Toe Amputation With Diabetes: Procedure and Recovery Issues (2022)

Digital amputation has the possible to enable patients with diabetes to resume everyday activities with couple of modifications in gait. Appropriately, these authors go over appropriate procedure planning, ways to guarantee suitable vascular supply and crucial surgical pearls.

The majority of podiatric doctors who treat patients with diabetes at some time will come across a patient in requirement of a partial or full digital amputation. These patients normally have actually had extensive treatments including various wound therapies, surgical debridements, prescription antibiotics in addition to laceration and drain. The indications for digital amputation consist of osteomyelitis, septic arthritis, gas gangrene, ischemia/gangrene and an advancing soft tissue infection.

In specific patients, an optional partial toe amputation with diabetesmight be suggested. These patients who do not have an active infection might suffer from a stiff hammertoe deformity with a non-healing ulcer on the pointer of their toe. In these situations, partial digital amputation would deal with the hammertoe deformity and the non-healing ulcer at the exact same time. A candidate for this type of a procedure would be a patient who is senior, someone who has multiple comorbidities or a specific with very little mobility who would gain from a fast and simple procedure with minimal postoperative healing time.

Generally, one can prevent higher level amputations with early digital amputations that enable patients to return to regular activities with very little disability.

Appropriately, let us take a closer take a look at the senior author’s technique to digital amputations including proper preoperative evaluation, cut planning and pearls in performing numerous digital treatments.

(Video) Diabetes and Amputation: Why It's Done and How to Prevent It

There are lots of advantages of more distal amputations in comparison with amputations at a higher level. Distal amputations are more practical and have numerous physiological benefits such as energy preservation throughout ambulation.

In a research study of 8 patients who had gone through partial foot amputationswith diabetes and a cohort of matched non-amputee control patients, Dillon and Barker report that amputations distal to the metatarsophalangeal joint (MPJ) had little impact on the typical pattern of ankle power generation.3 Distal amputations are preferred to proximal amputations as they protect length and therefore regular biomechanics of the foot. The easy rule of thumb is to conserve as much length as possible when performing partial foot amputations.

Toe Amputation Procedures

When carrying out main toe amputations, it is necessary to make an effort to leave a section of the proximal phalanx undamaged. Leaving a stump of the 2nd, third or 4th toe undamaged enables the stump to function as a buttress, avoiding the nearby toes from establishing a shift in the transverse aircraft. Amputations of minimal numbers generally result in a gait with very little to no disruption.

Concerns frequently show up regarding whether a guillotine amputation of the toe is proper. In our facility, we choose to prevent guillotine amputations and make an effort to prepare the incision in order to close the injury primarily or in a postponed main fashion. In order to carry out closure of the amputation site, we typically perform more proximal bone resection to enable tension complimentary closure. Although guillotine amputation of the toe can preserve length, the danger of leaving an open wound to recover via secondary intent does not surpass the advantage of primary closure when possible.

The preferred cut for a partial toe amputation is a transverse fish-mouth cut, which tends to give the best outcome both cosmetically and functionally.

(Video) PARTIAL TOE AMPUTATION DUE TO BONE INFECTION / DIABETES 😭😭😭

Relevant Insights On Performing A Hallux Amputation

The hallux plays an important role in supporting the medial element of the foot and the extensor hallucis longus (EHL) is one of the most essential extrinsic muscles of the foot throughout the swing phase of gait. Therefore, amputation of the hallux often causes an apropulsive gait.4 The degree of biomechanical dysfunction depends upon the level of amputation.

The anatomy of the hallux is different from the lower toes and should have a fast review. The base of the proximal phalanx has the insertion of the flexor hallucis brevis, sesamoid complex and plantar fascia, making up the windlass mechanism. The windlass system offers stability and rigidity to the medial side of the foot, avoiding arch collapse and allowing for a propulsive gait.

Accordingly, surgeons must not begin a hallux amputation lightly and need to work out care, precision and cautious cut planning. Overall hallux amputation will unavoidably cause extensor tendon contracture with advancement or exacerbation of lesser hammertoe deformities. The retrograde pressure from the minimal digits results in popular metatarsal heads and distal fat pad migration. The transfer of weightbearing becomes extremely evident and will regularly result in nearby metatarsal head ulcerations.

A research study by Mann and classmates reveals the impact of hallux amputation in patients who went through re-implantation of the hallux in place of a lost thumb. The authors found that the plantar pressure moved from the second metatarsal head to the third.5 This was because of the loss of the flexor hallucis brevis and windlass mechanism triggering the load to transfer laterally.

