I would like to invite you to peruse with me on a short hiatus from the informative reports on classic foot and ankle pathology and dip your feet in the ocean of medical ethics. As I filtered through some blogs that I occasionally find myself reading, I happened to come across a short article entitled “The Bioethics of Podiatry,” by Michael Cook. It was posted in late April of this year in The BioEdge, a weekly newsletter discussing frequently encountered bioethical issues. Obviously, as a foot and ankle specialist, the report was intriguing.

The article by Cook was a short, few paragraphs highlighting the “burgeoning field of aesthetic podiatry.” Cook mentions that Podiatrist, particularly in the Manhattan and Beverly Hills areas, are delving more and more into this realm and points out that an ever growing interest in foot and ankle surgery exists for the sole purpose of accommodating fashionable shoe gear. Now, I had to finish the article and investigate further as I found this troubling. Cook continues, and quotes a podiatrist in the Beverly Hills area who stated, “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.” Herein rests our question and why I titled the blog the way I did. First of all, is there an ethical concern with placing an individual under the knife for fashion’s sake, especially if the patient requests such actions? Lastly, what does this say about our culture that one’s confidence hinges on their outward appearance or fashion?

Now, I am not seeking to answer these questions in this blog per se, but perhaps provoke a form of mental dialogue. The podiatrist quoted above has a full marketing video highlighting procedures that he has renamed such as the High Heel Foot, Perfect 10 (toe shortening), and Foot Tuck (fat augmentation). All these procedures are designed to surgically modify ones foot to accommodate fashionable shoe gear. In my opinion, the Hippocratic Oath of “Do no harm,” screams out in this scenario. Any surgical procedure no matter how big or small carries significant risks of potential complications. Even if patients urgently request surgery for dreams of a fashion statement, one needs to consider the potential ethical ramifications; unless of course, you deem ethics as relative, which is yet another discussion all together. Regardless, what is more troubling, a surgeon willing to operate on otherwise healthy feet for improperly designed shoes or the fact that people are willing to take such risks in attempts to be fashionable? Or, is either troubling at all?

As foot and ankle surgeons our group is committed to improving quality of life, restoring functionality, and saving limbs and lives with our surgical and medical expertise. There comes a time when one must realize or understand that certain things or fashions are of the utmost importance. It is unfortunate that people feel they need inhumanly designed fashion to project confidence. It is certainly, in my opinion, a sad commentary on our culture and society. 

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