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Baring All for Summer

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Before a girl is old enough to wear her first pair of high heels, Cinderella delivers the bad news: If you want to marry Prince Charming, your foot must fit inside the glass slipper. And it’s not enough to wear the darned things; you’ve got to waltz in them all night and smile. These days, Cinderella would probably consult a surgical podiatrist. The burgeoning $3.5 billion cosmetic foot surgery business is responding to the demand for pretty feet and the desire to wear the latest designer shoes.

“I had a patient who never wore sandals or open-toed shoes,” recalls Dr. Stephen Monaco of A Foot Above Podiatry in Havertown. “She had horrible bunions and discoloration on her toes from nail fungus for years. After I corrected her problems, she walked into my office wearing sandals, beaming, with tears streaming down her face.”

Monaco says there are basically two types of foot problems: “Those that are congenital and progressive deformities with which you aren’t born but become worse over time due to neglect or ill-fitting shoes.” Common congenital defects that may be surgically corrected include an overly long second toe, hammertoes and webbed toes. Progressive deformities include bunions, curling toes, heel spurs and plantar warts.

“In the old days, we only performed foot surgery to relieve pain or a function problem,” says Main Line Health’s Eric Ricefield, who has offices in Paoli and Ardmore. “Now people are asking for surgery because their foot structure prohibits their wearing the style of shoe they like. Anything is possible, but if you opt for surgery, you may have to give something up. You might end up with a beautiful foot that hurts.”

Ricefield cautions patients to go into elective surgery fully aware of long-term issues that might arise, including residual discomfort that may linger long after healing. “Twenty-five percent of all the bones in the body are in the feet,” he says. “The foot of a person weighing 150 pounds absorbs 450 pounds of force with each step. If you remove too much bone and alter the contour of the toes, you can create a different problem.”

High heels lift the foot out of its natural position and shorten the Achilles tendon. This pitches the weight of the body forward onto the ball of the foot, which causes pain and increases the risk of an ankle sprain. (Remember the Miss Universe contestant who landed on her tush?)

A 1-inch heel increases pressure on the forefoot by 22 percent, a 2-inch heel by 57 percent, a 3-inch heel by 76 percent. As for 6-inch heels—well, you may as well drop a bowling ball on your foot for all the weight you’re asking it to bear.

So how do movie starlets glide down the red carpet in their gravity-defying heels? According to a pre-Oscars report on ABC News, they get “foot lifts”—collagen injected into the ball of the foot to relieve the pressure. “If your shoes are hurting, something is wrong,” says Dr. David Bernstein, a podiatrist with offices in Wayne and Paoli.

Orthotics can help, but Bernstein points out the difference between those that are custom-made and the ones you get at your local pharmacy. “Store-bought [versions] are one size, one shape—they are thicker and bulkier,” he says. “Your podiatrist can custom-make an orthotic out of graphite, which is stronger and extremely thin.”

As Main Line Health’s chief of podiatric surgery at Lankenau, Bryn Mawr and Paoli hospitals, Bernstein has seen it all. “A woman once came to my office with size 12 feet and asked if I could surgically change her into a size 7,” he says.

Bernstein turned her away. “I discourage surgery when expectations are beyond what can be delivered, or when there are medical complications such as poor circulation,” he says.

Ill-fitting shoes—especially pointy-toed high heels—can cause a painful pinching of the nerve between the toes called neuropathy. Although it may be relieved by cortisone injections and an orthotic to cushion the ball of the foot, the best long-term remedy is wearing a low-heeled, wide or open-toe shoe.

Both the American Podiatry Medical Association and the American Orthopedic Foot & Ankle Society have warned against cosmetically altering a foot that’s not causing pain. “I think it’s reprehensible for a physician to correct someone’s feet so they can get into Jimmy Choo shoes,” says one orthopedic surgeon from La Jolla, Calif.

Not all physicians agree. “Some women invest more in their shoes than they do in the stock market,” says a podiatrist from New York City.

Which may partly explain why many podiatry offices in New York and Los Angeles are filled with patients who are unhappy with the cosmetic surgery they had. In their eagerness to improve the appearance of their feet or change their shoe sizes, they unwittingly sacrificed comfort. So before having cosmetic surgery of any kind, get a second opinion and make sure your doctor is board certified by the American College of Podiatric Surgeons.

Also keep in mind that surgery is not the only answer to chronic foot pain. Prescription orthotics can address structural abnormalities in the foot, and physical therapy can increase range of motion in the ankle and decrease swelling and pain. Cortisone injections are often highly effective in treating problems of the Achilles tendon and pain in the heel, toe and mid-foot.

“When parents notice an abnormality in a child who’s just starting to walk, the first line of treatment is orthotics to better support the foot,” says Bernstein. “Surgery should not be considered until the child has reached maturity.”

And though summer may be the season to bare those pretty feet, it’s also the time to protect them from infections while avoiding inappropriate footwear and the temptation to go naked. “Walking barefoot is the worst thing you can do—unless you’re walking on wet sand,” cautions Monaco. “Dry sand is bad for your feet and legs. It exposes them to tremendous pressure and strain.”

He also warns against going barefoot on hard surfaces such as wood floors and cement, which offer no support. “Every October, I get a rash of patients who’ve gone barefoot all summer and are suffering from heel pain,” he says.

What about flip-flops? “They’re just for walking around the pool,” says Monaco. “I recommend a comfort walking sandal made by Mephisto, Merrell or Teva.”

Monaco also sings the praises of prescription Crocs, a special line of the popular shoes available only in physicians’ offices. “They’re impregnated with silver, which acts as an antifungal and antibacterial agent,” says Monaco. “We also have a special line of Crocs for people with heel pain or diabetes.”


Pedicure Smarts
Going for a professional pedicure (or manicure) is risky business, says Main Line Health’s Dr. David Bernstein. “Bring your own instruments and nail polish to prevent fungus infections,” he warns. “And never cut or push away the cuticle; its purpose is to protect the nail bed. Mess with it, and you’ll get fungus.”

The nail is a living structure that requires air and light. Some women change their nail polish but never leave it off long enough for the nail to “breathe.” That’s asking for trouble. “Nails need light like a house plant,” says Bernstein. “Take your polish off, and let your nails get exposure to air and light every two weeks for a few days.”

If your pedicure includes removing dry skin from your heels with a pumice stone, bring your own—or make sure they use a new one. “Beauty salons may use the same pumice stone from one person to the other, spreading infections and warts,” says Havertown’s Dr. Stephen Monaco.

He also warns that dry, cracking heels that don’t respond to creams may be asymptomatic athlete’s foot. There’s no itching or burning, but the scaly skin won’t go away. “We now have a wonderful, new prescription cream for that,” Monaco says.

And if you do get a nail fungus, don’t try to cover it up with polish. See a board-certified surgical podiatrist. New topical and oral treatments cure fungus infections within three months and present no serious health risks.


Shoe Sense
If your inner Sex and the City demands Jimmy Choos, Manolo Blahniks and other high-risk designer shoes, don’t despair. Take them to your podiatrist, who will remove the “ouch” with dress-shoe orthotics to cushion the balls of your feet and heels. They’re extremely thin, so no one will know.

If you really want to show your feet how much you care, go for shoes that combine fashion with healthy support, such as Naot, Dansko, Ecco and Merrell. These aren’t the lace-up clodhoppers your grandmother wore. They’re hip, trendy and chic. You’ll find them at various specialty shoe stores and in better department stores. Foot Solutions in Ardmore (28 Rittenhouse Place, 610-649-3112) offers a complimentary foot evaluation and high-heeled options from Oh!, Ara, Xsensible and more.

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