When approaching a hallux amputation, one must make an effort to salvage as much of the base of the proximal phalanx as possible. An ideal scenario would be to leave the base of the proximal phalanx intact in order to keep the windlass mechanism intact. Doing this would save the MPJ. Hakim-Zargar and colleagues reported that one need to maintain 10 mm of the hallux proximal phalangeal base throughout amputation to protect the integrity of the flexor hallucis brevis insertion to a physiologic load.6 Resecting the insertion results in decreased flexion stamina, retraction of the sesamoids and transfer metatarsalgia. In our experience, one can carry out most of hallux amputations without resecting the base of the proximal phalanx.

(Video) Diabetes 23, Clinical Cases of Diabetic Feet

Keys To Ensuring Adequate Vascular Supply

Arterial perfusion is commonly one of the most important predictors of healing and is likewise a crucial consider planning the level of amputation. Non-invasive arterial researches are the pillar recommendations prior to any amputation.7 In the senior author’s opinion, anticipating the level of amputation and the level of recovery depends upon a number of elements.

Initially, the surgeon has to comprehend that there is no particular pressure or value that is 100 percent predictive of recovery. Usually speaking, the toe pressure of > 40 mmHg is thought about to be consistent with healing. The greater the pressure is above 40 mmHg, the greater the probability of recovery.

So does this mean that patients with pressures of 40 mmHg and below will not be able to heal? The basic response is that some patients will be able to heal and some patients will not. It is our suggestion that anyone with toe pressures of less than 40 mmHg should undergo a vascular workup for a possible revascularization. Nevertheless, we all see patients who are too frail or too old, and are not prospects for revascularization. It is these patients– whose toe pressures are less than 40 mmHg and who are not candidates for revascularization — whom we have to evaluate and figure out whether their digital amputation will recover.

In summary, arterial examination needs to consist of noninvasive arterial testing in addition to a clinical evaluation by the specialist. Depending on toe pressures alone may lead one astray in anticipating healing in patients with severe arterial occlusive condition.

What You Should Know About Incision Planning

Incision planning can happen in different methods. It is very important to examine the extent of sensible tissue and make sure that there is sufficient protection. Commonly, we are forced to resect more of the phalanges in order to obtain tension totally free closure. However, this usually happens in patients who have osteomyelitis of the distal phalanx or those in whom the dorsal and/or plantar skin has necrosis that extends to the level of the proximal interphalangeal joint. This circumstance forces us to resect the non-infected bone in order to get to the sensible dorsal and plantar skin of the toe. Surgeons should prevent stress at the cut website to prevent dehiscence.

(Video) Diabetic Ulcerations and Amputations

Incision choices consist of transverse fish-mouth, sagittal fish-mouth or guillotine techniques. Our team believe that using more of the plantar skin is preferred considering that the plantar skin is 4 to 5 mm thick, which is two times thicker than the dorsal skin.11 Another common mistake made during amputation surgery is to remove too much viable skin. Our approach is to salvage as much practical dorsal and plantar skin as possible, then renovate as needed right away prior to closure.

Diabetic Toe Amputation Recovery

Proper post-op management is essential in patients following digital amputations. Even after an ideal medical intervention, problems can emerge due to less than perfect postoperative conditions.

One must encourage patients to restrict their activity for the first 3 to 5 days postoperatively. The immediate postoperative period is when hematomas develop. Hematomas might ultimately result in an infection and dehiscence if the patient is up on his/her feet.

Summary

Infections develop often in diabetic feet with ulcerations. If these infections become refractory to conservative steps, early medical intervention is important to reduce the requirement for popular amputations. Clinical judgment can typically provide trustworthy information as to whether medical intervention will be a successful treatment. If there are any concerns about the vascular status, one need to buy noninvasive vascular researches.

Amputation of foot toes will normally cause very little gait disruption. Nevertheless, when cutting off the hallux, there is a disturbance of weightbearing pressures, which increases the vulnerability of the continuing to be toes. When amputating the hallux, one must take care to maintain 10 mm of the proximal phalangeal base to maintain the stability of the intrinsic muscle attachments and the windlass system. During skin closure, the lengths of the flaps can vary but tension free closure with a plantar flap is ideal.

(Video) #12 Diabetic Foot Complications. This will save you from an amputation.

When one guarantees careful planning, digital amputation of toe is a procedure that can enable patients to go back to practical activity with minimal disturbance to their gait.

