specific ? about cosmetic foot surgery

emailnumber · Oct 8, 2007

I was wondering if any one knew if Illinois podiatric surgeons are allowed to perform cosmetic foot surgery for the sole purpose of making feet look better. I know there are some gray areas to this discussion, but I still wanna hear what people have to say about this.......Let the discussion begin!

NatCh · Oct 8, 2007

emailnumber said:
I was wondering if any one knew if Illinois podiatric surgeons are allowed to perform cosmetic foot surgery for the sole purpose of making feet look better. I know there are some gray areas to this discussion, but I still wanna hear what people have to say about this.......Let the discussion begin!

Allowed? I think all are allowed by law, but most folks don't do it in the name of ethics or fear of malpractice suits.

Nat

mrjbb · Oct 9, 2007

(could be completely wrong)---Guess I was..lol...

Feli · Oct 9, 2007

http://www.acfas.org/NR/rdonlyres/0...8F19E1/0/positionstatementcosmeticsurgery.pdf
"...Surgery performed solely for the purpose of improving the appearance or size of the foot or ankle carries risks without medical benefit, and therefore should not be undertaken."

In my personal opinion, I agree that it's unethical to do pure cosmetic surgery in podiatry. You should want to do surgeries to help alleviate someone's pain or correct a problematic deformity. Surgery jus to perfect the appearance is not needed, and the patients are usually neurotic or hysterical personalities who have unrealistic expectations and recovery timelines (often leading to litigation or disappointment as NatCh suggested). Fixing cleft lip or crazy teeth is one thing since that seriously affects a patient's quality of life, but I doubt any woman can't get dates just because her painless and perfectly functional 2nd toe isn't 100% straight and perfect length. This is a big issue, especially in Miami where there a ton of narcissistic people, but use your head and remember what being a doctor means (Dr. 90210 doesn't count lol).

edit to add:
Plastic surgery is a whole different issue that people often confuse with cosmetic since many docs are trained in both. If you want to use your knowledge of plastics to minimize scar formation while fixing a pathology, the patient will certainly appreciate it and you may prevent a painful or keloid scar. A nice appearance is icing on the cake for a needed procedure... asthetics should almost never be a primary factor in F&A surgery. Just my 2c on the issue...

NatCh · Oct 9, 2007

Feli said:
http://www.acfas.org/NR/rdonlyres/0...8F19E1/0/positionstatementcosmeticsurgery.pdf
"...Surgery performed solely for the purpose of improving the appearance or size of the foot or ankle carries risks without medical benefit, and therefore should not be undertaken."

In my personal opinion, I agree that it's unethical to do pure cosmetic surgery in podiatry. You should want to do surgeries to help alleviate someone's pain or correct a problematic deformity. Surgery jus to perfect the appearance is not needed, and the patients are usually neurotic or hysterical personalities who have unrealistic expectations and recovery timelines (often leading to litigation or disappointment as NatCh suggested). Fixing cleft lip or crazy teeth is one thing since that seriously affects a patient's quality of life, but I doubt any woman can't get dates just because her painless and perfectly functional 2nd toe isn't 100% straight and perfect length. This is a big issue, especially in Miami where there a ton of narcissistic people, but use your head and remember what being a doctor means (Dr. 90210 doesn't count lol).

edit to add:
Plastic surgery is a whole different issue that people often confuse with cosmetic since many docs are trained in both. If you want to use your knowledge of plastics to minimize scar formation while fixing a pathology, the patient will certainly appreciate it and you may prevent a painful or keloid scar. A nice appearance is icing on the cake for a needed procedure... asthetics should almost never be a primary factor in F&A surgery. Just my 2c on the issue...

I think the counter-argument from folks who do cosmetic foot surgery is that many people do feel the need to have work done, and to them it is important whether we feel it is or not. Those patients will seek out someone to do the work, possibly from a Cosmetic Plastic Surgeon who hasn't touched a bone saw since...ever. Why not provide surgery from someone who knows foot function?

I had a request just last week from a patient to do a procedure on an asymptomatic toe. She also doesn't like the appearance of her toe, so I guess that would qualify this procedure as cosmetic. I turned her down, saying that unless there's pain I won't do it. The tricky part there was that on her contralateral foot she does have pain and is scheduled for surgery (5th toe ostectomy for spur, helloma molle present). Her non-painful foot looks and feels just like the symptomatic foot did last year before it became painful. She feels very strongly that her non-painful toe is heading down the same path, and as long as we're in the O.R. why not do it preventively?

