Toe the line for fashion

Seen this season's must-have Manolos? Four inches of towering Lucite sandal wrapped in soft pink leather and tapered off in an arrow-point tip. Virgin-meets-vixen with a vertiginous heel. Totally, utterly feminine... unless you have calluses, thread veins and size eight plates of meat, in which case it's not a good look.

But changes to the world of cosmetics means that these days, if the shoe doesn't fit, you can simply change the foot. Bone shaving, toe shortening and nail narrowing are all big business in America.

In Brazil you can have silicone injections to the ball of the foot to give you support in high sling-backs or liposuction to give you better toe cleavage in peek-aboo sandals.

One New York chiropodist had a client who wanted her toe taken off completely (that season's toothpick Manolo was 20 per cent narrower). My Californian aunt had all the toenails on her feet removed, then tattooed back on in hot pink - to match her business card.

Anything for looks

But beauty at what price? Toe-shortening is a minor operation which entails cutting open the toe, severing the tendons, removing the middle bone and fusing the joints back together afterwards using stitches or a cool-touch laser.

The damage - besides the £2,000-£3,000 to the pocket - can be infection, nerve injury and months rehabilitating if it goes wrong.

Yet, despite the American Academy of Foot and Ankle Surgeons publicly condemning radical foot cosmetics last December - warning it 'should not be considered under any circumstances' - it hasn't caused thousands of Americans to stamp it out.

Iona Frank was one of them. 'I squared the decision (to have toe-shortening surgery) with myself and my wallet,' she said.

'I spend thousands of dollars a year on shoes. But I was embarrassed by my feet. Surgery wasn't pleasant but I'm thrilled with the results.'

She likens it to a woman with a hat fetish not caring a jot about her hair underneath.

Less extreme than Iona and more common among fashionistas, are foot 'semis'; instep air bags, laser nail lightening and toe vacuuming which last between three and six months.

Cushion that step

Dr Suzanne Levine, aka New York's 'Foot Face-lift Doctor' does up to 300 of her signature collagen cushion operations a year to help ladies who lurch in their four-inch heels. 'I don't believe in asking people to give up their heels,' she says. 'But wearing them too often means you can loosen the fat on the ball of the foot, or get stress fractures or a dropped neotarsal. I developed a series of injectable implants to address this and cushion the ball of the foot'.

Like a foot air bag, Levine injects the skin with a laser, which stimulates collagen production, giving the ball of the foot a spongier padding. Treatment costs about £300 a session and a full cushion takes three sessions and lasts six months. 'I think Jimmy Choo's done a great service to womankind by getting us to pay better attention to the feet,' says Levine with New York brio.

Even when that means we change ourselves to fit the damn things?

I ask.

'Shoes should be a pleasure not a pain' she bats back. 'I think it's a British hang-up, part of your stiff upper lip thing to grin and bear the pain.'

Inside my kitten heels my un-vacuumed sagging toes curl in shame.