgery. (This article can be found at www.nytimes.com or
Women are getting their toes (or parts of their toes) amputated in order to wear high-end high heel shoes with pointed boxes, like Manolo Blahnik and Jimmy Choo's.
People have different shapes of feet.
Some women have naturally pointed feet or feet that can easily fit into high heel footwear with either regular or long-pointed toe boxes. Each of their toes is significantly shorter than the one next to it, starting from the big toe and moving towards the little toe. These women are able to wear high heel shoes and especially, high heel boots with pointed toe boxes for long periods of time, even "24x7" (except when bathing).
Unfortunately, most women's feet are not pointed enough for pointed toe footwear. Some women have feet, in which the front parts are squared-shaped.
Their little toe is almost as long as their big toe. Such feet simply can not fit into pointed toe boxes. It is like trying to squeeze a square peg into a triangular hole. However, such feet will fit well in high heel footwear with square or baby doll toe boxes.
Pointed toe boxes can cause excruciating pain and make it impossible to walk (even a few steps). Also, they can cause permanent damage to the front part of the feet, making it impossible to wear high heels ever again.
Furthermore, skin needs air to breathe every now and then. If the toes are pressed together too tightly for a long enough period of time (like a normal 8 hour work day), the skin between the toes can even begin to rot or decompose.
It is my understanding that with cosmetic toe amputation surgery,
the toe is not usually amputated. Instead, the toe is cut open, some bone is removed and then, the toe is sewed back up. Then, the tip of the toe shrinks. The procedure is similar to the way shrunken heads were made in the Amazon (South America). The skull inside the head was removed, leaving only soft tissue.
This procedure usually involves the second toe that may be longer than all of the other toes. Also, this procedure seems less barbaric, brutal, outrageous and repulsive than simply chopping off all or part of a toe.
In regards to wearing pointed toe high heel footwear, some individuals have argued that the shoes should be made in wider widths to fit the feet rather than make the feet fit the shoes. I do not agree with this argument.
High heel footwear in wider (C and D) widths can help people with wider feet,
in the mid-foot and rear-foot (or heel) areas. However, wider widths provide only a little bit of extra space (less than 1/4 of an inch) with pointed toe boxes for the front part of the feet, where the toes are.
Of course, if women have their toes amputated in order to fit perfectly into
the pointed toe boxes, their feet may still be too wide in the middle and rear portions of the feet for the medium (B-) width that these high-end fashion shoes are only made for. The five metatarsals or bones in the each foot can become bunched together, like five pencils with a rubber band around them. When that happens, serious foot problems (like metasalgia and Merton's neuroma) are more likely to develop.
Furthermore, most luxury high-end pointed toe shoes and boots have thin soles that are not suitable for walking on uneven (or rough) outdoor ground surfaces. If the width of the shoes is already too narrow, they may prevent the use of ball-of-foot cushions. So, if these women wear these luxury high-end pointed toe shoes outdoors often, they may develop serious ball-of-the-foot problems and be unable to wear these shoes that they had their toe(s) amputated for.
Missing toes (or parts of toes) cause more body weight to be placed on the remaining toes and other parts of the feet, weakening them and making them more vulnerable to injury. Considering that, the pointed toe shoes may be providing some protection for feet with amputated toes, just as bandages or casings did for Chinese bound feet.
In other words, if individuals with amputated toes walk in shoes with non-pointed (larger) toe boxes or barefoot, their toes and feet may be more vulnerable to injury in their weakened condition. So, it may be necessary for those with amputated toes to always wear their pointed toe footwear, whenever they walk in order to avoid injury and problems.
Also, missing toes (or parts of toes) may affect the person's ability to jog and run. More importantly, all negative effects are likely to be permanent and may last for the remainder of the person's lifetime.
It is better for women to pick footwear with toe boxes that will properly fit the shape of their feet. By changing their preference a little, they can avoid the need for cosmetic toe amputation surgery.
I have written extensively about the importance of getting properly fitted footwear (in terms of length, width, and toe box) to help avoid numerous serious foot problems that are related to high heel footwear. People need to get shoes that fit their feet, rather than keep trying to make their feet fit the shoes.