It will be a huge financial burden to have to go to the O.R. twice. Between the O.R. fee, Surgeon's fee, Anesthesia fee, and time lost from work she's looking at at least $5K per trip to the O.R. If we do both toes now it will only cost her a few hundred dollars extra for the additional toe. If we wait and do her other toe in the future, say next year, it will cost her another $5K. I can see her point of view too.

Nat

Feli · Oct 9, 2007

NatCh said:
...Those patients will seek out someone to do the work, possibly from a Cosmetic Plastic Surgeon who hasn't touched a bone saw since...ever...

I see your point. Here in Fla, there are tons of other pods who would take the case if an intial pod turns it down, though. Those are also usually opulent cash-paying private patients who will pay a hefty sum also, and I guess I can see the allure of taking the cosmetic cases. Still, I just don't think it'd be worth the risk or bending your own ethical rules.

The (probable) pre-symptomatic patients are the real head-scratchers... you're absolutely right.

cool_vkb · Oct 9, 2007

Feli said:
I see your point. Here in Fla, there are tons of other pods who would take the case if an intial pod turns it down, though. Those are also usually opulent cash-paying private patients who will pay a hefty sum also, and I guess I can see the allure of taking the cosmetic cases. Still, I just don't think it'd be worth the risk or bending your own ethical rules.

The (probable) pre-symptomatic patients are the real head-scratchers... you're absolutely right.

hey feli! iam just curious. Is Florida considered a grand haven for Pods? I mean you know whenever there is some controversy regarding scope or procedures,etc Florida Pods are mentioned some how. he he he! Whats the deal with Florida? Is the Pod Association very active there or its just by good luck?

krabmas · Oct 9, 2007

Feli said:
http://www.acfas.org/NR/rdonlyres/0...8F19E1/0/positionstatementcosmeticsurgery.pdf
"...Surgery performed solely for the purpose of improving the appearance or size of the foot or ankle carries risks without medical benefit, and therefore should not be undertaken."

In my personal opinion, I agree that it's unethical to do pure cosmetic surgery in podiatry. You should want to do surgeries to help alleviate someone's pain or correct a problematic deformity. Surgery jus to perfect the appearance is not needed, and the patients are usually neurotic or hysterical personalities who have unrealistic expectations and recovery timelines (often leading to litigation or disappointment as NatCh suggested). Fixing cleft lip or crazy teeth is one thing since that seriously affects a patient's quality of life, but I doubt any woman can't get dates just because her painless and perfectly functional 2nd toe isn't 100% straight and perfect length. This is a big issue, especially in Miami where there a ton of narcissistic people, but use your head and remember what being a doctor means (Dr. 90210 doesn't count lol).

edit to add:
Plastic surgery is a whole different issue that people often confuse with cosmetic since many docs are trained in both. If you want to use your knowledge of plastics to minimize scar formation while fixing a pathology, the patient will certainly appreciate it and you may prevent a painful or keloid scar. A nice appearance is icing on the cake for a needed procedure... asthetics should almost never be a primary factor in F&A surgery. Just my 2c on the issue...

have you never seen the movie boomerang with Eddie Murphy?

mrjbb · Oct 10, 2007

cool_vkb said:
hey feli! iam just curious. Is Florida considered a grand haven for Pods? I mean you know whenever there is some controversy regarding scope or procedures,etc Florida Pods are mentioned some how. he he he! Whats the deal with Florida? Is the Pod Association very active there or its just by good luck?

I don't know but, I'm about to shadow Florida's Pod Association President... He's real nice but extremely busy... He wants show me a bunch of surgeries and stufff...

Red Head · Oct 10, 2007

i think with Florida, it depends on the location you work in (this is actually for any job in Florida)... Florida is very diverse (I don't mean that in just a culture sense)... if you haven't lived in Florida you might not know what i mean....

the more well known cities seem very different from one another... take for example Miami, Tampa, Ft. Lauderdale, Jacksonville, Naples, Orlando, Tallahassee, Gainesville...

take into account the numerous colleges and college students here UF, USF (go Bulls!), UM, FSU, UCF, NOVA, etc...

also take into account the baby boomers and retired folks here
tourism, theme parks, sports (Marlins, Devil Ray, Dolphins, Buccaneers, Jaguars, Lightning, Panthers ... etc... also college sports, soccer is big here, and minor leagues.... )

Florida is a growing state, 4th largest... soon to become the 3rd largest population wise

your style of living can range from living in the city, suburbia, on the beach, small town, on a farm, or even a boat (and it's not like most other states were everything is spread out... you can find these styles of living located right next to each other)

vincent · Oct 16, 2007

I think that it's unethical for cosmetic surgery in podiatry.

