The bioethics of podiatry

Michael Cook
27 April 2014
Reproduced with Permission

Bunions might seem ethically uncomplicated, but the burgeoning field of aesthetic podiatry must eventually raise some questions about what constitutes medically necessary treatment. In a New York Times feature , a Manhattan podiatrist says that the foot is "the final frontier" of aesthetic cosmetic surgery. "My practice has exploded because of Manolo Blahnik, Christian Louboutin and Nicholas Kirkwood," says Dr Neal Blitz. "There's nothing like opening a shoe closet that's been closed to somebody for years."

The specialists interviewed by the Times seem to cluster around Manhattan and Beverly Hills. They treat a range of conditions, most of them due to ill-fitting fashionable shoes. The procedures have names like High Heel Foot, Hitchhiker's Toe, Toebesity, Perfect 10! (toe-shortening), Model T (toe-lengthening), or Foot Tuck (fat augmentation).

Is it ethical to allow patients to undergo the discomfort and risk of surgery just to fit into a smaller shoe?

Dr Ali Sadrieh, a Beverly Hills podiatrist originally thought that it was mere vanity. "Patients would bring in shoes they dreamed of wearing," he told the Times. "On the surface, it looked shallow. But I came to see she needs these shoes to project confidence, they are part of her outside skin. That's the real world." (See Dr Sadrieh in a video above.)

Not all foot surgeons are convinced that such procedures are ethically sound. "The most important thing about a foot is that it doesn't hurt you and you can function," says Dr Jonathan T. Deland, of the Hospital for Special Surgery, a New York orthopaedic clinic. "If we're just talking about three-and-a-half-inch-heel stilettos that cause pain and if they wear a two-and-a-half-inch heel with no pain, then that's probably not a good reason to do surgery."