Cosmetic Procedures in Podiatry

[flyhi]

---

Members do not see this ad.

There is not much on SDN about cosmetic surgery/procedures in podiatry, but from what I have seen, it seems as though it is frowned upon. I am curious as to 1. if this is generally true out in practice and 2. if so, why?

I ask because cosmetic procedures are obviously well-accepted in the allo world - we can get everything from nose jobs, lipo, laser treatments, botox injections, eye lid lifts, glutes, chin, biceps and breast implants, etc... so why would it be any different for our feet? Let's please assume competent podiatrists who are not going to treat just for the sake of treating and cause harm to the patient.

I am aware of one very successful, well-known practice in NYC and actually drove by a Cosmetic Podiatry practice driving around South Beach, Miami.

Shouldn't everyone be able to have pretty feet? Thoughts?

 

[347932]

Let's please assume competent podiatrists who are not going to treat just for the sake of treating and cause harm to the patient.

That's the issue right there. When you are correcting something painful, the hoped conclusion to your care is the patient has less pain and is more functional. With cosmetic foot surgery, you are taking a painless issue and potential causing it to become painful. Especially with foot surgery, do you think the post op outcome is overly cosmetic? Don't get me wrong, scarring is minimal...etc, but to "shorten" toes to get them to fit into shoes is just plain barbaric in me eyes.

It also depends on demographics. I don't think I be able to make a living where I practice on cash procedures. South Beach? Maybe.

 

[dtrack22]

A Dr. recently told me a story of a lady coming into his office wanting a procedure done for cosmetic reasons. He asked if the deformity was painful. When the patient replied, "no" he said, "well, I can make it hurt."

The patient was upset he wouldn't do it. But he gave her the names of some other Dr.'s who he said would do a wonderful job and IMO avoided the possibility of litigation had the procedure been done and the outcome been less than favorable according to the patient.

Patients with unrealistic expectations can be the death of your practice, and since that is the bulk of people wanting cosmetic work done on their feet.......

 

[dtrack22]

One more thing. Think about all of the cosmetic procedures you listed (botox, butts, boobs, lips, etc.) and think about their functionality vs. the feet. Night and day difference if you ask me. Botox is temporary, boob jobs can be redone and if they get botched they might just look bad (there is little consequence outside of the person's image)...screw up somebody's foot, make it painful for them just to walk everyday, perform a corrective procedure that further deforms their foot, etc. Have fun with that.

 

[PADPM]

I believe dtrack's comments are spot on. I don't think it's valid to compare cosmetic foot surgery with breast augmentation, liposuction, etc. The foot is very unique and is a weightbearing structure and surgery usually involves not only skin, but tendons, bones, etc. And then you are weightbearing on the surgical site.

I've always recommended that patients change their shoes to fit their feet, not to surgically alter their feet to fit their shoes. You have to be VERY realistic in discussing cosmetic foot surgery with patients so they understand the significant possible complications that can occur. And despite your reassurance, it will be very difficult post operatively if that patient has a poor outcome or worse, significant pain, when there WAS no pain pre operatively.

When performing surgery of any kind, it's your duty to make sure the benefits outweigh the risks. And in cosmetic foot surgery, I can not honestly say that the POTENTIAL benefits outweigh the possible risks.

I entered this profession to first do no harm, and to make patients more comfortable to the best of my ability and assure proper function. I don't personally believe that cosmetic foot surgery fulfills my philosophies of practice.

Yes, it's certainly a money maker but to me sets a scary precedent. Have you heard of any hand surgeons performing cosmetic hand surgery to allow a woman to wear smaller sized rings? Have you heard of any orthopedic surgeon performing cosmetic arm surgery to allow a patient to wear smaller bracelets? The analogy is NOT off base. All these patients start with a completely healthy and asymptomatic body part and would be subjecting their bodies to surgery that serves no REAL medical benefit.

Everyone can choose how to practice, and I've chosen not to perform cosmetic foot surgery. Apparently the majority of my well respected peers have taken a similar stance, since the APMA, ACFAS, ABPS and orthopedic foot and ankle society have all stated that cosmetic foot surgery is not advocated by these groups.

 

[Sig Savant]

While everyone here is using the definition of "fitting a foot to a shoe", I take a different approach and define cosmetic procedures as fixing something the patient considers ugly. Brachymets cause no pain - isn't a procedure to fix a brachymet technically a cosmetic procedure?

