07/04/2014    Ed Cohen, DPM

ACFAS Podiatrists Call Cosmetic Foot Surgery "Ill-Advised Trend"

I think most surgery should be done for painful
conditions. If a patient has a corn, callus, or
bunion that is not painful I certainly wouldn't
recommend surgery. A lot of times a patient will
want me to operate on a second, third, or fourth
toe with a minor lesion for a painful toe which is
actually a neuroma which can usually be treated
with injections.

The goal of surgery should be to get the patient
back to work or normal activity as soon as
possible and to have a nice looking functional
foot.Sometimes surgery which would be considered
cosmetic is a good idea to perform. A good example
of this is a bunionectomy in which there is a
significant hallux valgus. The second and third
toes have no lesions and may be dorsiflexed and or
laterally deviated.If you do not address the
second and usually third toes with a proximal
phalangeal osteotomy you will have a space in
between the first and second toes after the first
metatarsal osteotomy bunion procedure.

The result could be a recurrence of the hallux
valgus deformity after the patient goes into
regular shoes. However, if you fill in the space
with a medial proximal osteotomy of the second and
possibly third toes it will help keep the big toe
from deviating laterally.

Another example of surgery which might be
considered cosmetic is to perform a second
metatarsal osteotomy in order to correct a
severely contracted second hammertoe which can't
be adequately corrected by the usually hammertoe
procedure due to the severe MPJ arthritic
contraction. In a severe case of dislocation you
may need to combine the metatarsal osteotomy with
a Haspal osteotomy.

Some people might consider straightening a big toe
by an EHL lengthening to be cosmetic, but if a
patient has a painful toenail it makes sense to
straighten the toe so it will not be hitting the
top of the shoe.

In general, I try to discourage cosmetic surgery
when the patient does not have a painful
condition.Even when the patient has a painful
condition I usually try conservative treatment
first.For any podiatrist that has an interest in
minimally invasive foot surgery with minimal
scaring and generally more ambulatory surgery.

Ed Cohen, DPM, Gulfport, MS, ecohen1344@aol.com

Other messages in this thread:

---

07/08/2014    Ed Cohen, DPM

ACFAS Podiatrists Call Cosmetic Foot Surgery "Ill-Advised Trend" (Bret Ribotsky, DPM)

RE: ACFAS Podiatrists Call Cosmetic Foot Surgery
"Ill-Advised Trend" (Bret Ribotsky, DPM)
From: Ed Cohen, DPM

I enjoyed reading Dr. Ribotsky's comment, but I
really think a lot of the procedures he does are
for pain and not all just for aesthetic
appearances. There are very few patients who want
hammertoe or bunion surgery for cosmetic reasons,
but there are more patients that might want the
fillers. These are some patients who want this
surgery because they can't wear fashionable shoes
without having pain.

If pain is the consideration, then I don't feel
this is cosmetic surgery. For most patients who
want this surgery and don't really have pain, I
tell them to wait and we can watch these
conditions and I sometimes provide conservative
care.Fillers might be a good option for these
patients.

I don't really have any experience with these
fillers which have been around for a long time,
maybe 35-40 years and I am sure they have improved
a lot.The fillers can't make the corn or callus go
away unless you are providing a buffer between the
bone and the shoe or ground.which might eliminate
the lesion without operating on the bone. Surgery,
a wider, higher toe box shoe, creams or possibly
an orthosis can do that or can possibly be
combined with these fillers. These fillers can't
straighten a crooked hammertoe or correct a hallux
valgus, but it seems like a good option for
patients that don't want surgery or for some
geriatric patients who would not be good surgical
candidates.Just as using a laser for mycotic
toenails can be much safer than lamisil these
procedures seem safe and there is no reason why
a podiatrist should not use these fillers.

Some podiatrists might consider me old-fashioned
because I don't use fillers. I am very happy using
minimally invasive surgery as taught by the AAFAS
.In some cases these corns and calluses can be
fixed with a tiny stab incision and a lot of times
the patients just takes a few if any pain pills If
Dr. Ribotsky has been using these fillers
successfully for nine years, these fillers must
have a lot of merit. I would like to invite Dr.
Ribotsky to one of the AAFAS cadaver labs to
lecture and demonstrate how and which fillers are
used as I understand there is a learning curve
especially for plantar lesions. He could
demonstrate in the cadaver lab these techniques
and we could show him some of our MIS procedures.

Ed Cohen, DPM, Gulfport, MS,ecohen1344@aol.com