Women in Britain are joining those in America in a race for cosmetic surgery on the lowest part of their lower extremities.

As today's women's shoe fashions - even those for winter - gravitate inexorably toward exposing ever more of the feet and toes, women with pedal anatomy considered to be imperfect are becoming more and more embarrassed. Consequently, they are flocking to cosmetic surgeons for corrective work on "cankles," imperfect "toe cascades" and hammertoes.

Cankles are in evidence when a woman's calf seems to go straight into her foot. They can be corrected by sucking the fat out of the ankle through liposuction.

Hammertoes are toes, usually the second or third, that are permanently flexed downward, resulting in a clawlike shape.

"Some patients come through with short toes that they would like lengthened, or they want to have their 'toe cascades' [the curve at the end of the foot, from the big toe down to the little one] improved, so that when they wear strappy sandals their toes don't look out of place," said Nigel Mercer, president of the British Association of Aesthetic Plastic Surgeons.

Most of these procedures come from America, where demand for cosmetic podiatry is even greater. "We do whatever patients ask for - toe straightening, toe shortening, toe lengthening," said Oliver Zong, director of surgery at New York clinic NYC Footcare. "A lot of people come in who have wide feet that they want narrowed so that they can wear fashionable shoes. There is no easy way to do this- you have to do both bone and soft tissue procedures. Patients have to be completely off their feet for a week, and they won't be healed for two months."

Zong's patients pay from $1,500 to have one toe shortened, to $15,000 to have both feet fully redone.

The irony, according to Mercer, is that "lots of operations to make feet look good in high heels are done because of the damage done by high heels in the first place."

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