Cosmetic Foot Surgery—To Cut or Not to Cut

In today’s search for a more beautiful appearance, some are turning to podiatrists requesting cosmetic procedures to “fix their feet.” Unsightly bunions and hammertoes are usually the reasons behind such requests. Cosmetic foot surgery brings up an ethical dilemma for the surgeon.

The surgeon’s perspective
The patient may think that they need surgery, but there can be unforeseen complications. Every surgical consent form has a list outlining possible complications. These complications don’t always happen, and some happen less than 2.5% of the time. Besides this non-exhaustive list, the surgeon must assess the risk vs. benefit for the patient. Consider that the normal reasons to undergo most surgery are: pain, ulceration, progressive deformity. The goal of the surgery is to reduce the pain, and eliminate the deformity causing the pain. What if you don’t have pain to start with? Surgery would only increase pain, and where’s the benefit in that?

Possible Complications:

1) Pain
2) Scarring
3) Swelling
4) numbness
5) Non-healing bone
6) Infection
7) Blood clots

Case study

Let’s look at an example of the following bunion patient. This 44 year old female patient presents to the clinic without pain, but really dislikes the look of her feet. She has moderately severe bunion deformities on both feet. Her chief complaint to the doctor is cosmesis, the appearance. Now, some physicians may operate, but this isn’t what they should do. One of the pillars of the Hippocratic oath states: “primum non nocere” or “first, do no harm.

toesIf you are like this patient and only want to get prettier feet, there may be one thing you will want to consider before considering surgery. There are no guarantees with surgery, and post-operative pain can happen with no fault to the surgeon. Our podiatrists do not want to introduce new pain or increase pain in anyway. The reality exists that after bunion surgery, or hammertoe surgery, you may still experience minimal pain. Yet, if you started with no pain prior to surgery, and you end up with minimal pain, we will have increased your pain level. This is unacceptable and one of the various reasons why performing a bunion surgery on a patient could be considered unethical.

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