With celebrities these days tottering around in seven-inch Christian Louboutin and Jimmy Choo "limo heels", lesser mortals are trying to follow suit at the cost of their sole well-being. Cramming your tootsies into vertiginous death traps is not a good idea. The feet are especially delicate, with 26 major bones, 30 joints and a complex web of nerves and tendons.
Even at three inches high, heels increase the weight on the forefront of the foot by 110 per cent, displacing bones and tissue, according to a study in the Journal of the American Podiatric Medical Association.
But some women are taking drastic steps to indulge their fashion fetish, opting for surgical procedures to get their feet stiletto-ready. A report in T he Wall Street Journal described the menu of services at Beverly Hills Aesthetic Foot Surgery in Studio City, California as an example of how far gone the trend is: there's the trademarked "Cinderella Procedure" - a preventive bunion correction that makes feet narrower; the "Perfect 10! Aesthetic Toe Shortening" that invisibly trims toes that hang over the end of sandals or have to be crushed into tight shoes; the "Foot-Tuck Fat Pad Augmentation" that takes fat from the patient's abdomen and injects it into the balls of the feet to provide extra cushioning for long days on high heels.
A group of American orthopaedic foot surgeons has voiced their objection over these treatments. "Shortening a toe to get into a tight-fitting shoe should not be a standard of care in any physician's office," says Donald R. Bohay, an orthopaedic surgeon in Grand Rapids, Michigan.
Collagen - a natural protein found in skin tissue - breaks down over time and can be replenished with injections, which "fill out" the skin. Requests for filler injections into women's toe pads, balls of the feet and heels have jumped 21 per cent in Britain, doubling last year's figure, according to the Daily Mail. The virtually painless procedure takes about 20 minutes and creates a pillow effect on the foot, eliminating the burning sensation associated with wearing high heels. Nicknamed the "Loub job" after Louboutin, it is administered by an experienced practitioner and costs from £320 (HK$4,000). It doesn't need to be removed or altered once it's been injected, and slight side effects tend to last fewer than 48 hours. Results are said to last up to six months.
These drastic procedures are still relatively uncommon in Hong Kong and the rest of Asia. According to Douglas Horne of Douglas Horne Podiatry Services, this type of surgery is not undertaken by podiatrists in Hong Kong. "I haven't had anyone ask me about cosmetic surgery options in the last year or so," he says. "Personally, I would be very wary of significant surgery purely for cosmetic reasons, as your foot is a complicated piece of machinery which is subject to great stresses and strains."
According to Dr Yeung Yeung, Orthopaedic Surgeon at Matilda International Hospital, the most commonly presented foot complaints are bunion (also known as hallux valgus, or lateral pointing of big toe resulting in prominent medial bone bump) and bunionette (bony prominence over lateral border of fifth toe). Surgery for these foot deformities involve reshaping the foot bone (metatarsal) into a more aligned straight orientation to improve the mechanical balance for proper posture and shoe wear. This is a functional treatment, although the effect of the surgery narrows the width of the foot so it looks cosmetically nicer and is easier to adjust into nicely made shoes.
Says Yeung: "Orthopaedic surgeons don't usually advocate surgery merely for cosmetic reasons or prevention of deformity. Surgical treatments carry risk of surgical site infection; implant irritation, recurrence of deformity or overcorrection, and chronic pain syndromes. The surgical procedure usually takes one to two hours, including both bony and soft tissue balancing procedures. Post-operatively, it takes two to three months for full recovery.
"As the knowledge of medical care improves, the general public is more accepting of surgical treatment, so there is a rise in the trend of this foot procedure. It is, however, still a procedure where we select the right candidate who can gain the benefit of functional improvement so as to make it worthwhile and outweigh the potential surgical risk."
On the flip side, there are people who've genuinely benefited from treatments on their feet that are more commonly associated with cosmetic surgery. For instance, while some women have had Botox injected in their feet to numb their nerves from the pain of wearing high heels or to deaden stinky sweat glands, there are also people who've seen considerable relief using Botox to help with the symptoms of multiple sclerosis or the pain associated with some diabetes symptoms.
Dr Lind Hall of Wayne Foot Specialists in Goldsboro, North Carolina, who has been practising podiatry for 25 years, prefers to leave surgery as a last resort. "I would encourage people to try to find a different shoe before they find a different foot," she says, motivating her patients to think outside the designer box. She reminds them that it's hard to smile if your feet hurt, and "there's nothing more beautiful than a smiling face. Comfort is beautiful."