Foot Binding, American Style

A woman with painted toe nails sunbathes on an urban beach during hot weather in Nottingham, central England, July 19, 2013. Britain's first prolonged heatwave in seven years has taken the country by surprise, with rails buckling, shops selling out of electric fans, and scientists estimating the surge in temperature could have caused hundreds of premature deaths. Darren Staples/Reuters

Billy Joel may love you "just the way you are," but many Americans have doubts about their appearances. More than 1.5 million people had cosmetic procedures in 2012 and nearly 15 million more had noninvasive, like Botox injections.

But one little-known surgical procedure promises perfection right down to your toes: cosmetic toe-shortening. Never heard of it? That's probably because toe-shortening - which involves removing a knuckle, then pinning the toe back together to re-fuse the bones - is still relatively new as an aesthetic treatment and is performed exclusively by podiatrists, a field generally associated less with Hollywood glamour, and more with Aunt Myrtle's bunions.

Though statistics on purely cosmetic toe-shortenings are hard to nail down (it's often performed in conjunction with noncosmetic surgeries, such as bunion removal), podiatrists agree it's growing in popularity. "Over the last two years there's been more interest in aesthetic foot surgery overall," says Dr. Neal Blitz, a Park Avenue aesthetic and reconstructive foot surgeon operating out of Mount Sinai hospital, and the creator of the Bunionplasty (plastic surgery for bunions). "A lot of women who've already had more standard procedures - say rhinoplasty, or Botox - want to see that same improvement in the appearance of their feet.

"And of course some women just love shoes; surgeries like this allow them to wear styles they love without experiencing pain or feeling self-conscious."

While the idea of "pretty" feet may seem strange to some, the notion goes back centuries. Foot-binding began in China as early as the 10th century, and continued well into the 20th century (the practice was officially banned in 1912, but some families secretly persisted long after). For the Chinese, binding the feet was as much about status as about creating the perfect, tiny foot; only women wealthy enough to never have to work - or walk - could hope to handicap themselves for beauty (some might say the same thing about modern cosmetic procedures).

Today, small feet are still prized, as are smooth skin, plumpness (some practices have also been known to offer fillers - such as Juvederm - to help with pain from heels and restore the appearance of youthful fullness), a high arch, and proportionate toes. Overlong digits, or toes that are too short or "fat," don't match the kinds of feet women see in everything from shoe commercials to beach resort sales pitches.

Nancy Velazquez, a high school teacher from New York's Rockaway Beach neighborhood in Queens, went to Blitz for toe-shortening and is a satisfied customer. "I'm honestly crazy about my toes now. I sound like a commercial - I tell so many people they should do it," she says.

Velazquez, 47, says that a bunion and overlong toes made it difficult for her to wear high heels or go dancing. While she lives on the beach, she stopped wearing sandals or flip-flops because she was too embarrassed about her feet. And though she did several toes on both feet at once, she said she was able to go back to work - which involves long days standing - just six weeks after surgery.

Liv Lewis, owner of a public relations firm in Teaneck, N.J., is similarly enthusiastic. Lewis needed foot surgery for bunions, but opted to undergo both toe-lengthening and toe-shortening as part of the same procedure. But she cautions that the surgery isn't for everyone. While she said the pain wasn't as bad as she'd expected, she compared it to "giving birth." Her recovery took around 12 weeks, and though she needed bunion surgery (as well as the optional toe-lengthening and -shortening procedures) on both feet, she's only done one so far, since operating on both at once would have left her essentially immobile (Lewis was able to manage with crutches and a walking boot). "I would say you shouldn't consider the surgery unless you have more serious problems, like I did, because of the recovery. I loved my results, but they didn't come easy."

Some podiatrists are skeptical. Dr. Mary Ann Bilotti, chief of podiatry at Franklin Hospital in Valley Stream, N.Y., says that while she recommends toe-shortening "when there's significant pain or more serious complications, such as diabetic ulceration or hammertoe," she wouldn't suggest it for purely cosmetic reasons.

"Any surgery can have complications, and they can be serious: infection, scarring, numbness, swelling and hypersensitivity are just a few. If the procedure is solely cosmetic, I would strongly suggest that patients seriously consider those risks."

Cost is also a concern; few insurance plans cover cosmetic procedures, and toe-shortening surgery costs, on average, $2,000 to $2,500 per toe.

Blitz acknowledges the procedure is controversial: "There's a school of thought that says, 'Why alter something that doesn't need to be altered?' I understand that, and beyond normal health concerns, there are many reasons I might tell a patient not to have the surgery. When you're removing an entire knuckle, the function of that toe is going to diminish, especially for activities like yoga, where you need your feet to bend and grip."

But few toe-shortenings are purely cosmetic, he insists. "In almost all cases where surgery is being considered, there's associated pain and the possibility of future problems if it's left untreated," he says.

It's doubtful most women (and few men have opted for this procedure) are aware of the dissent among podiatrists regarding toe surgery. Practices nationwide advertise it not as a necessary procedure, but as an alternative to missing out on sandal season.

In a business famed for inventing difficulties, promoting toe surgery might just seem like another way to make a buck. But in a culture obsessed with perfecting the body, whatever that may mean, toes are by no means the last frontier. At least one of the practices offering cosmetic toe-shortening is happy to help you "perfect" your genitalia, too - for a price.