Clinical Research on Foot & Ankle
Open Access

Toe amputation is a surgical procedure performed to remove one or more toes due to various medical conditions, including trauma, infection, ischemia, or complications from chronic diseases such as diabetes. This article provides a comprehensive overview of the indications, surgical techniques, complications, and postoperative care associated with toe amputation [1]. Toe amputation is a relatively common surgical intervention. Although considered a minor amputation, it can significantly impact mobility, quality of life, and overall health. It is frequently performed to prevent the spread of infection or gangrene and to address severe deformities or irreparable trauma [2]. Toe amputation is a surgical procedure involving the removal of one or more toes, typically performed to treat severe trauma, infection, necrosis, or chronic conditions such as diabetes and peripheral arterial disease (PAD) [3]. Although the procedure may seem minor compared to larger limb amputations, it carries significant implications for a patient’s mobility, quality of life, and overall health [4]. Understanding the indications, surgical techniques, potential complications, and postoperative care is essential for both healthcare providers and patients to ensure optimal outcomes. The decision to amputate a toe is often driven by the need to prevent the spread of infection or necrosis, alleviate chronic pain, or address structural deformities. Diabetic foot ulcers, a common complication of poorly controlled diabetes, are one of the primary causes leading to toe amputation [5]. In cases of gangrene or severe infection, amputation may become necessary to prevent systemic spread and preserve the patient’s overall health. Additionally, traumatic injuries, such as crush injuries or frostbite, may warrant toe amputation when tissue viability is compromised. Other indications include congenital abnormalities, malignant tumors, or chronic deformities causing pain and functional impairment [6]. The surgical procedure itself varies based on the affected toe, the severity of the condition, and the underlying pathology. Surgeons aim to preserve as much healthy tissue as possible while ensuring complete removal of the damaged or diseased area. Techniques may range from simple disarticulation of the phalangeal joints to partial or full toe removal, sometimes including adjacent tissue if infection or necrosis has spread. Proper surgical planning and execution are crucial to minimize complications and enhance the likelihood of a functional recovery [7]. Complications following toe amputation can range from minor wound infections to more severe issues, such as poor healing, chronic pain, or further tissue necrosis, particularly in patients with vascular conditions or diabetes. Postoperative care is a critical aspect of the recovery process. It involves wound management, pain control, physical therapy, and the use of appropriate footwear or orthotic devices. The goal of postoperative care is to promote healing, prevent complications, and help the patient regain maximum functionality and mobility. In some cases, psychological support and rehabilitation may be necessary, as the loss of even a single toe can affect balance, gait, and emotional well-being [8].

Understanding the comprehensive aspects of toe amputation—from its indications and surgical techniques to its complications and recovery process—enables healthcare providers to make informed decisions and offer better patient care. It also empowers patients to actively participate in their recovery, adhere to preventive measures, and improve their overall quality of life.

Toe amputation is indicated in several medical scenarios, including:

Trauma- Severe crush injuries, fractures, or extensive soft tissue damage.

Infection- Chronic osteomyelitis, abscess, or septic arthritis unresponsive to antibiotics.

Peripheral Artery Disease (PAD)- Ischemic necrosis due to inadequate blood supply.

Diabetes Complications- Non-healing ulcers, gangrene, and Charcot foot.

Tumors or Malignancies- Rare but occasionally indicated for malignant lesions.

Congenital Deformities- Severe deformities affecting function or causing pain.

Before performing toe amputation, a thorough preoperative evaluation is necessary:

To assess vascular status, comorbidities, and the extent of infection.

Diagnostic imaging

X-rays to evaluate bone integrity.

MRI/CT scans in cases of suspected osteomyelitis or deep tissue involvement.

Vascular Studies- Ankle-brachial index (ABI) or Doppler ultrasound to evaluate blood flow.

Laboratory Tests- CBC, blood glucose, and infection markers (ESR, CRP).

The choice of surgical technique depends on the indication and the number of toes to be amputated.

Types of toe amputation

Removal of the distal phalanx only.

Complete removal of the toe at the metatarsophalangeal (MTP) joint.

Removal of the toe along with the associated metatarsal bone.

Multiple Toe Amputation: Performed in cases of extensive infection or gangrene.

Surgical Procedure

Anesthesia: Local, regional, or general anesthesia depending on patient factors.

Incision and resection

An elliptical incision is made around the base of the toe.

Care is taken to preserve viable tissue.

Bone is cut using a bone saw or rongeur.

Achieved with electrocautery or ligatures.

Skin edges are approximated using interrupted sutures, and a non-adherent dressing is applied.

Effective postoperative care is essential to prevent complications and promote healing.

NSAIDs or opioids for pain control.

Prophylactic antibiotics.

