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

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