-----------------------------
cosmetic surgery Brazil

narkotiks · Oct 18, 2007

vincent said:
I think that it's unethical for cosmetic surgery in podiatry.

-----------------------------
cosmetic surgery Brazil

i don't. ethics can't be formulated based on regions of the body--it is either ok to change one's appearance or it is not.

krabmas · Oct 18, 2007

narkotiks said:
i don't. ethics can't be formulated based on regions of the body--it is either ok to change one's appearance or it is not.

the foot is not just about appearances. you have to walk on it. I am not against cosmetic foot surgery but I am not 100% for it either. FOr the right patient it is OK. But patient selection is huge, I mean huge.

narkotiks · Oct 19, 2007

krabmas said:
the foot is not just about appearances. you have to walk on it. I am not against cosmetic foot surgery but I am not 100% for it either. FOr the right patient it is OK. But patient selection is huge, I mean huge.

yes, and that is where it becomes grey. one extreme is to walk the thin line between a great customer/patient-v-an addict (not that many people would become addicted to cosmetic foot surgery, but cosmesis in general may be the issue and the foot is just another area to perfect) and the other extreme would be to write off cosmetic foot procedures as unethical and unnecessary. where, krabmas, will you stand in this open field? in other words, what is the criteria you would like met before feeling warm and fuzzy about perfoming on a patient?

whiskers · Oct 21, 2007

PODIATRY is NOT cosmetic surgery.

Cosmetic surgeons undergo a completely different residency.

A Podiatrist may learn a few cosmetic surgery pointers in residency, but they IMO should not be doing any surgeries strictly for cosmetics.

krabmas · Oct 23, 2007

narkotiks said:
yes, and that is where it becomes grey. one extreme is to walk the thin line between a great customer/patient-v-an addict (not that many people would become addicted to cosmetic foot surgery, but cosmesis in general may be the issue and the foot is just another area to perfect) and the other extreme would be to write off cosmetic foot procedures as unethical and unnecessary. where, krabmas, will you stand in this open field? in other words, what is the criteria you would like met before feeling warm and fuzzy about perfoming on a patient?

I probably have already unknowingly done some procedures that are for cosmesis. I have done plenty of hammertoes and a few bunions. Who knows what the patient said to get the surgeon to agree to do the surgery. Patients know what to tell the surgeon to get the insurance to cover the surgery. That being said, I think that most patients really are in pain and have trouble finding shoes to fit. There are those few patients that will come in saying that the toe is funny looking and will then say that it is painful. But they are more concerned with the look of the toe than the pain that only happens in certain shoes.

I cannot say how I will feel about doing purely cosmetic procedures yet. I must figure out how good of a surgeon I will be 1st. Since there is the potential for more pain following the surgery than before with cosmetic procedures on the foot one must be a very competant and technically capable surgeon.

Come to think of it - I did a hammer toe procedure on a patient for a long second toe w/ no hammer toe deformity. Just shortened the toe for better shoe fit.

I also think that any surgery that we perform (trauma, bunion, hammertoe, flat foot) is in some ways cosmetic. For trauma the patient expectation is lower but for an elective procedure even if it is for extreme pain the patient does not want an ulgy scar. Remember the patient must still be able to wear shoes and ulgy scars are typically hypertrophic in nature and can be painful in shoes.

I cannot say for sure what patient or what problem I would consider doing cosmetic surgery for. It would really be case by case and depend on the gut feeling that I get from the patient. I would question why they want said procedure and how many other cosmetic surgeries they have had and what their experience was with those procedures. pain tolerance after wards, how anesthesia was tolerated, are they happy with the outcome, would they get the same procedure again, would they use the same surgeon again?

narkotiks · Oct 24, 2007

krabmas said:
I probably have already unknowingly done some procedures that are for cosmesis. I have done plenty of hammertoes and a few bunions. Who knows what the patient said to get the surgeon to agree to do the surgery. Patients know what to tell the surgeon to get the insurance to cover the surgery. That being said, I think that most patients really are in pain and have trouble finding shoes to fit. There are those few patients that will come in saying that the toe is funny looking and will then say that it is painful. But they are more concerned with the look of the toe than the pain that only happens in certain shoes.

I cannot say how I will feel about doing purely cosmetic procedures yet. I must figure out how good of a surgeon I will be 1st. Since there is the potential for more pain following the surgery than before with cosmetic procedures on the foot one must be a very competant and technically capable surgeon.

Come to think of it - I did a hammer toe procedure on a patient for a long second toe w/ no hammer toe deformity. Just shortened the toe for better shoe fit.

