• Amputation of the Foot or Toe

    (Toe Amputation; Foot Amputation)

    Definition

    Surgical removal of a toe, foot, or part of a foot

    Reasons for Procedure

    Amputation is most often done to:
    • Treat infections
    • Remove dead or damaged tissue, such as gangrene may cause
    Gangrene of Foot
    gangrene on foot
    Copyright © Nucleus Medical Media, Inc.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have an amputation, your doctor will review a list of possible complications, which may include:
    • Difficulty healing
    • Infection
    • Stump pain (severe pain in the remaining tissue)
    • Phantom limb pain (a painful sensation that the foot or toe is still there)
    • Continued spread of gangrene, requiring amputation of more areas of your foot, toes, or leg
    • Bleeding
    • Nerve damage
    • Limp (depending on which toe has been removed)
    • Contracture deformity
    Factors that may increase the risk of complications include:
    • Smoking
    • Infection
    • Poorly controlled diabetes
    • Poor blood circulation
    • Bleeding disorders
    • Heart problems or high blood pressure
    • Smoking
    • Kidney failure
    • Obesity
    • Advanced age

    What to Expect

    Prior to Procedure

    Before the surgery, your doctor may do some of the following:
    • Blood tests
    • X-ray of toe and foot
    • Bone scan to see if the bone is infected
    • Tests to evaluate blood circulation and help the doctor determine how much of the foot or toe needs to be amputated
    Talk to the doctor about the medicines you are taking. You may be asked to adjust the dose or stop taking certain medicines, such as:
    • Aspirin or other anti-inflammatory drugs (may need to stop up to one week before)
    • Blood-thinning medicines, such as:
      • Clopidogrel (Plavix)
      • Warfarin (Coumadin)
      • Ticlopidine (Ticlid)
    In the days leading up to your surgery:
    • Arrange for a ride to and from the hospital.
    • Arrange for help at home after the surgery.
    • The night before, eat a light meal. Do not eat or drink anything after midnight.
    • You may be asked to shower the morning of your procedure. You may be asked to use a special antibacterial soap.

    Anesthesia

    Based on your surgery and general health, you may have:
    • General anesthesia —You will be asleep.
    • Local anesthesia—The area that is being operated on will be numbed.
    • Spinal anesthesia —Medicine is delivered to the spine to numb the lower body.

    Description of the Procedure

    You will be given IV fluids and antibiotics. Your foot will be washed with an antibacterial solution. The surgeon will make an incision into the skin around the area. The blood vessels will be tied off or sealed with an electrical current. This will prevent bleeding. The involved bones will be removed.
    The ends of the remaining bone(s) will be smoothed. The remaining skin and muscle will be pulled over the open area. It will be closed with stitches. A sterile dressing will then be placed over the incision.
    If there is an active infection, tubes may be left in place to allow fluids to drain. In some cases, the skin will not be closed but will instead be packed with a moist dressing.
    Amputation of Crushed Toe
    crush toe amputation
    Copyright © Nucleus Medical Media, Inc.

    Immediately After Procedure

    You will be taken to a recovery room. There, you will be monitored for any negative effects from the surgery or anesthesia. You will be given pain medicine. You may also receive antibiotic medicines.

    How Long Will It Take?

    20-60 minutes

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. The area will be painful after the surgery. You will be given medicine to help control the pain.

    Average Hospital Stay

    The usual length of stay is 2-7 days. Your doctor may choose to keep you longer if complications arise.

    Post-procedure Care

    At the Hospital
    • Your foot will be kept elevated.
    • The toe or foot will be wrapped with a bulky dressing. This will protect it from injury.
    • You will be encouraged to get up and begin walking as soon as the wound allows.
    • A physical therapist will likely assist you in walking at first.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • You may need to wear a cast, a special postoperative shoe, or a regular shoe with the foot box removed until the stitches are taken out. Stitches will be removed in about three weeks.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • You may be advised to begin an exercise, physical therapy, or rehabilitation program.
    • If you are a smoker, you should quit .
    • Be sure to follow your doctor’s instructions about activity and medicines.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Chalky white or blackish appearance of foot, other toes, or leg
    • Decreased sensation, numbness, or tingling in the rest of your foot, toes, or leg
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or that persist for more than one day after discharge from the hospital
    • Pain that you cannot control with the medicines you have been given
    • Pain, burning, urgency or frequency of urination, or blood in the urine
    • Cough, shortness of breath, or chest pain
    • Joint pain, fatigue, stiffness, rash, or other new symptoms
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/

    American Diabetes Association http://www.diabetes.org/

    CANADIAN RESOURCES

    Canadian Diabetes Association http://www.diabetes.ca/

    The Canadian Orthopaedic Association http://www.coa-aco.org/

    References

    Armstrong DG, Lavery LA. Diabetic foot ulcers: prevention, diagnosis and classification. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/980315ap/armstron.html . Accessed June 9, 2008.

    Baima J, Trovato M, Hopkins M, deLateur B. Achieving Functional Ambulation in a Patient with Chopart Amputation. American Journal of Physical Medicine & Rehabilitation . 2008;87(6):510-513. Canale ST, Daugherty K, Jones L eds. Campbell's Operative Orthopaedics . 9th ed. Philadelphia, PN: Mosby-Year Book; 1998.

    Canale ST, Daugherty K, Jones L eds. Campbell's Operative Orthopaedics . 10th ed. Philadelphia, PN: Mosby-Year Book; 2003.

    Parrett B, Pribaz J, Matros E, Przylecki W, Sampson C, Orgill D. Risk Analysis for the Reverse Sural Fasciocutaneous Flap in Distal Leg Reconstruction. Plastic and Reconstructive Surgery . 2009;123(5):1499-1504.

    Sales CM, Goldsmith J, Veith FJ eds. Handbook of Vascular Surgery . Sudbury, MA: Quality Medical Publishing; 1996.

    Townsend C, Beauchamp DR eds. Sabiston Textbook of Surgery . 16th ed. Oxford, UK: WB Saunders; 2001. Townsend C, Beauchamp DR eds. Sabiston Textbook of Surgery . 17th ed. Oxford, UK: WB Saunders; 2004.

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