On any given day, the new 22,000-square-foot shoe salon at Barneys New York’s Madison Avenue flagship boasts thousands of pairs on offer, many of them more extreme than the next: strappy Tabitha Simmons sandals, towering Sergio Rossi stiletto booties, crystal-encrusted Christian Louboutin pumps that sell for $4,000 and make their wearer four and a half inches taller. But with each new height we’re willing to scale for great shoes, we’re also expecting far more from our feet. After all, what’s the point of splurging on a pair of meticulously crafted shoes if they draw attention to feet that are a big old mess?

With the high-end shoe industry growing at a rapid clip—women spend an estimated $20 billion a year on shoes—the field of foot aesthetics is booming. Cosmetic dermatologists and plastic surgeons are offering treatments that include foot narrowing, fat augmentation (for “comfort” padding) and the “pinky tuck,” to fix what happens when the last toe gets jammed into those extra-narrow Charlotte Olympias. For women who come in complaining of feet unsuitable—too wide, too long, just too ugly—for their snakeskin Brian Atwoods, toes can be shortened, lengthened, straightened or slimmed. Nonsurgical procedures include Botox to reduce sweat (and, therefore, blisters), injectables like Restylane and Radiesse to make walking easier and laser therapy for uneven pigmentation and spider veins.

“Women are wearing the highest shoes they’ve ever worn, five- and six- inch stilettos and platforms,” says cosmetic dermatologist Dr. Howard Sobel. “And this puts pressure on certain areas of the body to look good, like the feet, the ankles and the calves.” If the shoe doesn’t fit, well, there’s a fix for that. And it has nothing to do with wearing sensible flats.

In his Manhattan skin clinic and spa, Dr. Sobel offers services like acid peels and microdermabrasion that treat the foot in the same manner as the face, as well as laser treatments to get rid of discoloration and scars. After successful treatment with temporary filler, he’ll inject silicone for permanently padded feet. The dermatologist also reports a rise in the number of women seeking aesthetic work—liposuction, sculpting and skin resurfacing—on ankles and calves.

“High heels means we’re spending far more time looking at women’s calves,” Dr. Sobel says. “It used to be that people came in for lipo on their hips and thighs. Now it’s hips, thighs, calves and ankles.” That might mean giving an ankle a little more curve, re-shaping the leg or eliminating cankles. “I see many women who are very thin, totally straight,” he observes, “but they put on a pair of nice heels and their leg looks like a bat.” He performs operations with local anesthetic so that patients can stand up at the end of the procedure and get an idea of what their legs look like.

Of course, these treatments aren’t always preemptive. Sometimes they’re necessary fixes for damage from particularly harsh heels. Anyone who’s spent $1,400 on a pair of stilettos that require six months to break in knows that price doesn’t always correlate to comfort; in fact, it can be quite the opposite. “Some women can wear very high, very strappy shoes and have no problem at all,” says foot surgeon Dr. Ali Sadrieh of Evo Advanced Foot Surgery in Studio City, California, whose practice offers aesthetic toe shortening and lengthening, fat augmentation on the balls of the feet and the popular “Cinderella procedure,” a preventive bunion surgery that makes feet narrower. “But for many women, spending up to 10 hours a day in a pair of four- or five-inch heels can mangle and deform otherwise healthy feet.”

Alexandra Lentine is a convert to taking these sorts of measures. The 25-year-old was on her feet all day; by the time she was ready to go out for the evening, she could barely slip on a pair of heels—never mind go dancing in them. Philadelphia-area plastic surgeon Dr. Steven Davis injected Restylane into the balls of her feet for extra padding. “There is literally no pain anymore,” she says. “I’ve gone a little nuts in the shoe department since.” Now, she’s considering fat augmentation as a permanent solution.

But foot beautification doesn’t come without risks. “Cosmetic surgery for some things, like shortening a long second toe, has the potential for serious complications,” says Dr. Michael Nirenberg, a podiatric physician and surgeon in Crown Point, Indiana, who has consulted with aesthetic patients as young as 14. “For that reason, I am very selective. If a procedure is strictly cosmetic and has the potential for serious complications, I will not do it.” The American Podiatric Medical Association also encourages surgeries be performed solely for medical reasons.

The debate might not matter. “The foot has been part of our sexuality for 3,000 years, and women are going to wear the shoes they want to wear,” says Dr. Sadrieh, who argues that pretty, well-kept feet are signifiers of success. “And as long as they’re wearing them, there will be a need for the feet in them to look their best.”