In the past few years, there have been many more new shoe and boot styles with larger toe boxes (including semi-pointed, round, tapered-pointed, square and baby-doll) and heels up to 4 inches high. High shoe designers and retailers deserve a lot of credit for making them available.
However, some high-end labels only have shoe styles with pointed-toe boxes,
which contributes to this overall problem. Also, shoe designers and retailers still need to make available more styles of shoes and boots with larger toe boxes and heels over 4 inches high.
High heel footwear with long pointed toe boxes by Manolo Blahnik, Jimmy Choo and other similar high-end shoe retailers have truly become "luxury" items and
status symbols for today's women. This is not just my opinion. When asked "what do you find luxurious?", actress Joy Bryant answered
"Getting a facial, manicure and pedicure. And wearing Manolo Blahniks - like every girl, I love those shoes." in Movieline magazine (December/January 2003 issue, page 10). This can only increase women's desire to undergo drastic surgery (if needed) to wear these shoe styles.
Unfortunately, if one studies high heel shoe styles over the past few centuries, they will realize that Manolo Blahnik and similar shoe styles are sure to go out of favor at some point in time. I expect a brand new high heel shoe design (that may not have a pointed toe box) to succeed them, rather than an old design come back into vogue.
However, it is highly unlikely for high heels with pointed toe boxes to go completely out of style at any time. The "classic pump" with 2.75 to 5 inch high stiletto heels and regular pointed toe boxes will always be in style.
Some people are feet lovers. Besides loving to kiss and lick women's high heel shoes, they also like to kiss and lick women's feet. These people may find feet with amputated toes that are horribly disfigured to be unappealing.
Feet with missing toes can also be an eyesore to anyone who looked at them.
So, it can be inappropriate for people with missing toes to wear open-toe shoes
and sandals in public.
Of course, if the surgery is done in such a way that the feet still look esthetically pleasing afterwards, then there is no concern. The way the feet will look after surgery should always be a concern for the surgeon and the individual getting the surgery.
It was surprising to discover that podiatrists, including Dr. Suzanne M Levine (located at Institute Beauté on Park Avenue) and Oliver Zong, DPM (located in the Wall Street area) in New York City, are performing what has been labeled "cosmetic toe amputation surgery". However, it is more surprising that real women have paid considerable amounts of money, reportedly $2500.00 US per toe amputation, for the surgery. This included an (obviously intelligent) 27 years old female attorney.
Unfortunately, the news article seems to indicate that some of the women who have gotten cosmetic toe amputation surgery have encountered bad problems. Now, according to AOFAS President Glenn B. Pfeffer, M.D., San Francisco, CA (at
http://www.aofas.com/ ) "Complications can include infection, nerve injury, prolonged swelling of a toe, and even chronic pain with walking". That reminds me of the serious problems and misery that women encountered in the first 30 years of breast augmentation and implant surgery.
The one real concern with cosmetic toe amputation surgery is that it may be flawed and often fail. Someone in authority needs to do a detailed investigation quickly and determine the success/failure ratios for this type of surgery. I would suspect that it may depend on which toes (or parts of toes) are amputated.
In regards to Collagen Injections into the Balls of Feet :
The article (mentioned above) titled "If Shoe Won't Fit, Fix the Foot? Popular Surgery Raises Concern" by Gardiner Harris in the New York Times on December 7, 2003, also mentioned collagen injections into the balls of feet.
I first read about this surgery first in USA Today on 14 November, 2000. It was referred to as "cool zap" and did not mention anything about collagen.
The natural pads in the balls of the feet can wear out in some instances. Ball of feet cushions can be used to prevent this problem as well as remedy it.
The idea of repairing the foot pads was brilliant. Unfortunately, collagen injections do not appear to work with good long term results.
Perhaps, with more research:
a better material can be found or developed for injection.
a special shock adsorbing material can be found or developed that can be surgically pasted to the bottom of the toe and metatarsal bones (in the front part of the feet). Consider the fact that some real people have had metal plates attached to their skull and other bones in their body,
"beautiful, flesh-colored and breathe-able ball-of-foot cushions", that can be permanently attached to the external parts of the bottom of the feet, can be invented.