Regular dressing changes.

Check for signs of infection (redness, swelling, drainage).

Early mobilization with assistive devices (walker or crutches).

Physical therapy to improve gait and balance.

Custom orthotics or shoes to reduce pressure on the remaining toes.

Complications

Although toe amputation is generally safe, complications may occur:

• Infection: Secondary bacterial infection at the surgical site.
• Poor Wound Healing: Common in diabetic and vascular-compromised patients.
• Phantom Limb Pain: Sensation of the missing toe.
• Impaired Gait and Balance: Loss of toe function can impact walking stability.
• Recurrence of Infection or Necrosis: May necessitate further amputation.

The prognosis depends on the underlying condition and the patient’s overall health.

In cases of isolated trauma or localized infection, toe amputation has a good prognosis.

Patients with advanced diabetes or PAD may face delayed healing or require additional amputations.

Patients benefit from physical therapy to enhance mobility and prevent secondary complications.

Conclusion

Toe amputation is a critical surgical intervention for managing severe toe injuries, infections, and ischemia. Proper patient selection, meticulous surgical technique, and comprehensive postoperative care are key to optimizing outcomes. Multidisciplinary collaboration between orthopedic surgeons, podiatrists, and wound care specialists enhances patient care and reduces complications. Toe amputation, while sometimes unavoidable, is a complex surgical intervention that carries both physical and emotional implications for patients. Although the procedure itself may be relatively straightforward, the underlying causes, potential complications, and recovery process require a multidisciplinary approach to ensure successful outcomes. Proper identification of the indications for amputation, including timely intervention in cases of infection or tissue necrosis, is essential in preventing further systemic complications. The surgical technique and skill of the operating team play a vital role in preserving tissue viability, reducing the risk of postoperative infections, and enhancing the patient’s chances of regaining functional mobility. Despite the removal of a relatively small body part, the procedure can significantly impact a patient’s gait, balance, and overall mobility. This makes postoperative care, including physical therapy and appropriate footwear, an essential component of recovery. Long-term management is equally important, particularly for patients with chronic conditions such as diabetes or PAD, who are at an increased risk of recurrent ulcers, infections, and subsequent amputations. Preventive measures, including routine foot care, proper glucose management, and regular vascular assessments, are critical in reducing the likelihood of future complications.

Ultimately, toe amputation is not merely a surgical intervention—it represents a turning point in a patient’s health journey. With proper medical care, rehabilitation, and lifestyle adjustments, patients can achieve a functional recovery and maintain a good quality of life. Healthcare providers must offer comprehensive support, including both physical and emotional care, to help patients adapt to the changes and thrive in their recovery.

References

1. Stewart S, Dalbeth N, Vandal AC, Rome K (2016) The first metatarsophalangeal joint in gout: a systematic review and meta-analysis.BMC Musculoskelet Disord17: 69-96.

Indexed at, Google Scholar, Crossref

2. Polachek A, Li S, Chandran V, Gladman D (2017) Clinical enthesitis in a prospective longitudinal psoriatic arthritis cohort: incidence, prevalence, characteristics and outcome: Enthesitis in psoriatic arthritis.Arthritis Care Res69: 1685-1691.

Indexed at, Google Scholar, Crossref

3. Koca TT, Göğebakan H, Koçyiğit BF, Nacitarhan V, Yildir CZ (2019) Foot functions in ankylosing spondylitis.Clin Rheumatol38: 1083-1088.

Indexed at, Google Scholar, Crossref

4. Koumakis E, Gossec L, Elhai M, Burki V, Durnez A, et al. (2012) Heel pain in spondyloarthritis: results of a cross-sectional study of 275 patients.Clin Exp Rheumatol30: 487-491.

Indexed at, Google Scholar

5. Ozaras N, Havan N, Poyraz E, Rezvanı A, Aydın T (2016) Functional limitations due to foot involvement in spondyloarthritis.J Phys Ther Sci 28: 2005-2008.

Indexed at, Google Scholar, Crossref

6. Hyslop E, McInnes IB, Woodburn J, Turner DE (2010) Foot problems in psoriatic arthritis: high burden and low care provision.Ann Rheum Dis 69: 928-963.

Indexed at, Google Scholar, Crossref

7. Hudish LI, Reusch JE, Sussel L (2019) Β cell dysfunction during progression of metabolic syndrome to type 2 diabetes. J Clin Investig 129: 4001-4008.

Indexed at, Google Scholar, Crossref

8. Jung CH, Son JW, Kang S, Kim WJ, Kim H, et al. (2021) Diabetes fact sheets in korea, 2020: An appraisal of current status. Diabetes Metab J 45: 1-10.

Indexed at, Google Scholar, Crossref