text: ''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. 
   
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   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. 
   
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   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. 
   
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   ''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.'' ||||| When Dr. Ali Sadrieh, a podiatrist, started Evo Advanced Foot Surgery in Beverly Hills, Calif., 13 years ago, he thought it seemed a little vain for women to ask for surgery because their feet hurt wearing fashionable shoes. 
   
   “Patients would bring in shoes they dreamed of wearing,” he said over tea recently at the St. Regis New York, where he was staying to see New York patients. “On the surface, it looked shallow. But I came to see she needs these shoes to project confidence, they are part of her outside skin. That’s the real world.” 
   
   For Dr. Sadrieh (who was wearing made-to-order Gucci brogues), foot surgery is a fusion of medicine and fairy tale. At his practice, you don’t have a bunionectomy; you have a Cinderella procedure. 
   
   “I had never met a patient who asked for a hallux valgus correction with osteotomy and screw fixation,” he said. “So I decided to create a name that captures the result of the procedure, without all the Latin. The point of the Cinderella: being able to put a shoe on that didn’t fit comfortably before.” 
   
   He also has coined the Perfect 10! (aesthetic toe-shortening — once administered, he said, to a 17-year-old fashion model, so she could wear the shoes her career demanded); Model T (toe-lengthening); and Foot Tuck, a fat-pad augmentation that he said helps with high heels. 
   
   And he is not the only doctor changing the face, as it were, of foot surgery. 
   
   Dr. Neal Blitz, a podiatrist who specializes in aesthetic and reconstructive procedures (including a Bunionplasty) at his private practice in Manhattan, and operates at Mount Sinai Hospital, calls this body part “the final frontier” for those who have had work done on their faces. “My practice has exploded because of Manolo Blahnik, Christian Louboutin and Nicholas Kirkwood,” he said in a recent phone interview. “There’s nothing like opening a shoe closet that’s been closed to somebody for years.” 
   
   Perish all thought of Dr. Scholl’s or Birkenstocks in these waiting rooms. Dr. Oliver Zong, founder of NYC Footcare and self-proclaimed “originator of the foot face-lift and toe tuck,” routinely corrects such conditions as High Heel Foot (a term he coined to describe a deformed foot that’s conformed to the shape of a stiletto), and Hitchhiker’s Toe, (an abnormally large big toe that sticks out like the thumb of a hitchhiker). He recently introduced the phrase “Toebesity,” which he plans to describe on his site, where flashing text promises: “Designer feet for designer shoes.” 
   
   One designer, Cathy Hardwick, who gave Tom Ford his first assistant job, had bilateral bunion surgery from Dr. Richard Frankel, the founder of Park 56 Podiatry, in 2008. “He didn’t want to operate, it was so little,” she said of the bump. But, she added: “It was unsightly and it hurt when I wore certain shoes. A few years later he operated. My foot is perfect now. And I can wear sandals I couldn’t wear before.” 
   
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   Indeed, it’s not unusual for patients to walk into Dr. Suzanne Levine’s Institute Beauté, a podiatry clinic and medical spa on Park Avenue, with a bag full of shoes they can’t wear because of bunions and hammertoes. Victorian boots, Jimmy Choos and Manolo Blahniks are some of the examples on floor-to-ceiling glass shelves. Dr. Levine consults with patients on the designer high heels best suited to their particular feet, knowing, for example that both Prada and Michael Kors make a wider-than-average shoe last. “Some people won’t go to the beach or the pool, they’re so embarrassed about their feet,” said Dr. Levine, who was wearing chunky-heeled Michael Kors bootees during a recent interview. 
   
   Her solutions, described in five books such as, “My Feet Are Killing Me,” include, among others, platelet-rich plasma therapy; stem-cell injections; injectable fillers for metatarsal cushioning; Botox; Dysport; Myobloc for excess sweating. She also advocates exercises for the feet. 
   
   The craziest request she’s received? “Once a patient came in asking for toe liposuction,” Dr. Levine said incredulously. And Dr. Zong said he had a patient ask to have a pinkie toe removed to fit into her shoes. Neither request was granted. 
   
   Dr. Jonathan T. Deland, chief of the foot and ankle service and attending orthopedic surgeon at the Hospital for Special Surgery, is opposed to even less-radical cosmetic procedures. 
   
