A toe amputation may be necessary for a number of reasons, including following an accident or reduced blood supply due to a medical condition. The thought of this type of surgery can be frightening, but a toe amputation is actually surprisingly common.
Andrew Goldberg, consultant orthopaedic foot and ankle surgeon at The Wellington Hospital, part of HCA Healthcare, looks at the toe amputation process, aftercare and potential complications:
Common reasons for toe amputation
There are a number of different reasons why a toe may need to be amputated. As with various other amputations, a common reason is following trauma or injury.
Another reason for toe amputation is when the blood supply to the toe is reduced, in conditions such as vascular disease, diabetes or frostbite. In these situations, the toe can become gangrenous due to a lack of blood supply, which can be life threatening if not addressed.
In some cases, infection of the foot can lead to amputation, especially if antibiotics or other treatments do not work.
The toe amputation process
Depending on your general health, toe amputation surgery can be carried out under either general or regional anaesthesia.
Ahead of the surgery, any medical conditions you have must always be optimised. For example, if you have diabetes, sugar levels must be controlled with medication.
During the surgery, your surgeon will make an incision in the skin around the toe, ensuring there is enough skin preserved to allow closure. The necessary bone is removed, usually at the metatarsophalangeal joint. In order to close, the remaining skin and muscle or tendon will be pulled over the open area and the incision will be stitched closed.
A toe amputation is a relatively short procedure, and can take anywhere between 30 and 60 minutes. You might be given antibiotics at the beginning of the procedure, which may be continued afterwards, depending on the cause of the surgery.
Toe amputation: aftercare advice
Following the procedure, you will be monitored carefully for any side effects from surgery or anaesthesia. Pain medication may be prescribed to help manage the pain.
Depending on the individual and whether complications arise, your hospital stay can vary. In simple cases, surgery may be carried out as a day case. In more complicated cases, for example, a person with poorly controlled diabetes and poor blood supply, the patient may be required to stay in hospital for much longer, largely to look after the medical issues.
Important factors to consider following a toe amputation include:
Elevation after surgery helps to reduce swelling. After surgery, the foot will usually be elevated and kept dressed, to ensure no infection gets into the wound. In cases where poor blood supply is an issue, elevation of the foot will be sacrificed, because it’s a fine balance between the blood reaching the foot and swelling developing.
As soon as the wound begins to heal, a patient will be encouraged to start walking with the help of a physical therapist.
Some toe amputation patients are given a rehabilitation programme to follow at home. This may involve avoiding specific activities until the incision has fully healed.
Following a toe amputation, it’s important to consult your doctor if there are any signs of infection, swelling, increased pain, bleeding, or decreased sensation in the rest of the foot or toes.
Toe amputation recovery time
Your stitches will be removed about 10 days post-surgery. In the majority of patients, pain starts to ease within a week of the procedure.
You may need to wear a special type of shoe for around two to four weeks following surgery.
Toe amputation potential complications
As with all surgical procedures, toe amputation carries a risk of complications. However, severe complications are rare.
Possible complications include the risk of infection and slow or difficult healing.
There is also a risk of the other toes moving closer together to fill the void, or overriding one another as they are pushed around inside a shoe.
As with all amputations, there is also a possibility of experiencing either ‘stump pain’ or ‘phantom limb pain’.
• Stump pain
This is a severe pain in the remaining tissue, which can be managed with painkillers. It generally resolves with time.
• Phantom limb pain
This refers to the phenomenon of feeling pain or sensations in the amputated toe, as if it is still there. It is more common in adults than in children. Those who have experienced pre-amputation pain or infection may also be more susceptible to it.
Phantom limb pain usually diminishes over time. However, its impact can sometimes be quite severe, so it’s essential that patients seek support and don’t dismiss their symptoms. It can be managed with a combination of medication, electrical nerve stimulation, massage or even virtual reality therapy.
Toe amputation implications for daily life
Toes are important for balance and provide support when walking. Consequently, losing one or more toes can affect balance in the short-term. Having a big toe amputated has a more dramatic impact, as it bears the brunt of your weight when walking. This can affect general day-to-day life, especially with sports and exercise.
However, this can be managed by following the prescribed rehabilitation programme and taking time to get used to balancing without the toe.
Special toe spacers or insoles (orthotics) for your shoes can also help to manage the impact of toe amputation.
Toe amputation and mental health
Amputation of any kind can have a huge psychological impact, as you will need to adjust to the loss of sensation and function, as well as your new sense of body image and identity.
Following amputation, some common emotions you might might experience include depression and anxiety. Many people who have had an amputation can also feel emotions similar to the feeling of death of a loved one, such as grief or bereavement. This is especially prevalent for those who have had an emergency amputation, who have not had time to adjust to the idea.
If you are struggling to come to terms with your amputation, or are experiencing feelings of grief, depression or anxiety, open up to those close to you, and speak with your doctor about the help and support available.
Last updated: 03-03-2020