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What Is Toe Amputation?
Vascular surgeons usually perform toe amputation surgery on patients with foot infections as a result of diabetes. Diabetes can cause hardening of the arteries (atherosclerosis), and patients with diabetes can develop foot/toe ulcerations. Diabetes is also a factor in blocked arteries resulting in inadequate blood supply to the foot, which can result in decaying tissue, additional infections, pain, and swelling. Toe amputation is considered a minor procedure and ray amputation is a particular form of amputation where a toe and part of the metatarsal bone is removed. Where serious infection is present, a forefoot amputation can sometimes be performed to remove more than one toe. In this procedure all of the toes and the ball of the foot are removed.
Figure: Wound evaluated on 2 to 3 days intervals and closed after 7 days of Proxiderm application. Appearance at 10 days.
Figure: Toe amputation on a 55 year old diabetic patient. Appearance at 5 days post amputation.
You will probably have a general anaesthetic, and will be asleep for the whole operation. Sometimes patients are numbed from the waist down with an injection in the back. If the latter takes place, you will be awake, you might feel that ’something is happening’ in your toe but you will not feel any pain from the waist down. Your toe is taken off. The surgeon may need to take off some of the skin from the foot near the toe to get the best healing. Usually the skin can be stitched up over the wound after removing the toe. Sometimes it is better to let the wound heal up by itself without any stitches. This takes three or four weeks or more. How long you will be in the hospital depends very much on your general condition. Ideally you can go home after a day or so. Often patients find it more convenient to stay for a week or longer.
You have a problem necessitating amputation of one or more toes or your forefoot. This is typically due to dead tissue. If three or more toes are lost, a transmetatarsal amputation (TMA) is usually the best option. Both amputations are usually well tolerated and walking is usually normal after some practice.
After The Procedure
Unless same-day discharge is planned ahead of time, you will be in the hospital for 1-2 days. During this time the physical therapists will see you to help you with strategies for getting around. It is absolutely critical that you STAY OFF THE FOOT ENTIRELY until cleared by your surgeon - at least two weeks - this means that you should not even touch it to the ground, even for a moment. The foot may swell as well, so you should keep it elevated AT OR ABOVE YOUR HEART whenever possible, especially during the first few days. If you go home with a dressing, you can remove it 36-48 hours after the operation, after which you can shower normally. You should not, however, soak the foot until cleared by the surgeon. If staples or sutures are present they will be removed a few weeks following the procedure. You will see your physician 2-4 weeks after surgery, and should not drive or touch the foot to the ground until you receive specific instructions to do so.
Treatment for amputations due to injury may include:
- Wound irrigation
- Rinsing the wound
- Wound cleansing
- Wound exploration
- Wound debridement
- Removal of dead or dirty tissue
- Removal of foreign bodies in the wound
- Tetanus vaccination
- Surgery to reattach amputated tissue
- Amputations clinical trials
Call Your Doctor If Any of the Following Occurs
- Signs of infection, including fever and chills
- Redness, warmth, swelling, increasing pain, excessive bleeding, or discharge at the incision site
- Chalky white or blackish appearance of foot, other toes, or leg
- Decreased sensation, numbness, or tingling in the rest of your foot, toes, or leg
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Difficulty healing
- Collection of blood (hematoma)
- Phantom limb pain (a painful sensation that the foot or toe is still there)
- Stump pain (severe pain in the remaining tissue)
- Continued spread of gangrene, requiring amputation of more areas of your foot, toes, or leg
- Depending on which toe has been removed, you may walk with a limp
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