Cinderella surgery: the cutting edge way to squeeze into heels like these

At her clinic on Park Avenue in New York, podiatrist Dr Suzanne Levine is explaining why increasing numbers of women are having their toes shortened or lengthened to make their feet look prettier.

Let me guess. Is it because they are shallow and self-obsessed to the point of mania? Perfectionists whose narcissistic quest for beauty extends all the way down to the darkest corner of an innocent pop sock, where a deformed morsel of flesh lurks, the sad runt of the toe litter, the final frontier in the war against imperfection?

"Well, it is a brave new world out there in terms of feet," said Levine. "If nature has given you something you don't like, you can have it fixed."

This might involve having your toe cut open, the bone sawn in two, put back together with a screw and the whole thing sewn back up again. It's a lot of effort just so that your feet are sandal-fresh for summer or you can finally squeeze into those designer stilettos. But Cinderella surgery, as it is called, is the next big thing in the world of nip and tuck.

Other popular procedures include the removal of bunions, even though the protrusions are not causing serious pain, and tackling a previously unheard of condition called toe-besity. Those with the opposite problem - not enough fleshy padding in the balls of the feet, which can cause pain when wearing high heels - can have fillers injected.

In a world in which nose jobs, breast implants, knee tucks and Botox are commonplace, perhaps it is not surprising that Cinderella surgery has become so popular. There are no firm statistics on the rise of aesthetic foot procedures, but they seem to have germinated in the late '90s when Carrie Bradshaw in Sex and the City personified female devotion to shoes, teetering around Manhattan in her expensive heels. "The fact is," said Carrie in one episode, "sometimes it's really hard to walk in a single woman's shoes. That's why we need really special ones now and then to make the walk a little more fun."

And that is where the problem starts. Our feet are not designed to totter around in killer heels for long periods of time, but many women choose pain over the comfort of flats every time. Just try to stop them.

"I don't do surgery just so women can fit into shoes - that's not what I'm about," said Levine. "I'm helping women stay in heels because they're going to do it anyway. They come to me and say: 'My last podiatrist told me to stop wearing heels, but I'm not going to, so what can you do?'"

What, indeed? According to Levine, aesthetic foot procedures are particularly popular with the kind of baby boomers who have the time and the inclination to treat themselves and their fading looks as an ongoing restoration project. And if a lot of work needs to be done in the bunioned, corny, misshapen basement department, then so be it.

Levine said she saw a lot of women who were trying to hold back the years in more orthodox ways, but were let down by their feet.

"Fashionable clothes and orthopaedic-type shoes? It's not a good look. My patients say to me: 'Suzanne, if I have to take off my heels, I'm going to feel my age.' Psychologically, it's damaging."

In the waiting area of Levine's Institute Beauté there are glass cabinets filled with delicious designer footwear: sought-after Christian Louboutins, desirable Jimmy Choos, heavenly Manolo Blahniks. Each shoe is beautiful and covetable - an agonising sight for the patients who hobble in believing that such treasures are beyond them and their hideous goblin feet. It is like displaying cream cakes in a dietician's reception area.

For many women, it is cripplingly narrow and high shoes that cause the problems in the first place, followed by the overwhelming desire to carry on wearing them. "The number one reason people come to see me is because they suffer from a burning feeling under the balls of their feet," said Levine. "They compare it to walking on a pebble or feeling that their feet are on fire."

This is because, as we age, we lose the fat padding on our feet, rather like a worn-down tyre. The added strain of high heels makes this worse and Levine treats tortured soles by plumping them with a filling agent, Sculptra (poly-L-lactic acid), which cosmetic surgeons use to smooth lines and wrinkles on the face.

Once the filler is injected into the ball of the foot, the cushioning effect is "like walking on air". Levine calls this procedure, which costs between $500 (about R5300) and $1500, Pillows for Your Feet. It is especially popular among celebrities who have to walk red carpets and hang around for hours at awards ceremonies. For ordinary mortals who cannot afford this treatment, there are always Levine's soft-gel shoe inserts, which cost $12.

It is not just older women who are gingerly tiptoeing their way to foot perfection. Younger women, with a lifetime of bunions and foot discomfort stretching out in front of them, are also demanding "extra upholstery" so that they can stay upright in their 5-inch, 6-inch and even 7-inch heels.

Why is the siren lure of shoes hard for women to resist? We squeeze our feet into gorgeous but impractical footwear because high heels can make any woman - young or old, fat or thin - feel terrific. During her recent stint as guest editor of Woman's Hour on Radio 4, JK Rowling admitted she was one of the millions of women who were passionate about heels. The 1.6m author confessed that she was not a "sensible flats girl", except when walking the dog. She described shoes as "the most mythologised and fetish-ised fashion item of all" and speculated about why so many women were in thrall to their stilettos.

At his practice in downtown Manhattan, Dr Oliver Zong, who coined the term toe-besity, acknowledged that the lengths to which some women would go to fit into desirable shoes was "rather odd". Some women, he said, felt like they could "just order a new pair of feet, as if they can get them delivered by Amazon or something".

He recalled a woman who came into his surgery recently, having flown in from Hong Kong, and asked him to reduce her feet from a US size 10 to a size 7. He declined.

But Zong does do a lot of toe shortening and toe lengthening and charges $1750 per toe. He has been particularly busy in the run-up to summer. "People say they avoid going to the beach or they won't go near a swimming pool because they hate their feet, and once they've had surgery, they get back their self-esteem," he said.

The latest craze is narrowing wide toenails. Zong said many women also suffered from toe-besity and wanted to slim down their big toes. "We take out the excess fat - it's actually just a tiny amount - and we might shave down the bone a bit to make it aesthetically pleasing."

Why do women choose to submit to all this? "It's mostly because they want to fit into narrow shoes," said Zong.

At his clinic in Beverly Hills, podiatrist Dr Ali Sadrieh said it was unrealistic to expect women not to wear narrow-toed high heels.

He said he turned down patients if their perceived deformities were minimal, but added: "We have the skills and the technology to do these surgeries at minimal risk, so why shouldn't we? I had a woman in here the other day. She's 32 and her foot is ugly. She went to three different doctors, who told her there was nothing they could do because her bunion wasn't advanced enough. It doesn't hurt her, but it bothers her and she has a hard time finding fashionable shoes. So she's just got to live with that bump on her foot?"

I'm guessing ... no?

In the US, Cinderella surgery is controversial and the American College of Foot and Ankle Surgeons frowns on surgery for aesthetic reasons. Such warnings do not seem to be stopping the increasing numbers of women - and some men - who are willing to have their feet sliced and diced in the name of beauty.

These days, it seems, a pedicure and a few layers of polish are simply not enough.