The need for this type of surgery can be avoided or minimized, if all high heel shoes and boots were made with thicker soles and/or built-in high-quality ball-of-foot cushions.
In regards to Cosmetic Foot Surgery In General :
The news article reported that a medical foot organization was planning to "condemn" cosmetic foot surgery, while another medical foot organization was planning to "discourage" it because of many failed cosmetic foot surgeries.
Unfortunately, the article did not mention which types of operations are failing and what percentage of them. However, the operations seemed to include "cosmetic toe amputation surgery" and "collagen injections into the balls of feet".
To "discourage" such surgery will be as useless and ineffective as advising people to not wear high heels (as these medical foot organizations did for decades). To "condemn" would be almost as useless as to "discourage". "Prohibiting or making cosmetic foot surgery illegal" might be better, but there are quack doctors down in Mexico. Some of them may offer cosmetic foot surgery, if it became illegal in the U.S.A..
Obviously, failed foot surgeries raise a lot of concern and rightfully so.
However, Dr. Suzanne M. Levine (who wears high heels herself) has offered a tough defense for doing these operations.
I agree with Dr. Levine's arguments and support cosmetic foot surgery in general. Like all cosmetic surgery, cosmetic foot surgery is useful for the correction of birth defects and reconstruction of body parts that are injured in accidents. However, I am NOT advocating nor recommending anyone to get cosmetic toe amputation surgery to wear a particular style of high heel shoes
with pointed toe boxes.
The fact that there has already been women who have elected to get cosmetic foot surgery and paid hefty fees shows that there is a demand for cosmetic foot surgery. However, better regulation (on state, federal and international levels) is clearly needed. Every new cosmetic foot surgery procedure should be performed on an experimental basis only in conjunction with a podiatric medical college faculty, until the procedure has a proven track record of success.
All new cosmetic foot surgery procedures need be well documented and follow-up post-analysis done, so that key statistics, like rate of successes/failures, can be computed. Furthermore, there should be laws requiring that these statistics be published and made available free to the public.
The real concern about cosmetic foot surgery is whether or not each particular cosmetic foot surgery procedure can normally be done with good or favorable long term results. If a high percentage (20% or more) of a particular cosmetic foot surgery procedure is failing, then that procedure should be banned or outlawed internationally. However, if only a small percentage (less than 20%) is failing, then refining may be all that is needed.
Unfortunately, the latest studies and reports indicate that the cosmetic foot surgery operations discussed above are failing. The complications are horrific and potentially crippling.
Finally, individuals who undergo any type of cosmetic foot surgery should be aware of all of the risks that are involved. Patients should find out everything known about the surgery including all the pro's and con's.
They should also get a second opinion from a surgeon who is opposed to such surgery and perhaps, treated failed cases. Furthermore, they should be aware that some surgeons may be better (have more experience and/or skill) than others.
with great interest me and my girlfriend have read your website and your
opinion on elective foot surgery for being able to wear High Heels. I am a
friend of the 1960’s and of course of the super-pointed shoes of this time.
My girl is doing me the favour to wear pointed toe-shoes, but for the
vintage-shoes from the 1960’s, which I collect, her feet are not yet right
shaped. This is a pity, I think she started too late (with 19 years) wearing
heels and pointed toe-shoes, so that her feet could not properly “grow” into them.
It seems, that the surgery-procedures are really expensive and only
available in the US. From my knowledge about the 1960’s I know, that many
woman, who suffered from overlapping toes in this time, caused be the
super-pointed shoes, had the toe amputated in the traditionally way. And I
remember a elderly Lady, I have seen in the summertime, wearing high heeled
sandals. That she had only 8 toes left, you could only be aware, if your are
really looking exact, like I did.
The traditional way of amputating is much easier to practice I think and in
the east-neighbour lands of Germany cheaper (I my girl is willing to do me
the fovour). My question is: Do you know which toes should be removed,
better the second ones or the third ones?
The lady I have seen had on the left side the second and on the right side
the third removed, because these were the overlapping ones. But the
overlapping-process took years and was very painful, what I would like to
spare the tender toes and feet of my beloved girl.
Thank you in advance
What kind of a narrow high heel shoe allows one toe to sit on top of another?