FAQs

How long does it take a diabetic to heal from a toe amputation? ›

A surgeon will remove the damaged tissue and keep as much healthy tissue as possible. After surgery, you'll stay in the hospital for a few days. It may take 4 to 6 weeks for your wound to heal completely.

What are 3 things you should never do to the feet of someone with diabetes? ›

Avoid soaking your feet, as this can lead to dry skin. Dry your feet gently, especially between the toes. Moisturize your feet and ankles with lotion or petroleum jelly. Do not put oils or creams between your toes — the extra moisture can lead to infection.

How long do you stay in hospital after toe amputation? ›

The average hospital stay after toe amputation is from two to seven days. The staff will monitor your healing during your hospital stay, give you pain medicines, and start physical therapy.

How serious is a toe amputation? ›

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.

How long after toe amputation can I walk? ›

It may take up to 2 months to heal. Physical activity may be limited during recovery. You may need to ask for help with daily activities and delay return to work.

Can you walk after a toe amputation? ›

Your balance may be affected; however, most people will walk and even run again after toe amputation. Losing your big toe will affect walking and running the most, but physical therapy and shoe inserts can help with resuming normal activities.

Should diabetic wear compression socks? ›

Fit is especially important for people with diabetes who have poor circulation and experience swelling in the feet or legs. In that case, compression socks may be recommended. These are snug-fitting socks that promote blood flow. Compression socks should not be so tight that they impair circulation.

What happens to your toes when you have diabetes? ›

Although rare, nerve damage from diabetes can lead to changes in the shape of your feet, such as Charcot's foot. Charcot's foot may start with redness, warmth, and swelling. Later, bones in your feet and toes can shift or break, which can cause your feet to have an odd shape, such as a “rocker bottom.”

Which toe is the least important? ›

The least important of your toes are undoubtedly your pinky toes. As the smallest toes, they bear the least weight and have the least impact on maintaining balance. People born without pinky toes or those who lose one in an accident will see very little, if any, changes to how their feet function.

What is the recovery for having a toe removed? ›

Your Recovery

For most people, pain improves within a week after surgery. You may have stitches or sutures. The doctor will probably take these out about 10 days after the surgery. You may need to wear a cast or a special type of shoe for about 2 to 4 weeks.

Is a toe amputation a major surgery? ›

Background: Digital toe amputation is a relatively minor surgical procedure but there is a historical view that it is the "first stage in a predictable clinical course" leading to eventual limb loss. There is a paucity of contemporaneous data on the long-term outcomes of patients undergoing toe amputation.

Is toe amputation painful? ›

What will happen during toe amputation? You may be given anesthesia to numb your leg or foot. You may feel pressure or pushing during surgery, but you should not feel any pain.

Why do diabetics get toes amputated? ›

Because many diabetic patients can't feel pain or have a loss of sensation in their feet and/or toes, ulcers or wounds can develop and become infected, and diabetic foot or leg amputation may be required if the infection isn't treated.

What kind of anesthesia is used for toe amputation? ›

Local anesthesia alone is often satisfactory, either in the form of a ring block or a regional (usually ankle) block. Spinal or epidural anesthesia can also be used, though the use of antiplatelet or anticoagulant medications in this population is frequent. General anesthesia may also be feasible.

How much is a toe worth? ›

Why is a thumb worth more than a finger?
Body part lostCompensation
Eye$64,000
Thumb$35,000
First finger$18,400
Big toe$15,200
8 more rows
11 Jun 2002

Can you drive with an amputated toe? ›

People who have undergone amputation can still drive and retain their independence. If you have recently experienced limb loss, rest assured that there are modified ways to get back to doing all your normal day-to-day activities.

Can you get fake toes? ›

We mimic the texture, color and translucency of your skin and nails to create prosthetic toes that closely match your existing toes. Prosthetic toes may be needed due to: Congenital or birth difference; such as brachymetatarsia (abnormally short toe), Amniotic band syndrome, or symbrachydactyly (missing toes at birth)

Which toe is most important for walking? ›

It probably is no surprise that your big toe is the most important when maintaining balance and bearing body weight. Your big toes bear just about 2 times the amount of weight as all your other toes combined! It still should not shock you that the pinky toes are the least important.

Is there a prosthesis for amputated toes? ›

Toe Prosthetics: You may be required to use toe prosthetics if your balance remains an issue after rehabilitation. When it comes to a cosmetic replacement for your toe, there are options of prostheses available in the market. It can be made as rigid as required to give you additional support and balance while walking.

