The "argument" several doctors have had about
cosmetic surgery and its applicability to
podiatry does miss several points, one of them
being so-called "preventive surgery." An
example of this in podiatry would be a surgical
procedure on a frank deformity in say a diabetic
or pre-diabetic in the effort to reduce the risk
of that deformity, while presently asymptomatic
of causing dangerous problems in the future.
This might be a hammertoe that although it does
not have a corn or area of inflammation on it
now, might very well be dangerous in the future.
There are other examples of this in general
medicine. One of them is the extremely rare
condition called "body dysmorphic syndrome."
This strange disease results in the patient not
seeing a part of his/her anatomy as a
legitimate "part of his body." This causes great
anxiety and it is not unusual for such patients
to actually attempt to cut off parts of their
own bodies.
Another example is when a female patient has a
family history of metastatic breast carcinoma
and this occurs in multiple female related
relatives. Sometimes these family members see
the breast cancer at a very young age. Daughters
of these patients worry about their propensity
to get breast cancer and deliberately elect to
have a double mastectomy, even though there is
no cancer present at time of surgery. This can
also translate to changing a unilateral
mastectomy to a double at time of the first
cancer surgery.
These are not specifically cosmetic in nature,
but occur in the absence of the typical pattern
of surgical necessity as described by standard
of care. My take on these kinds of procedures is
that they are best done by large academic or
University clinics with a cadre' of lawyers on
retainer. By any metric you choose, cosmetic
podiatry surgery would be tough to defend in
court, even if it is helpful to the patients'
body image, at least at time of surgery.
Michael M. Rosenblatt, DPM, San Jose, CA,
Rosey1@prodigy.net