As far as I know, most of the super-pointed-toe-shoes from the early 1960ties allowed this. 1961/1963 the fit of the high-fashion-shoes was extremely narrow and in some way absurd looking, that is the man reason, why I (and my girlfriend) find these shoes very sexy. (In this time, a lot of women permanently altered their feet through these shoes).
I once visited a factory for shoe-lasts in Germany (Fagus in Alfeld an der
Leine) where they had displayed some shoe lasts from this period and the
shoes that were made on these. On of the employees of this small exhibition
was an retired worker, who remembered this time very well. He told me that
the owner of this factory was very interested in "health-care" of the foot
and he tried to refuse the wishes of the fashion firms, but business was
business also in this time.
He said that in the peak period of this fashion 1962 the shoe lasts of some
Italian shoemakers had nearly no difference between the left an the right
shoe - a step backwards to the 18th/19th century, where shoes were made from
one last and the wearers had to "break them in". He said that these 1962
shoes were nearly unwearable (maybe that makes these vintage-shoes so
fascinating for me (and so painful for my beloved) and the "pointed" shoes
from today with the longer toe-box so boring).
The toe-boxes were much shorter then today and so the pressure from the
forefoot was much higher. If a girl/woman wanted to keep the shoe in shape
(which of coarse most of them wanted) she could not dilate them at the side
- the only trick was to stretch them in the middle/top so that the squeezed
toes had a bit more space.
I the meantime I read an old german book about surgery of the foot and leg
(Georg Hohmann: Fuß und Bein. Ihre Erkrankungen und deren Behandlung, München 1948 (4th ed.)), where is mentioned that one should better not remove the fifth toe, even when severely hammered, but that it is possible to abscise overlapping toes to get the women some relief from pain. But I don’t want my beloved girl to have to suffer unnecessary pain.
J.L. - (Montag, 27. Dezember 2004 19:03)
I selected your email for reply because you mentioned some new interesting points:
<< I am a friend of the 1960’s and of course of the super-pointed shoes of this time. >>
I am not familiar with these German shoes. In regards to the 1960's, all I can think of are pictures of Playboy bunnies wearing their pointed-toe high-heeled pumps. However, many of these Playboy bunnies worked entire shifts in Playboy clubs wearing their pumps so that their pumps could not be so painful and un-wearable.
The most narrow pointed-toe shoes that I have seen were those sold by Fredericks of Hollywood (whose customer base was mostly skinny young women) in the 1990's. Their pumps had genuine leather soles, full 5 inch heels, metal heel tips (just the tips were metal) and were much closer to A (or narrow) width than C (or wide) width.
<< I think she started too late (with 19 years) wearing heels and pointed toe-shoes, so that her feet could not properly “grow” into them. >>
I mentioned in my book "All About Wearing High Heels" that females grow until they are 21 years old and that it would be best to wait until then to wear high heels. One of the reasons is to not stunt the growth of the feet. The process of Chinese foot-binding proved that it is possible to stunt the growth of feet. It is better to allow the feet to grow as long as they can because the longer the feet, the higher the heels one can wear.
I believe that women have all different shapes of feet (including pointed feet that fit well in pointed-toe high heel footwear) because of DNA (or genetics) rather than feet shaping. However, the idea of feet shaping during the growing years is interesting. While it might be possible, it would probably require the constant use of the desired shape of shoes and that could be painful (like Chinese foot-binding).
<< these 1962 shoes were nearly unwearable (maybe that makes these vintage-shoes so fascinating for me (and so painful for my beloved) and the "pointed" shoes from today with the longer toe-box so boring). >>
While the long pointed-toe box is not as sexy as the regular and traditional pointed-toe box, I find high-heeled shoes with the long pointed-toe box to be very sexy and I know that many people agree with me. Just count the number of male heads that turn at the sight of Manulo Blanik, Jimmy Choo and look-a-like shoes. Also, if I am not mistaken, the long pointed-toe box appeared in the United Kingdom as ultra-sexy "fetish wear" long before they became "fashion wear" with Manulo Blanik's shoes.
<< Do you know which toes should be removed, better the second ones or the third ones? >>
I do NOT know which toes to remove. I can only comment that:
In many places in the United States, a 19 year old is a minor unless married.