How many toes do you need to walk? ›

The Department of Defense's medical standards require rejecting anyone with a "current absence of a foot or any portion thereof." Yet, doctors consider having nine toes a minor impairment that does little to keep soldiers, runners or walkers off their feet.

What's the worst food for diabetics? ›

Worst Choices
  • Fried meats.
  • Higher-fat cuts of meat, such as ribs.
  • Pork bacon.
  • Regular cheeses.
  • Poultry with skin.
  • Deep-fried fish.
  • Deep-fried tofu.
  • Beans prepared with lard.
6 Dec 2020

What fruits to avoid if you are diabetic? ›

Fruit is also an important source of vitamins, minerals, and fiber. However, fruit can also be high in sugar. People with diabetes must keep a watchful eye on their sugar intake to avoid blood sugar spikes.
...
These include:
  • apples.
  • apricots.
  • avocados.
  • bananas.
  • blackberries.
  • blueberries.
  • cantaloupes.
  • cherries.
29 Mar 2021

Should a diabetic wear socks to bed? ›

Consider socks made specifically for patients living with diabetes. These socks have extra cushioning, do not have elastic tops, are higher than the ankle and are made from fibers that wick moisture away from the skin. Wear socks to bed. If your feet get cold at night, wear socks.

What number is considered high blood sugar? ›

In general: Less than 140 mg/dL (7.8 mmol/L ) is normal. 140 to 199 mg/dL (7.8 to 11.0 mmol/L ) is consistent with prediabetes. 200 mg/dL (11.1 mmol/L ) or higher after two hours suggests diabetes.

Is Tylenol OK for diabetics? ›

TYLENOL® is the #1 Doctor Recommended Pain Relief brand for patients with diabetes. Pain relievers may affect blood pressure. TYLENOL® is the #1 doctor recommended pain relief brand for those with high blood pressure.

What happens when toes turn black? ›

Gangrene is a serious condition where a loss of blood supply causes body tissue to die. It can affect any part of the body but typically starts in the toes, feet, fingers and hands. Gangrene can occur as a result of an injury, infection or a long-term condition that affects blood circulation.

When should I be worried about numbness in my toes? ›

You should get emergency help for: Any tingling or numbness in the toes that spreads up the body. Weakness of any part of your body that's spreading rapidly. Trouble breathing while lying down.

Is diabetic foot curable? ›

Unfortunately, there's no cure for diabetic neuropathy. But you can take steps to slow the progression of this disease. Your doctor will likely recommend pain medication to help alleviate nerve pain. For mild nerve pain, you can take over-the-counter medications like acetaminophen or ibuprofen.

Are toes necessary? ›

When you walk or run, the big toe plays an essential role in arch stabilization during mid-stance, and during the take-off phase of the Normal Gait Cycle.

Why is the pinky toe important? ›

Our little toes or “pinky toes” are important for helping us maintain our balance when we stand or move. Injuries or deformities to this toe can be painful and can throw off our gait.

Why is the big toe important? ›

The main function of the big toe is to direct body weight through the foot in the direction of travel (Yavuz et al., 2009). Stoneham et al (2018) recently demonstrated the association between big toe valgus (inward squash of big toe towards other toes) and foot pronation while running barefoot.

Can you walk without all your toes? ›

It is still possible to walk without any of them, but your gait will need to compensate. There are prosthetics and shoe inserts available that may be of benefit too, depending on which one or how many you have missing.

What happens if you amputate your big toe? ›

You may have problems with walking or balance, especially if you lose your big toe. You may need to have special insoles made to fit in your shoes. These insoles are called orthotics. You may go home on the day of surgery.

Can you get stitches between toes? ›

Taking care of stitches in your foot, whether they're stitches on the bottom of your foot or stitches in between your toes, is not as hard as it might seem. Like with other parts of your body, stitches need to be kept clean and dry and checked regularly to avoid infections.

How can a diabetic wound heal faster? ›

A common diet recommendation for people living with diabetes is less carbohydrates and more protein. That's because if you're eating foods with less sugar and lower glycemic levels, it's a lot easier to keep blood sugar levels in check. Eating more protein has an added advantage – it can help wounds heal more quickly.

Why do diabetics have toes amputated? ›

Diabetes is linked to two other conditions that raise the chances of foot amputation: peripheral artery disease (PAD) and diabetic neuropathy. PAD can narrow the arteries that carry blood to your legs and feet and make you more likely to get ulcers (open sores) and infections.

