What’s the first thing that came to mind when you saw the word “cosmetic” in the title?  Was it maybe breast implants or a face lift, tummy tuck or liposuction?  These are the traditional uses of the word cosmetic and refer to correcting problems in people, who in their opinion, need to look better in order to feel better.  Over the years it has become popular for people who can afford to undergo these same surgeries to enlarge their breasts, tighten the skin of their face to reduce wrinkles, and even remove fat from areas considered to be unsightly.

In the foot people can have unsightly problems and what’s worse pain.  A bunion is a lump on the inside of the foot behind the big toe.  The size can vary and the toe can begin to move closer to and even under the 2nd toe.  When the smaller toes are buckled that is a hammertoe.  Here’s the key:  because we wear shoes, bunions and hammertoes hurt much sooner than if we went barefoot all the time.  Let me make this perfectly clear, wearing shoes does not cause the deformity, but wearing shoes does make a deformity hurt sooner than it otherwise would.

Bunion and hammertoe surgery can be cosmetic, which in my opinion means the deformity will look better after corrected so that you feel better since pain will be gone.  That’s a little bit different from other forms of cosmetic surgery.  When I perform bunion surgery or hammertoe surgery I always keep in mind the fact that you will be walking on the end result for years to come.  Because the bunion and hammertoe develop in an unstable foot I have to make sure the problem does not return.  Face lifts, tummy tucks, or breast augmentation have their long term considerations, but honestly you will not be walking, hiking, or running on these parts of your body.

There are people who want to fit into those 4” spiked heels at any cost.  They want their wide foot narrowed and long toe shortened.  I’m not talking about business executives who have to maintain a specific style of dress in order to advance their career and suffer horrible pain in these shoes.  I’m talking about people who would otherwise have no pain, but insist on wearing these heels for social purposes.  I caution those people who do not have pain!  Foot surgery can result in scar within the joint leading to stiffness and arthritis.  There is no true preventive surgery for arthritis.

One final word.  Recently a Beverly Hills Podiatrist coined the term “Cinderella Surgery” for correcting a bunion, long 2nd toe, and bunionette (on the outside of the foot) so that women can wear their high heels.  He did a very nice piece on the television show, The Doctors.  My problem is this:  I always say, feet are like snowflakes no two are alike, well here is a podiatrist telling women he can perform the same procedures on their feet in every case so they can walk immediately after surgery and their feet will fit into their stilettos.  That is just not possible without making some sacrifices.  To read about these sacrifices that might be made check back every few days for my new articles on cosmetic bunion surgery and cosmetic hammertoe surgery.  

A hammertoe is when your toe buckles or bends as a result of an unstable foot.  This can range from a mild twisting of the toe to such a severe buckling that the toe sits on the top of your foot.  Dress shoes for women and men are not made with ample room for the toes.  When a toe is buckled there is pressure and rubbing of the toe against the shoe leading to pain, redness, and formation of hard skin known as corns and calluses.

Hammertoe surgery has been described in a previous article where I talked about the difference between correcting the 2nd and 3rd toes vs. the 4th and 5th.  To review the 2nd and 3rd toes usually involve toe fusion surgery, while the 4th and 5th involve toe joint surgery where the joint is removed.  Muscles and tendons are often rebalanced around the base of the toe and sometimes work further back in the metatarsal is needed.  Cosmetic surgery on a hammertoe can mean hiding the scar or just the fact that I will make your toe look better.

Many people have one toe longer than the others and consider this unsightly.  Mind you this toe is not buckled and not painful, but some people want this toe shortened.  A doctor might decide to remove some bone from the toe shortening this long toe and performing toe fusion surgery thinking he is making the toe stable.  Unfortunately there are tendons in each and every toe that are not shortened with the toe because tendons don’t heal well.  Tendons rely on being a specific length, for geeks like me that would be 125% of the muscle/tendon resting length, in order to work.  So yes I can shorten your toe and in turn I have just made your toe unstable.  I might have performed toe fusion surgery to make that toe joint stable, but the other joints are not, so your toe buckles and now you have a toe sticking straight up in the air.  Would that be worth it to you?  As the podiatrist who spends a great deal of time fixing poor surgical outcomes, I can tell you it is much more difficult for me to correct this problem.

