Does My Toe Need Amputation?

Toe amputation is typically performed on patients with a diabetic foot when the toe cannot be saved.

Toe amputation is a common procedure performed by a wide variety of healthcare providers. One of the most common indications for toe amputation is patients with a diabetic foot. Most of these procedures are performed by a general or foot surgeon. 

Toe amputation is usually performed as a last resort when medical treatment fails, or the toe cannot be salvaged. Systemic diseases such as diabetes and hypertension need to be managed, and they affect the blood vessels and nerves.

The method of toe amputation (disarticulation vs. osteotomy) and the level of amputation (partial or whole digit) depend on the extent of disease and anatomy. With any amputation, the degree of postoperative functional loss is usually expected and proportional to the amount of tissue amputated. The big toe is considered the most important of the toes in functional terms.

There are three broad indications for amputation of any body part:

• Dead
• Deadly
• Dead loss

A “dead” toe is the one in which the blood supply is so completely compromised that infarction and necrosis (tissue death) develop with a nonviable tissue turning dry and black. A “dead” toe is most commonly observed as a complication of diabetes due to vascular disease. Other major risk factors for peripheral vascular disease are smoking, hypertension, hyperlipidemia, narrowing or spasm of blood vessels, or severe frostbite.

A “deadly” category results in systemic sequelae and can be deadly if not managed immediately. Malignancy may also require amputation, though infrequently.

A toe is a “dead loss” when it is diseased to the point where it is irreparable and is no longer functional.

The main contraindication for toe amputation is if the dead tissue is poorly demarcated and patchy. If the borders of the dead tissue area are unclear, the surgeon would not be able to demarcate the extent of the disease, affecting the results of surgery. Amputation of any body part is contraindicated if it results in a significant decrease in quality of life in case of a limited life expectancy.

Prior to toe amputation, the surgeon performs a detailed clinical assessment and complete blood analysis. Moreover, they perform a thorough assessment of the status of nerves and blood vessels of both limbs.

• The procedure is performed under anesthesia and is relatively quick. 
• The affected toe is completely amputated with a margin of normal, healthy tissue. 
• The method of toe amputation (disarticulation vs osteotomy) and the extent of amputation (partial or whole digit) depend on the extent of disease and anatomy. 
• The wound is left open. Dressing and wound cleaning are done regularly until the wound heals completely. 
• The complete recovery period from the toe amputation surgery is two to four weeks.

Some common complications encountered are as follows:

• Pain, swelling, and bruising
• Inadequate hemostasis (blood clotting), which causes bleeding 
• Hematoma (blood clot) 
• Inadequate amputation leading to spread of disease
• Failure to heal—this could be due to inadequate blood supply as well or due to ongoing infection
• Spread of infection to the rest of the body (tetanus)