I do not know what the laws are where you live in Germany. Unless your girlfriend is a legal adult or married to you, elective toe amputation surgery may be a legal issue.
Again, I do NOT advocate nor recommend any kind of toe amputation or shortening surgery to fit a certain type of shoe. It is much better and wiser to wear only properly fitted shoes, especially if they have high heels.
John, I suggest that you have your toes amputated before encouraging your girlfriend or anyone else to do so. I am certain that it will not be a pleasant experience. However, if your girlfriend still wants to get traditional toe amputation surgery to wear your super-pointed shoes on her own free will (her choice and her choice alone), then I would respect her freedom of choice to do such a shocking thing.
In regards to feet, nothing will shock me as much as the documentary "Splendid Slippers" written by Beverly Jackson about Chinese girls getting their feet bound. With that in mind, all women who get cosmetic (or traditional) toe amputation surgery should document their experience (in some form that is available to the public) so that others, who follow in their footsteps,
can benefit from such knowledge. Also, they should provide some proof (e.g., photos of the feet) so that we know that it is not a hoax.
While I have seen some of the women who had cosmetic toe amputation surgery on television shortly after their surgery, I am more interested in follow-up reports (perhaps, about every five years). The long-term results of their operations are more important than short-term results.
If the second toe is removed, it may increase the possibility of developing a bunion. A bunion can become so painful that it becomes impossible to walk.
If the fourth toe is removed, it may increase the possibility of developing a bunionette. A bunionette cam become so painful that it becomes impossible to walk.
The cosmetic foot surgeons in New York have been trimming toes so that each foot becomes pointed in shape. Each toe is significantly shorter than the one next to it, starting from the first (or big) toe and going down to the fifth (or shortest) toe.
This is important. If your girlfriend's feet are not pointed to begin with,
then amputating any of the inner toes will be useless.
High heels increase the pressure on the ball of the foot (or front part of the foot). So, if too much of an inner toe is amputated and there is an empty space, it might cause the toes next to it to collapse (or break) and become a serious problem.
Since toe amputation surgery is irreversible, all women getting elective toe amputation surgery should think about the long term implications and the need for lifetime commitment before surgery.
As I documented in my book, women who have the most success wearing high heels throughout their lifetime are careful to avoid accidents and injuries. That includes wearing only properly-fitted shoes.
Even if great results are guaranteed, toe amputation surgery is not for everyone. Only women who truly love the look of pointed-toe footwear and are totally willing, dedicated and committed to wearing ONLY the pointed-toe footwear for the remainder of their lives should ever consider elective toe amputation surgery.
Again, the pointed-toe shoes that toes are trimmed for may provide some protection (as bandages or casings did for Chinese bound feet) and should probably be the only shoes worn after the feet heal from surgery. Amputating or shortening any toe will weaken the feet structurally and make the entire foot more vulnerable to injury.
In other words, if toes are trimmed to fit pointed-toe footwear, then the pointed-toe footwear may become the ONLY properly-fitted footwear for those feet. Walking without the proper casings can lead to serious and irreparable damage to the surgically-altered and structurally-weakened feet and leave their owners hobbling around for life. Perhaps, this is one of the reasons why cosmetic toe amputation surgery cases may fail.
<< I read an old german book about surgery of the foot and leg (Georg Hohmann: Fuß und Bein. Ihre Erkrankungen und deren Behandlung, München 1948 (4th ed.)), where is mentioned that one should better not remove the fifth toe, even when severely hammered, but that it is possible to abscise overlapping toes to get the women some relief from pain. >>
A doctor in 1948 can be considered incompetent, unqualified or a quack by medical standards today. Nowadays, overlapping toes are taped down and straightened out. If that was not possible (e.g., to wear super-pointed toe shoes), then I would suggest cutting holes in the shoes directly above the overlapping toes to get some relief from pain.
J.J. - January 2, 2005
In regards to the last email, I came across an interesting picture showing a woman's fourth toe overlapping the fifth toe on one foot wearing open-toe sandals. I have seen this same woman wear pointed-toe high heel pumps and boots. So, the problem is probably temporary and caused by the toe strap being too narrow for her feet.
