New Fashion Rage: Women Chopping Off Their Toes

[DudeAsInCool]

December 7, 2003

By GARDINER HARRIS

Days after her daughter's engagement a year ago, Sheree

Reese went to her doctor and said that she would do almost

anything to wear stilettos again.

"I was not going to walk down the aisle in sneakers," said

Dr. Reese, a 60-year-old professor of speech pathology at

Kean University in Union, N.J. She had been forced to give

up wearing her collection of high-end, high-heeled shoes

because they caused searing pain.

So Dr. Reese, like a growing number of American women, put

her foot under the knife. The objective was to remove a

bunion, a swelling of the big-toe joint, but the results

were disastrous. "The pain spread to my other toes and

never went away," she said. "Suddenly, I couldn't walk in

anything. My foot, metaphorically, died."

With vanity always in fashion and shoes reaching iconic

cultural status, women are having parts of their toes

lopped off to fit into the latest Manolo Blahniks or Jimmy

Choos. Cheerful how-to stories about these operations have

appeared in women's magazines and major newspapers and on

television news programs.

But the stories rarely note the perils of the procedures.

For the sake of better "toe cleavage," as it is known to

the fashion-conscious, women are risking permanent

disability, according to many orthopedists and podiatrists.

"It's a scary trend," said Dr. Rock Positano, director of

the nonoperative foot and ankle service at the Hospital for

Special Surgery in Manhattan. Dr. Positano said that his

waiting room is increasingly filled with women hobbled by

failed cosmetic foot procedures, those done solely to

improve the appearance of the foot or help patients fit

into fashionable shoes.

More than half of the 175 members of the American

Orthopaedic Foot & Ankle Society who responded to a recent

survey by the group said that they had treated patients

with problems resulting from cosmetic foot surgery. The

society will soon issue a statement condemning the

procedures, said Rich Cantrall, its executive director.

The American Podiatric Medical Association is also likely

to formally discourage medically unnecessary foot

operations, said Dr. Glenn Gastwirth, executive director of

the group.

"I think it's reprehensible for a physician to correct

someone's feet so they can get into Jimmy Choo shoes," said

Dr. Sharon Dreeben, an orthopedic surgeon in La Jolla,

Calif., who is chairwoman of the foot and ankle society's

public education committee.

But advocates for the procedures say that critics simply do

not understand the importance of high heels. "Some of these

women invest more in their shoes than they do in the stock

market," said Dr. Suzanne M. Levine, an Upper East Side

podiatrist who is widely quoted in women's magazines and

has appeared on network television promoting the

procedures.

"Take your average woman and give her heels instead of

flats, and she'll suddenly get whistles on the street," Dr.

Levine said. "I do everything I can to get them back into

their shoes."

Foot fashion and function have, of course, long been in

conflict. Chinese girls' feet were bound to shorten them by

bending the toes backward. High heels have been fashionable

in the United States for decades, even though they can

cause not only serious foot problems but knee, pelvic,

back, shoulder and even jaw pain.

It is not just the height of shoes that can lead to damage.

A 1991 study found that almost 90 percent of women

routinely wear shoes that are one to two sizes too narrow.

A 1993 study found that women have more than 80 percent of

all foot surgeries, primarily because their shoes are too

tight.

Narrow shoes can cause the big toe to bend outward,

permanently changing the shape of the bone and causing a

bunion, or swollen big-toe joint. Women have more than 94

percent of bunion surgeries, the 1993 study found. By

scrunching up the smaller toes, fashionable shoes can also

cause or worsen claw or hammer toes, a condition in which

the smaller toes are permanently bent downward. Painful and

unsightly corns or calluses often form on the tops of such

toes.

Foot doctors disagree sharply over how to respond to such

problems. Most advise patients to stop wearing the

offending shoes. "It's far simpler to cut the shoe to fit

the foot than to cut the foot to fit the shoe," said Dr.

Pierce Scranton, a Seattle orthopedic surgeon who was an

author of the 1993 study.

But an increasing number of doctors are performing delicate

and expensive operations to allow women to continue to wear

their favorite shoes.

