Friday, June 22, 2018

Foot Facelift : Cosmetic Foot Surgery

When you stop to think about it, people are strange (cue Jim Morrison and The Doors). The length some of us go to be in fashion is quite remarkable. I said length, but should have said short, because I understand many ladies have been arriving at their friendly cosmetic surgeon to have their toes shortened. Yes, the little pinkies are amputated. For no medical reason but just to be able to fit more comfortably in the lean slick fashionable shoes which are enjoying a new vogue.

Now the idea of a foot facelift is not new and it appears a prominent member of the Royal Family (UK) of yesteryear had his, yes ‘His’, little toes amputated to fit more comfortably into the trim brogues he made so popular in the thirties. By coincidence we are currently enjoying a Renaissance of the glamour period.

According to the late William Rossi in his toe curlingly, funny book on the Sexlife of the Foot and Shoe (Kreiger Press) in fifteenth century Spain, the fashion for broad toe shoes (Bear’s Paw) that measured 12 inches across the ball of the foot with individual compartments for each toe came about because the prince regent was born with polydactilism (six toes). Absence of antibiotics and a high morbidity rates, post-surgery meant the prince was allowed to keep his extra toes and the shoe fashions were changed to accommodate extra width.

The “podiatrist’s delight” did last two centuries and certainly replaced the fashion for long toed shoes (poulaines) but it is unlikely one event at that time would have set the change in foot sartoria across all of Europe. According to contemporary writing and painting the change in fashion took place almost instantly. Communications were poor by modern standards and fashions would in the Middle Ages take decades to pass from one court to another. One tangible explanation is the change in shoe design was necessitated by the presence of disease. Syphilis was rife in the 15th century and a disease sequestrate was severe foot ulceration which would require shoes, like moon boots.

Is the popularity of toe cutting the symptom of a modern malaise? Apotemnophilia is a psychological disorder where the need for amputation of a limb or part thereof becomes an obsession. Today the disorder has a poor prognosis as counselling and pharmaceutical managements have little effect. The lifelong compulsion drives many people to seek amputation but when medical authorities refuse, the individuals will often undertake self-amputation, sometimes with tragic consequences. One cannot help but wonder if “the toe cutter phenomena” is not a fashion folly but a true indication of a popular neurosis.

Can we live without our little toes? Apparently so, indeed many amputees live perfectly fulfilling lives without any toes but this is not recommended if it can be possibly, avoided. Several years ago I did some preliminary research at the Bioengineering Unit at Strathclyde University in Scotland and was amazed to find out how much toes contributed to foot function during walking. The small toes have three little bones which give two knuckles and sometimes osteoarthritis (osteoarthrosis) fuses the knuckle joints and leaves a prominent “sticky up” portion. I am using technical terms now but the condition is usually called a hammer toe. Foot surgeons may remove the joint if it is the cause of extreme pain and or recurrent infection. Pain is usually the sole (excuse the terrible pun), criteria for orthopaedic intervention, or it has been until now.

Cosmetic foot surgery has changed all that in our modern primitive society and now we have the technology to do literally anything to our bodies and that is exactly what we appear to do. The dilemma caused by the bioethics of toe cutting has really challenged the moral codes of the medical profession and what was once frowned upon in orthodox circles is now being openly challenged by an informed public.

Reviewed 22/06/2018

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