J.J. - May 11, 2005
Why would any one want to have surgery on their feet? Just to fit in some high heel shoes that they like! For one thing I would not do that for any reasons in my life. The reason I would not do that is if you wear different kinds of shoes
then your feet would look weird and everyone will ask "what happen to your feet and why do they look like that?" Then you would have to say "Oh I saw a pair of shoes I wanted and my toes where to big so I thought I go cut some of my toes off so that my feet would fit in the shoe." And how stupied would you think they thought you where now just so you can have a pair of shoes that you wanted. That is why I think it is so stupied to do and I don't care how great the shoes are, I still wont do it.
B. - 12 Feb 2006
<< Why would any one want to have surgery on their feet? >>
They "love" the look of these style of shoes, "love" to wear these style of shoes and/or want the extra attention that they will get from people looking at them wearing these style of shoes.
I agree with you. It would be wiser for these women to simply wear "other styles of high heel footwear with bigger toe boxes that fit them perfectly" than to get cosmetic toe amputation surgery.
One of Dr. Sudrich's patients, a young woman had bandages around her toes on both feet.
A photo of her feet before surgery was shown. The second toe was longer than the big toe on each feet.
At the end, Dr. Sudrich removed the bandages to show shorter middle toes on each foot.
Basically, this doctor cuts open each toe to be shortened on its side.
Then, (comes the new twist to cosmetic toe surgery when)
he removes some bone between the toe and replaces it with a fixation devise (or special rod-like object).
Note that there are x-ray photos of the before and after feet at both of the above web sites.
I am providing this information strictly for informational purposes only.
I am not recommending nor condemning this type of surgery.
After seeing this program, I had a number of concerns.
The fixation devise connecting the bone at the tip of the toe to the remainder of the toe or metatarsal bone
appeared to be made of metal (???). Metal conducts heat and cold. That could present a problem when taking
hot baths and walking outdoors in very cold weather.
I remember walking outdoors in very cold weather and ending up with feet that felt frozen many times.
If the fixation devise is made of metal, the person may develop frostbite more easily and need to have her toes amputated.
Affected person(s) should be very cautious and probably wear Polarwrap Toasty Feet Insoles (or similar stuff)
and/or platform shoes/boots in very cold weather.
When Dr. Sudrich removed the bandages off of the lady's feet, the second toes appeared to be equal in length
compared to the big toes. I wondered why he did not make them a bit shorter. As I previously written,
women with pointed feet (in which each toe is shorter than the one next to it, from the big toe down to the pinky toe)
have the easiest time wearing pointed toe high heel footwear (especially, with ultra high heels).
With simple observation, you can see that the big toes always work their way towards the center point
of pointed toe high heel shoes. If long enough, the big toes will eventually appear at the opening of high heel shoes
that have small "peekaboo" openings at the center of the toe boxes.
All of the other toes end up squashed, facing the outer edge of the shoes.
I was concerned about the point at which each foot bends (between the ball-of-foot and the remainder of the foot),
while wearing high heel footwear. If any fixation device were to be at a bend point,
it might rip through the skin under the toe (due to the tremendous amount of force placed on the
ball-of-foot when wearing high heel shoes).
Also, to help prevent this problem, I wondered if the patient had her feet x-rayed before surgery,
while wearing the pointed toe high heel shoes that she hoped to wear after surgery,
to give the doctor a better idea of how much real bone would be needed in each toe
in forming the ball-of-foot in the high heel shoes.
Also, note that the higher the heels (especially, with ultra-high heels), the shorter the ball-of-foot may become
and/or more stress on the ball-of-foot. So, the question is how will the remaining bone in each shortened toe
hold up to the stress?
If anything goes wrong after surgery (especially with the bones that the fixation devise is connected to),
it may be difficult and possibly, impossible to repair. So, I would regard this as very high risk surgery.
Of course, if everything goes well and works well, then wonderful. However, if this surgery fails or the remaining bone
ever breaks (or crumbles), then the person may have trouble walking and experience lots of pain for the
remainder of her life.
If I were to get this type of surgery, I would require references from at least two other patients,
who had the same type of surgery at least 14 months earlier. Also, I would only get the surgery from a doctor
who follows up with his patients at least 14 months after surgery.