If a person is so afraid to show off their feet that it negatively affects their life, and are willing to undergo physical pain to fix their emotional pain, I would perform that procedure. I understand that amputating a fifth toe to fit a shoe is a little far, but there are examples that are less drastic that are still considered cosmetic.

 

[347932]

Brachymets cause no pain - isn't a procedure to fix a brachymet technically a cosmetic procedure?

Sure it can. I've done plenty that caused transfer pain to other mets as well as submet lesions.

If a person is so afraid to show off their feet that it negatively affects their life, and are willing to undergo physical pain to fix their emotional pain, I would perform that procedure. I understand that amputating a fifth toe to fit a shoe is a little far, but there are examples that are less drastic that are still considered cosmetic.

Good luck winning that case if it ever goes to court...

 

[flyhi]

Thanks for the replies. Interesting. I realize cosmetic surgery to the foot in the form of anything weight bearing carries a different risk than say, breast implants, but MDs also deal with quite a bit of inherent risks and controversial surgeries. Ever seen a bad face lift?

Anyway, good food for thought. Thanks.

 

[347932]

Ever seen a bad face lift?

Nope. Mine worked out pretty well, thanks for asking.😀

 

[dtrack22]

...but MDs also deal with quite a bit of inherent risks and controversial surgeries. Ever seen a bad face lift?

But as long as you aren't negligent during or after the procedure I don't know how you would be liable for that particular bad outcome. I don't know the answer, but I would think that an elective foot procedure (cosmetic) with a bad outcome could still bring a lawsuit, even though the procedure was elective and informed consent was given. Just performing the procedure in the first place seems like it could be construed as "negligent" in court...I'm sure one of the more experienced docs could answer. I'm curious as to the malpractice risks involved.

 

[janV88]

A PURELY cosmetic foot surgery is not something a foot surgeon should perform due to the many documented bad outcomes that can happen.

But I doubt that real world cases are PURELY cosmetic. There MUST be pathology there. What's wrong with a patient whose QOL could benefit from surgery AND chooses to go to a surgeon with better aesthetic technique?

The surgeon is just choosing to modify the procedure (every so slightly) to have a more visually appealing outcome. And they chose to market themselves that way. Doing foot surgery to "narrow" a patients foot without a documentable increased IM angle, etc. is a lawsuit waiting to happen but I don't see anything wrong with a surgeon marketing themselves as being able to provide a "better" aesthetic outcome. Now I do agree that it is deceiving if the surgeon were to "trademark" or claim that a procedure is "new" when in fact it is the same procedure any other podiatrist would.

 

[347932]

There ARE surgeons who do procedures purely for cosmetic reasons in our profession. Shorten toes to fit into shoes. Amps to fit into shoes. If there is no claim of PAIN, the procedure is cosmetic. Plain and simple.

 

[janV88]

There ARE surgeons who do procedures purely for cosmetic reasons in our profession. Shorten toes to fit into shoes. Amps to fit into shoes. If there is no claim of PAIN, the procedure is cosmetic. Plain and simple.

I agree with you. I did not know that surgeons would actually do this without an existing pathology. My response was geared towards the "Cosmetic" podiatrist that I saw on "The Doctors". IIRC the patient they invited to the show did complain of pain, increased IM angle, and her bunion was clearly erythematous.

 

[PADPM]

Once again, when performing surgery of any kind, the potential benefits must outweigh the potential risks. With cosmetic foot surgery, the answer is very simple.

Just because a procedure is what the patient "wants", doesn't mean you won't get destroyed in court. The patient isn't educated enough to make the final decision, the surgeon has the education and supposed expertise to guide the patient to the correct decision.

If a cosmetic case goes sour, just like any other malpractice suit, the surgeon will be held to the "standard of care". And I believe the general consensus remains that the standard of care when performing foot surgery involves treating a pathology to relieve some problem OTHER than cosmetic.

Remember, breast augmentations, lipo, facelifts, etc., are ONLY cosmetic procedures, so the standard changes. (other than breast aug's for pts who had mastectomies, etc) . When a DPM is performing a bunionectomy, hammertoe repair, etc., the standard of care at this time is that those procedures should be performed to address a pathology, not a cosmetic issue.

 

[dtrack22]

Remember, breast augmentations, lipo, facelifts, etc., are ONLY cosmetic procedures, so the standard changes. (other than breast aug's for pts who had mastectomies, etc) . When a DPM is performing a bunionectomy, hammertoe repair, etc., the standard of care at this time is that those procedures should be performed to address a pathology, not a cosmetic issue.

Thanks for the clarification on this