Dr. Levine's Park Avenue office, called Institute Beauté,

is decorated with cream and rose-colored wallpaper,

pictures of Dr. Levine with celebrities like Oprah Winfrey,

Katie Couric, Diane Sawyer and Joan Lunden, and framed

copies of articles in which she is quoted. Dr. Levine has

medium-length blond hair, a striking resemblance to the

singer Deborah Harry, and often wears fashionable high

heels. A public relations firm schedules her media

appearances.

Sitting with a brown Yorkie in her lap, Dr. Levine explains

that she is "simply fulfilling a need, a need to wear

stylish shoes." Although she would not provide specific

numbers, Dr. Levine said that this year she will undertake

40 percent more cosmetic foot surgeries than she did three

years ago. Among the most common are operations to shorten

toes, at a cost of $2,500 per toe, and collagen injections

into the balls of the feet - to restore padding lost from

years of wearing high heels - about $500 per injection, she

said.

Her business is taking off, Dr. Levine explained, because

shoes are an increasingly indispensable fashion accessory.

"These women come in and say, `Listen, I just came from my

other podiatrist who told me to stop wearing high heels,

and I don't want to hear that,' " she said.

Many of her patients are youthful, beautiful women who want

to look their best, she said. To prove her point, she

walked into an examining room where Jennifer Cho, a

27-year-old Manhattan lawyer was waiting to have the

stitches on her right toes examined.

Wearing high heels caused her discomfort, Ms. Cho said, and

her toes had begun to curl downward and develop corns. She

saw Dr. Levine on NBC's "Today" program and decided to have

the problem fixed. On Monday, Dr. Levine shortened the toes

on Ms. Cho's right foot, and she is scheduled to operate on

the left toes on Friday.

"This will help me wear the shoes that I want to wear," Ms.

Cho said happily.

Dr. Levine and her partner, Dr. Everett Lautin, said that

critics do not understand that when doctors tell their

patients not to wear high heels, patients do so anyway.

"People say, `why do toe surgery if they work just fine?' "

Dr. Lautin said. "Well, `why do a nose job when your nose

is working just fine?' It's the same thing. People want to

look their best."

The answer, Dr. Positano said, is that "you don't walk on

your face." The foot is a complex network of 26 bones, 33

joints, 107 ligaments and 19 muscles that must support more

than 100,000 pounds of pressure for every mile walked. Even

small changes can unexpectedly undermine the foot's

structural integrity and cause crippling pain, Dr. Positano

and others said.

Even collagen injections have risks. Simone Levitt's toes

are numb because collagen injections into the pads of her

feet damaged nerves. Ms. Levitt was persuaded to get them

because she thought they would allow her to walk freely in

high heels. "Like a dope, I let this happen," said Ms.

Levitt, 74, who lives in the Upper East Side of Manhattan.

Now Ms. Levitt said that she is unable to wear anything but

sneakers and that her feet hurt constantly.

These risks explain why many foot doctors advise patients

to try everything - including never wearing high heels

again - before risking surgery. There are no solid figures

for cosmetic foot procedures, so the American Orthopaedic

Foot & Ankle Society is beginning a study to measure how

common the operations have become.

Critics say that one factor compelling the increase they

are seeing in such procedures is a push by doctors to

expand their practices in areas not covered by managed

care. "People are making a lot of money off of this,

because patients pay in cash," said Dr. Dreeben, the

California surgeon.

Dr. Levine said that insurers pay for many of her

procedures, because patients are in pain. "I'm not looking

to make a killing," she said. "I make a living."

Dr. Reese finally found 2-inch heels that she could briefly

wear while walking down the aisle at her daughter's wedding

in July. She quickly changed into a pair of ballet slippers

that she had dyed black and fitted with special supports.

She expects, however, that she will never again be able to

walk barefoot or wear anything but specially designed

shoes.

"I really regret being worried about looking good for my

daughter's wedding," Dr. Reese said, "because I'll pay for

it for the rest of my life."

http://www.nytimes.com/2003/12/07/health/0...5793087502d1150

[Shawn]

Great concept, self mutilation can be so sexy. :(

"I really regret being worried about looking good for my

daughter's wedding," Dr. Reese said, "because I'll pay for

it for the rest of my life."

Umm, you're a doctor. You might have known better.