Toe amputation: a guide for patients

There are many different deformities that affect toes resulting in pressure points that can be painful. Whenever possible a deformed toe is straightened but, if this is not possible, amputation may be the best treatment.

A partial or total toe amputation can greatly improve comfort and footwear fitting with the advantage of a very short healing and recovery time. Amputations do not affect your walking or balance. The foot usually, after healing, rarely looks as if a toe is missing.

Distal tip amputation

Intermediate amputation

Removal of the toe will be at the proximal interphalangeal (PIP) joint or through the intermediate phalanx (see diagram above).

Proximal amputation

Removal of the toe will be at the MTP joint (see diagram above).

The skin incision is a teardrop shape with the top edge over the joint between the toes. The joint capsule and the overlying skin are closed to cover the head of the metatarsal. The result is cosmetically very acceptable.

What treatments are available?

Treatment can consist of both conservative and surgical options:

Non-surgical treatment (conservative)

• Alteration of footwear: Changing to a wider/deeper fitting shoe can reduce the pressure on the toe.
• Use of protective padding and silicone toe mould.

If conservative treatment fails and the toe continues to cause problems surgery would be recommended.

About day case surgery under local anaesthetic

Surgery is carried out under local anaesthetic as a day case. This means that you are awake during the operation but a screen will prevent you from seeing the operation.

To numb your toe, you will be given some injections around the base of your toe or around your ankle (ankle block).

You can eat and drink on the day of surgery; there is no need for fasting.

The operation may take up to 30 minutes but you should be prepared to be at the hospital longer than this to allow for preparation and recovery. Throughout the operation you will have a tight band (called a tourniquet) placed around your ankle to keep the blood away from your foot. This is sometimes uncomfortable but is released immediately after the operation.

You must have a competent adult at home for the first day and night after surgery.

If you decide on surgical management you will be invited back to attend a pre-surgical assessment clinic. A nurse will take a medical history and if you are on any medication please bring a list of these with you. This is a good opportunity to ask us any questions or concerns you may have about the procedure.

Recovery after your operation

The first two to three days:

• You must rest with your foot raised to hip level.
• You should restrict your walking to bathroom visits only, and if you have been given crutches you must use them in the way you have been shown. You may be able to place a little weight on your foot.

• You should take the painkillers that have been prescribed to you and if you experience pain, it is usually worse for the first two days.
• After three to four days if you are still experiencing pain that is not relieved by the painkillers you should contact the department directly.
• If you have any concerns about your foot you should contact the podiatric surgery department directly.
• The department is closed over the weekend. During out of hours you should contact your GP or attend your local accident and emergency department.
• You can get about a little more after three days.

Two weeks after surgery

• One to two weeks after the operation you must attend the department so you can have your dressing removed.
• The skin should be healing well by this time and any non-dissolvable stitches will be removed.
• You should no longer need a bandage and will be able to wear a normal shoe again.
• At this stage you can gradually and gently increase your activities. You will still need to rest regularly.

Between two and six weeks after surgery

• A few days after the stitches have been removed you can bath your foot unless you have been told differently by a member of staff.
• During this time the foot gradually returns to normal and you may be able to vary your footwear a little.
• There may still be noticeable swelling especially towards the end of the day. This is quite normal at this stage.
• You may also return to work after four weeks (depending on the type of work and footwear in which you are allowed to return). For certain jobs this could be an unrealistic expectation.
• At two weeks you can generally return to driving, however you must feel able to perform an emergency stop.
• Although normal everyday activities will be possible, sporting activities may still be restricted at this stage.

Between six and 12 weeks after surgery

• The foot should now be comfortable and returning to normal but there may still be a minimal amount of swelling.
• You can return to sporting activities and gym workouts.

Six months after surgery

• The residual swelling should now be very slight, although the healing process continues for a year. You should be getting the full benefit from your surgery.

Twelve months after the surgery

• All healing is now complete.

Frequent or serious occurring risks

Unfortunately, all operations carry a small risk of complications; these are uncommon in foot surgery at this clinic and are mostly resolved without permanent disability or pain. If you have any concerns about the examples of complications given here, please discuss them with your specialist before deciding to have surgery.

• Infection (two in 100)
• Delayed healing of the skin (eight in 100)
• Non-compliance of patients (four in 100)
• Prolonged swelling post operatively (four in 100)
• Thick or sensitive scar formation (four in 100)
• Blood clot deep vein thrombosis (DVT).

Complications following foot surgery are rare events but can occur. It is important to remember that if a complication arises you will be required to visit the hospital more frequently and there could be a significant impact on your recovery and return to work time. Foot surgery should be avoided for cosmetic gain only.