If Shoe Won't Fit, Fix the Foot? Popular Surgery Raises Concern

The New York Times—December 7, 2003

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 Non-surgical Foot and Ankle Service at  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.

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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.

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