Forget zapping frown lines, slimming noses, or plumping lips, breasts and bottoms. In their endless pursuit of perfection, plastic surgeons have now turned their gaze south – down to the imperfect "toe cascades", "cankles" and hammer toes that are blighting unwitting British women.
Fuelled by the current vogue for statement shoes – from the gun-shaped Chanel heels Madonna stepped out in after announcing her impending divorce, to the skyscraper platforms and studded stilettos spotted on high streets around the country – increasing numbers of women are having their feet chiselled, chopped and filed into submission.
Surgeons at the Harley Medical Group, the UK's biggest provider of cosmetic surgery, have seen a 9 per cent increase in patients requesting liposuction in the past year, a rise due in part to the thousands of women now opting to have fat sucked out of the ankle, in the hope of correcting shapeless "cankles" – calves that appear to go straight into the foot.
Slimming down the ankle is just one of many procedures that are becoming more popular in the UK, which has seen an average 54 per cent year-on-year increase in the cosmetic surgery market since 2005.
Specialist London clinics such as Cosmetic Foot Surgery UK are seeing a rising demand for procedures correcting bunions, lumps and bumps, bent "hammer toes" and flat feet, with patients admitting to feeling embarrassed revealing their deformed feet to the world.
"Some patients come through with short toes that they would like lengthened, or they want to have their 'toe cascades' [curve at the end of the foot, from the big toe down to the little toe] 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 (BAAPS).
Indeed, this season's shoes are designed to highlight the foot, with peep-toes making a comeback on the catwalks courtesy of Jimmy Choo, Christian Louboutin, Christian Dior and Alexander McQueen. Cold weather doesn't offer its usual respite, with new trend "bandals" – the love child of boots and sandals – revealing more of the foot than traditional winter offerings.
Most procedures are imports from the US, where there is a much bigger market for cosmetic podiatry. "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."
Patients at Dr Zong's clinic – 99 per cent of whom are women – pay from $1,500 (£750) to have a single toe shortened, to $15,000 (£7,500) to have both feet transformed into picture-perfect tootsies; a lengthy process which could involve narrowing the foot, raising the arch of the foot and straightening out, shortening or lengthening toes. "I get quite a lot of patients from the UK, and we're looking into setting up over there. These procedures are growing in popularity in the UK; vanity isn't something that the US owns," Dr Zong said.
Ironically, many of the women opting for this painful and expensive foot surgery are doing so because they have damaged their feet wearing high heels or shoes with pointed toes. "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. Bunions can be caused by pushing the foot into a narrow shoe, or toes can also start to 'claw' because of wearing high heels," Mr Mercer said.
Earlier this month a study commissioned by fitness-shoe firm MBT showed that surgery to correct damage done by high heels cost the UK £29m a year, with even celebrities falling prey to such accessory-induced injuries. Victoria Beckham's passion for gravity-defying stilettos has reportedly left her with chronic bunions.
"In the 1980s and early 1990s there was a fashion for wearing flatter shoes. Now that the fashion for really high heels has come back, we are sure to see a rise in incidences of this kind of surgery," Mr Mercer said.
Corrective foot surgery is notoriously painful, and the results are not always permanent: if women wear high heels again after surgery to remove bunions, they can reappear. This is not enough to persuade many women to give up their high-heel habit. "Shoes for a lot of women border on the fetish. It is not sexual, but they are so covetable," said Hannah Teare, fashion editor of Tatler magazine.
"For some women, having beautiful feet is part of that, but for me surgery is definitely too far. It is slightly barbaric to cut your feet up, plus, having an operation means that you won't be able to wear your beautiful shoes for ages."