What exactly do I mean by hiding your scar?  Most hammertoe surgery is done through the top of the toe.  This is beneficial if I have to address the tendons, ligaments, joint capsule, and even bone at the base of the toe or metatarsal.  If your toe can be treated just by toe joint surgery alone than I can make the incision on the side of your toe so that no one will ever see your scar.  The sacrifice I am making to use this incision is that I cannot rebalance the joint in the ball of your foot.  If your toe is buckled and you have pain in the ball of your foot do not expect a scar any where other than the top of your toe.

Cosmetic hammertoe surgery means making your toe look better and relieving pain.  I have talked about some of the risks and sacrifices that are involved in making this decision.  Remember what I always say, feet are like snowflakes, no two are alike.  Your surgery will be different from your friends and it should be.  Don’t forget to read the articles on toe surgery without the pin and recovery from hammertoe surgery.

That unsightly lump or bump on the inside of your foot behind your big toe is known as a bunion.  This is the hallmark of having an unstable foot.  When your foot won’t work in a stable position the bone behind your big toe (1st metatarsal) drifts toward the inside of your foot.  As the bump on the inside of your foot gets bigger, the big toe gradually slips off of the metatarsal and drifts toward the 2nd toe.  Think of it this way:  a table has a broken leg.  That table is no longer stable in that area.  If you begin to stack objects on the table, eventually the weight over the missing leg will build up and the table will tilt.  The bones along the inside of your arch are very important to maintaining a stable foot when you walk.  Having a bunion makes other areas of the foot unstable leading to hammertoes, arthritis in the back part of your foot, heel pain, inflamed tendons, on and on.

Because your bunion involves an unstable foot, surgery to correct the bunion has to take into consideration this issue of stability.  There are many different surgeries for correcting a bunion ranging from simply removing the lump, correcting the bone in various places, or fusing the joint at the base of the metatarsal.  Planning bunion surgery requires a thorough evaluation of your foot at rest, standing, and walking.  At Desert Foot Surgeons, I perform video gait analysis on all patients with bunions.  I am currently involved in a research project that will show other foot surgeons how to determine exactly where to correct a bunion for the most stable result.

Bunion surgery is very complicated because of the stability issue.  Other surgeons promoting aesthetic bunion surgery state that their surgery will work to, “maintain or enhance the mechanics of the foot”.  Many of these aesthetic foot surgeons also tell patients they can walk immediately after surgery.  That means that they are either just removing the bump or correcting the bone near the lump.  Medical research has shown that this approach to bunion surgery makes the big toe less stable leading to further loss of a stable 2nd toe causing a hammertoe and those other problems we talked about above.

My approach to bunion surgery is to use science and apply to your problem.  You and I will talk about the best surgery to correct your problem.  If you cannot cooperate with the recovery I will work with you to get to the point that you can manage the rehabilitation or suggest alternatives.  It is these alternatives that you  need to understand.  When alternatives are chosen you are making sacrifices.  In the case of a bunion you are usually sacrificing stability.  Think of the table with one broken leg.  If you repair the table leg with duct tape the table is still unstable and will eventually tilt and possibly break completely when objects are placed on the table.

As far as cosmetic bunion surgery, the placement of the scar has to allow the surgeon to clearly see the bone being worked on.  I don’t want you to have an ugly scar, so whenever possible I will hide the scar.  But fair warning, the bigger the bunion the less likely it will be to hide your scar.

When considering cosmetic surgery, remember the goal is to make your lump or bump look better and relieve pain.  If the scar can be hidden it will, but the key to correcting your problem is choosing the correct surgical procedure based on a thorough exam including gait analysis.  Performing an alternative surgery requires sacrifices be made on your part and the part of your surgeon.  When all is said and done, a scar, time off your foot, having to perform physical therapy are reasonable things in order to make pain go away and prevent the problem from returning.