For a growing number of women who want to strut their stuff in high heels, the latest footwear fashion accessories are surgical saws, titanium rods and liposuction needles.
Toe shortening and fat injections into the foot pad are among the popular procedures in a new plastic surgery craze focused on feet. Paying up to $3,000 per procedure, more and more women are surgically transforming themselves into Cinderella from the ankle down. Helping women squeeze into high heels -- and curing the damage they cause -- is a $45 million a year business.
"All the girls are wearing cute high heels, open toes and they look pretty, and me -- I have to wear always closed shoes because I feel like they're staring at my long toe," Audy, who asked to be identified by first name only, told ABC News. She was awaiting cosmetic surgery to make her second toe shorter than her big toe.
Podiatrist Ali Sadrieh in Beverly Hills, Calif., performs the toe shortening procedure, which involves actually dislocating the toe and sawing out a 2-millimeter chunk of bone. He then inserts a titanium rod to bring the shortened bone back together.
Another procedure gaining traction in the world of foot facelifts plumps up the bottom of the foot to make high heel wearing more comfortable, like permanently installing a Dr. Scholl's pad. It involves liposuctioning fat from a patient's belly and injecting it into the balls of the feet.
And then there is the ever popular pinky toe tuck, in which fat is taken out of the little toe to make it narrower.
While cosmetic surgery on the feet is trending high with women as a permanent solution for their footwear crises, it is largely frowned upon by The American Podiatric Medical Association and officially opposed by the American Orthopedic Foot and Ankle Society (AOFAS) because of risks and complications of the operation.
Potential problems include permanent nerve damage, infection, scarring, a recurrence of the deformity that was supposedly fixed and chronic pain when wearing not just high heels, but all shoes, according to the AOFAS.
Answering Call of Manolo Blahnik: Cosmetic Surgery For Feet
Still, the call of Manolo Blahnik is irresistible to many women who are willing to accept the risks as the price of fashion. Dr. Sadrieh says he stands ready to scrub and assist them in answering that sartorial siren song.
"It'd be an ideal world if we could synthesize some engineering, some beautiful design and some medical knowledge into one ball and relinquish these women from the suffering that they're having every day. Until then, I'll keep fixing them," Sadrieh said.
The agony and the ecstasy of footwear has existed since 1000 B.C., when women started wearing high heels to convey social status and sex appeal. The earliest version of stilettos was discovered in the tombs of ancient Egypt.
The hankering for high heels continues today and is sending Dr. Sadrieh's patients like Audy, who sought toe shortening surgery, and Kelly, who wanted fattened foot pads. Both patients asked to be identified by first name only.
Examining Kelly's feet before the procedure, Sadrieh told ABC News, "This is a nice thick callous she's got. It's exaggerated or exasperated because of the shoes and the function of the foot. So this callous is really the target spot of fat injection. This band right here really is where all the fat is going to go."
He then liposuctioned fat from her belly and injected it into the spot. Afterward, Kelly experienced some normal swelling -- jokingly referred to as "toebesity." The swelling was expected to go away and leave her with a small pocket of fat to pad her weary feet.
After the procedure, Kelly told ABC News that the podiatric makeover was a "piece of cake. I can feel the pillows in my feet. It's like puffy pillows."
Audy, meanwhile, completed her surgery and ended up with a second toe that is finally shorter than its larger neighbor.
Sadrieh will likely remain busy since nosebleed-inducing heels appear to be the height of fashion. This year's runway darling was a shoe with a 12-inch heel, nicknamed the "skyscraper sandal," from Romanian designer Mihai Albu.
Fashionable or not, the human foot is clearly something near and dear to Sadrieh's heart and he says he is a man who loves his work.
"I don't have a foot fetish, but it's what I do," laughed Sadrieh. "I'm always looking at feet -- it's like a software programmer, always checking out the code. Or an auto body guy saying, 'Did you (see) that car?' I can't help it. It's what I do. I look at feet. And I think we can't discount the fact that there is a sexuality to the foot."