   “The most important thing about a foot is that is doesn’t hurt you and you can function,” he said. “If we’re just talking about three-and-a-half-inch-heel stilettos that cause pain and if they wear a two-and-a-half-inch heel with no pain, then that’s probably not a good reason to do surgery.” 
   
   Dr. Deland is cautious about injections designed to pad the feet. “If there was an injection that really worked and that lasted, a lot of good doctors would be using it, because it’s a common problem,” he said. “The answer is, there is not. The patient should ask, ‘Hey, doctor, can you give me the article or the reference that shows long-term follow-up for that procedure?’ ” 
   
   But to Annette Healey, an executive vice president in retail services with CBRE, elective bunion surgery felt like a necessity. “Sneakers never worked for my career,” said Ms. Healey. She had elective bunion surgery in 2011 two days after Christmas, “while everyone was away in St. Barts,” she added, so she “could camouflage it better with Uggs.” 
   
   Her orthopedic surgeon, Dr. Craig Radnay, told her that her gait had become increasingly affected by her foot issues and that she was hurting her back. 
   
   Ms. Healey said she can now walk 20 miles in fashionable boots. “If you live in New York, your feet are your wheels,” she said. Though she spends 95 percent of her time in chic flats or wedges, she also wears Prada, Manolo and Gucci heels. But there are limits. “Sadly, I will never get my foot into a Christian Louboutin,” she said. ||||| It’s like something out of a fairy tale: a New York princess can’t fit into her Louboutuins, so she calls her fairy godmother plastic surgeon and he snips little pieces off her feet until her shoes fit like magic! And then she and her shoes live happily ever after. 
   
   As much as this might sound like a plot point in some horror-themed installment of Sex and the City, elective foot surgery is actually a thing that more than a few women are choosing to do. You can get your toes shortened or lengthened, your bunions removed, and even get fat injected into the bottoms of your feet so you have a permanent Dr. Scholls made of flesh, according to the New York Times‘s report on the surgery-for-shoes phenomenon. 
   
   Apparently women get surgery to correct “high heel foot” (when your foot is stuck in the shape of a high heel) or “hitchhikers toe,” (when your big toe sticks out.) Some doctors have even gotten requests for toe liposuction, which they’ve denied. Dr. Oliver Zong, who founded NYC Footcare and coined the term “toebesity,” once had a woman ask him to remove her pinkie toe (he didn’t do it.) 
   
   “Cinderella surgery” is just the latest in a long line of gross things women do to fit into clothes. Some women elect to have botox injected into their calves to slim them down for certain boots and skinnyjeans (although the process is dangerous, because of the major arteries in the legs). People get butt implants to channel Beyonce and J.Lo. Even guys are getting beard implants so they can participate in the lumberjack fad. 
   
   Let’s just take second to remember that in the original Grimm’s fairy tale, the evil stepsisters cut off their heels and toes to try to fit into the glass slipper. Then they got their eyes pecked out by pigeons for being shallow. Just saying. 
   
   [NYT]
target: – How far are women willing to go for fashion? According to the New York Times, pretty far. The newspaper walks a mile in the shoes of a handful of LA- and NYC-based podiatrists who perform procedures specifically designed to help women fit comfortably into designer heels. What types of surgery are women undergoing for the sake of their Manolo Blahniks? Aesthetic toe-shortening, fat-pad augmentation, and toe-lengthening procedures, by way of one Beverly Hills podiatrist, who brands his procedures with names like "the Cinderella" and "Perfect 10!" A Park Avenue podiatrist, who recommends Prada and Michael Kors for women looking for a wider shoe, offers injectable fillers for cushioning and other injections to tame profuse sweating; another NYC practitioner corrects what he calls Hitchhiker's Toe (a case of an outsize big toe) but drew the line at one patient's request: amputation of a pinkie toe to allow for a better fit. And it's not a new trend: The Times checked in on it in 2003, focusing on the "perils on the procedures"—an elective bunion removal, for instance, that ended up saddling the patient with serious foot pain. Time points out that woman are doing other "gross things" for fashion's sake, like Botoxing their calves to make them skinnier, and thereby better suited for skinnyjeans and slim boots. (And then there are these 7 people, who went under the knife in an attempt to look like a celeb.)