Why do they amputate toes diabetes? ›

Because many diabetic patients can't feel pain or have a loss of sensation in their feet and/or toes, ulcers or wounds can develop and become infected, and diabetic foot or leg amputation may be required if the infection isn't treated.

Can diabetics survive amputation? ›

Previous reports have shown that patients with diabetes-related amputations have a high risk of mortality, with a 5-year survival rate of 40–48% regardless of the etiology of the amputation [5–7].

Why is my toe wound not healing? ›

If you suffer a foot injury, infection can inhibit the healing process. There are many different types of infection, but one of the most serious is cellulitis, which is a bacterial skin infection that often causes pain, redness, and swelling, and it's a common cause of slow-healing foot wounds.

What is the fastest way to heal a toe wound? ›

6 Tips For Foot Wound Care
  1. Clean wounds right away. For a clean-cut or scrape, the first thing to do is clean the wound with sterile saline and antibacterial soap. ...
  2. Apply antibiotic cream. ...
  3. Cover with a bandage. ...
  4. Healing begins almost immediately. ...
  5. Look for signs of infection. ...
  6. See a doctor right away if your wound:
11 Feb 2021

Why do diabetics not heal well? ›

Uncontrolled diabetes may also affect circulation, causing blood to move more slowly, which makes it more difficult for the body to deliver nutrients to wounds. As a result, the injuries heal slowly or may not heal at all. Diabetes can also cause diabetic neuropathy, which can affect wound healing.

What happens after toe amputation? ›

Your Recovery

For most people, pain improves within a week after surgery. You may have stitches or sutures. The doctor will probably take these out about 10 days after the surgery. You may need to wear a cast or a special type of shoe for about 2 to 4 weeks.

Is toe amputation painful? ›

What will happen during toe amputation? You may be given anesthesia to numb your leg or foot. You may feel pressure or pushing during surgery, but you should not feel any pain.

Is a toe amputation a major surgery? ›

Background: Digital toe amputation is a relatively minor surgical procedure but there is a historical view that it is the "first stage in a predictable clinical course" leading to eventual limb loss. There is a paucity of contemporaneous data on the long-term outcomes of patients undergoing toe amputation.

What happens if you don't amputate diabetes? ›

Untreated, it can lead to serious complications such as kidney failure and blindness. People with diabetes often have reduced sensation in their feet, as well as poor circulation. As many as one-third of people with the most common form — Type 2 — develop foot ulcers or a break in the skin that can become infected.

Can you drive with an amputated toe? ›

People who have undergone amputation can still drive and retain their independence. If you have recently experienced limb loss, rest assured that there are modified ways to get back to doing all your normal day-to-day activities.

Can black toes be saved? ›

Tissue that has been damaged by gangrene can't be saved. But treatment is available to help prevent gangrene from getting worse.

Does toe amputation qualify for disability? ›

A traumatic amputation is the loss of a body part—usually a finger, toe, arm, or leg—that occurs as the result of an accident or trauma. An amputation is considered a disabling condition by the Social Security Administration (SSA) and may qualify you for SSD benefits.

Why does amputation shorten life expectancy? ›

How Does Traumatic Amputation Affect Life Expectancy? Post-traumatic lower limb amputees have an increased morbidity and mortality from cardiovascular disease. Psychological stress, insulin resistance, and behaviors such as smoking, alcohol use, and physical inactivity are prevalent in traumatic lower limb amputees.

What amputation has the highest death rate? ›

Overall, the 5-year mortality rate was very high among patients with any amputation (major and minor combined), ranging from 53% to 100%, and in patients with major amputations, ranging from 52% to 80%. Mortality after below-the-knee amputation ranged from 40% to 82% and after above-the-knee amputation from 40% to 90%.

Videos

1. Transmetatarsal Foot Amputation Surgery Technique guide by Dr. Kolodenker Diabetic Foot
(Dr. Gennady Kolodenker, DPM)
2. Beware of Diabetic Foot Ulcers and How to Quickly Heal Them
(Dr. Andrew Schneider)
3. Diabetic Foot Infections: Toe to Toe
(IDPodcasts)
4. Deion Sanders Reveals He Had Two Toes Amputated Following Foot Surgery Complications | PEOPLE
(People)
5. Evaluation and Management of Diabetes-Related Foot Complications
(UAB Medicine)
6. Patient Stories | Toe Amputation
(Lexington Podiatry)

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