I also think that any surgery that we perform (trauma, bunion, hammertoe, flat foot) is in some ways cosmetic. For trauma the patient expectation is lower but for an elective procedure even if it is for extreme pain the patient does not want an ulgy scar. Remember the patient must still be able to wear shoes and ulgy scars are typically hypertrophic in nature and can be painful in shoes.

I cannot say for sure what patient or what problem I would consider doing cosmetic surgery for. It would really be case by case and depend on the gut feeling that I get from the patient. I would question why they want said procedure and how many other cosmetic surgeries they have had and what their experience was with those procedures. pain tolerance after wards, how anesthesia was tolerated, are they happy with the outcome, would they get the same procedure again, would they use the same surgeon again?

good points. to me, half of the issue seems to be the surgical skill of the doc, not just the patient's desires. if you are an excellent surgeon, adverse consequences could be significantly low, your patient could have incrediblly(?) normal foot function, and thus the issue of ethics would no longer be at question b/c the sacrifices made are not interupting normal foot function. i like where your head's at, krabmas!

krabmas · Oct 24, 2007

narkotiks said:
good points. to me, half of the issue seems to be the surgical skill of the doc, not just the patient's desires. if you are an excellent surgeon, adverse consequences could be significantly low, your patient could have incrediblly(?) normal foot function, and thus the issue of ethics would no longer be at question b/c the sacrifices made are not interupting normal foot function. i like where your head's at, krabmas!

thank you!

ethics are very important when deciding what to do for your patient.

Feli · Oct 24, 2007

narkotiks said:
...if you are an excellent surgeon, adverse consequences could be significantly low, your patient could have incrediblly(?) normal foot function, and thus the issue of ethics would no longer be at question b/c the sacrifices made are not interupting normal foot function...

I'm not sure if I agree here or not.^

It's said that, "If you aren't having complications, you aren't doing surgery."

This is the flier for a conference I'll be attending next weekend:
http://www.podiatryinstitute.com/pdfs/Sanibel07.pdf
You will see on pg5 that many renowned podiatric surgeons are presenting, but Sunday's topic is complications. They happen to even the best.

The bottom line is just that I sure wouldn't want to have to say that I had complications on a patient who was pain-free before the surgery (meaning the surgery was purely cosmetic). That's playing with fire IMO. No matter how technically good you are, you will have complications due to dumb luck or patient noncompliance with post-op instructions. If you are doing the surgery to fix a deformity which is painful, putting the patient at risk for ulcer, etc, then those complication risks are acceptable. If there was no deformity or it's not painful or problematic and the pre-op reasoning is just that Mrs. Jones didn't like her floating toe or didn't like the way her feet looked in her favorite sandals, then the complication risks are not worth it... or at least that's how I feel and how I interpret the ACFAS position statement I posted in my first post here. JMO...

krabmas · Oct 24, 2007

Feli said:
I'm not sure if I agree here or not.^

It's said that, "If you aren't having complications, you aren't doing surgery."

This is the flier for a conference I'll be attending next weekend:
http://www.podiatryinstitute.com/pdfs/Sanibel07.pdf
You will see on pg5 that many renowned podiatric surgeons are presenting, but Sunday's topic is complications. They happen to even the best.

The bottom line is just that I sure wouldn't want to have to say that I had complications on a patient who was pain-free before the surgery (meaning the surgery was purely cosmetic). That's playing with fire IMO. No matter how technically good you are, you will have complications due to dumb luck or patient noncompliance with post-op instructions. If you are doing the surgery to fix a deformity which is painful, putting the patient at risk for ulcer, etc, then those complication risks are acceptable. If there was no deformity or it's not painful or problematic and the pre-op reasoning is just that Mrs. Jones didn't like her floating toe or didn't like the way her feet looked in her favorite sandals, then the complication risks are not worth it... or at least that's how I feel and how I interpret the ACFAS position statement I posted in my first post here. JMO...

All surgeons have complications. Plastic surgeons as well. It is a risk to perform surgery and a risk to have surgery done. You as well as the patient will have to way the risks and benefits.

Patient 1 has a painful 2nd hammer toe. Surgeon performs surgery. Toe gets infected w/ OM. The 2nd toe is amputated. The patient then develops a bunion. This patient does not want further surgery and lives with a painful bunion that is more painful than the original hammer toe.

Patient 2 has an ugly non-painful hammertoe. She wants it fixed so it will not be so ugly in sandals and open-toed shoes. This hammer toe is fixed and patient has no pain besides normal post-op pain. She is happy with the results.

You can not predict to whom or what the complications will be. I do not think that all podiatric surgeons should do cosmetic surgery. I think each one needs to find their comfort zone and practice it.

And when you have to oppurtunity to be the expert witness against me for a cosmetic case - 1st if you do not perform cosmetic foot surgery then you should not be the expert witness and 2nd you were not in the office for the consultations. Just because something is not painful does not mean that it does not bother the patient.

It is the surgeons job to explain the risks and benefits to the patient and allow the patient to make an informed decision once the surgeon thinks that surgery is an OK option.

krabmas · Oct 24, 2007

Something that I saw on the podiatry management website.

RE: Shorten My Feet So I Can Wear These Fabulous Shoes

Today a 67 year old female came to my office. She was carrying a large bag of shoes and told me that her feet did not fit into these shoes and that she wanted my help. I checked the shoes and then her foot and realized that the shoes were a size 6.5 and her foot was an 8. I told her that these shoes were the wrong size. She told me she knew, but wanted to fit into them any way.

She told me that recently got married to an nice 81 year old man whose wife died 6 years ago. When she moved into his home she found a closet specifically designed for ladies shoes which contained 400 pairs of Manolo Blahniks and Jimmy Choo shoes worth over $100,000. She was willing to have surgery to shorten her feet just to wear them.

I told her the surgery could be done to shorten each of her metatarsals, but there would be very serious risks involved. She said, "I'll take the chance." Then I told her I would charge her $ 100,000 dollars for the surgery (thinking this would change her mind). She said she will talk it over with her husband and let me know. I then suggested that she use the $100,000 to buy new shoes, She said she will think about it. Only in Boca Raton.

dpmgrad · Oct 24, 2007

krabmas said:
Something that I saw on the podiatry management website.

RE: Shorten My Feet So I Can Wear These Fabulous Shoes

Today a 67 year old female came to my office. She was carrying a large bag of shoes and told me that her feet did not fit into these shoes and that she wanted my help. I checked the shoes and then her foot and realized that the shoes were a size 6.5 and her foot was an 8. I told her that these shoes were the wrong size. She told me she knew, but wanted to fit into them any way.

She told me that recently got married to an nice 81 year old man whose wife died 6 years ago. When she moved into his home she found a closet specifically designed for ladies shoes which contained 400 pairs of Manolo Blahniks and Jimmy Choo shoes worth over $100,000. She was willing to have surgery to shorten her feet just to wear them.

I told her the surgery could be done to shorten each of her metatarsals, but there would be very serious risks involved. She said, "I'll take the chance." Then I told her I would charge her $ 100,000 dollars for the surgery (thinking this would change her mind). She said she will talk it over with her husband and let me know. I then suggested that she use the $100,000 to buy new shoes, She said she will think about it. Only in Boca Raton.

I could not believe this when I read this in the PM Newsletter in my email today.

krabmas · Oct 24, 2007

dpmgrad said:
I could not believe this when I read this in the PM Newsletter in my email today.

Since I believe in cosmetic podiatric surgery I thought to myself... "what would I say to this patient. Would I consider doing the surgery? would I tell her to get a second opinion?"

JK - I would not even consider doing this.

well... maybe.

Maybe if it was $400,000 worth of shoes.

krabmas · Oct 24, 2007

I forgot to add to one of my above posts....

As a 3rd year student one of the 1st surgeries I observed was for brachymetatarsia and bunion w/ short 1st mets.

after multiple procedures the 16 yo patient had BL lapidi and 4th metatarsals callus distraction w/ mini-rails.

Her only complaint pre-operatively was that she was self-conscious wearing flip-flops. She had no pain.

Post-operatively she had BL elevated 1st metatarsals w/ transfer lesions under the 2nd met heads. She has been dispensed orthotics. Unless she undergoes more surgery to plantarflex her 1st mets she will continue to have pain and calluses. (I would not do Weils on the 2nd mets because then there would be transfers to the 3rd.)

Just something to think about.

I've seen plenty more cases like this where the only complaint was the appearance. The results were typically better.

Feli · Oct 24, 2007

krabmas said:
...It is a risk to perform surgery and a risk to have surgery done. You as well as the patient will have to way the risks and benefits...

...It is the surgeons job to explain the risks and benefits to the patient and allow the patient to make an informed decision once the surgeon thinks that surgery is an OK option.

This is the bottom line IMO^

This is a tricky issue and one that there will always be professional differences of opinion. The PodiatryM article is funny as heck, and I see those kinds of patients quite a bit in clinic down here (usually not to that extreme, but still).

Brachymet, polydactly, syndactly, etc are tricky. They are recognized abnormalities, so I don't really think their correction is considered cosmetic.

specific ? about cosmetic foot surgery

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