Amputation of the Foot or Toe

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Definition | Body Parts Involved | Reasons for Procedure | Complications | What to Expect | Outcome | Call Doctor If

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Definition

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

Parts of the Body Involved

Toe, foot

Reasons for Procedure

Amputation is done to treat gangrene in the foot or toes. Conditions that cause decreased blood circulation, which may lead to gangrene include:

• Complications of diabetes (this is the most common reason)
• Bone infection (osteomyelitis)
• Trauma
• Cancer
• Severe frostbite
• Raynaud's disease
• Buerger's disease
• Severe atherosclerosis
• Blood clots

Risk Factors for Complications during the Procedure

• Infection
• Diabetes
• Poor blood circulation
• Bleeding disorders
• Congestive heart failure

What to Expect

Prior to Procedure

Your doctor will likely do the following:

• Blood tests
• X-rays of toe and foot
• Tests to evaluate blood circulation and help the surgeon determine how much of the foot or toe needs to be amputated:
  • Xenon 133 studies
  • Oxygen tension measurement
  • Doppler measurement
  • Skin fluorescent studies
  • Skin perfusion measurements
  • Infrared evaluation of skin temperature

In the days leading up to your surgery:

• The night before, eat a light meal and do not eat or drink anything after midnight
• You may be asked to shower the morning of your procedure, and you may be given special antibacterial soap to use
• Arrange for a ride to and from the procedure
• Arrange for help at home after returning from the hospital

During Procedure - IV fluids, sedation, anesthesia

Anesthesia - General

Description of the Procedure - Your foot is draped with sterile cloths and washed with an antibacterial solution. The surgeon makes an incision into the skin, around the area to be removed. The skin and muscle are fashioned into a "flap" which is used to cover the open area after the foot or toe has been removed. Blood vessels are tied off or cauterized (burned) to prevent bleeding. The bone(s) may need to be cut with a special bone saw.

After the foot or toe is removed, the ends of the bone(s) are smoothed with a special surgical rasp. If there is an active infection, drainage tubes may be left in place to allow fluids to drain. The remaining skin and muscle flap are pulled over the open area and closed with stitches. A sterile dressing is placed over the incision.

After Procedure:

• Pain medications
• Possibly antibiotics
• Foot should be kept elevated

How Long Will It Take? 20-60 minutes

Will It Hurt? Anesthesia prevents pain during surgery

Possible Complications:

• Difficulty healing
• Phantom limb pain (a painful sensation that the foot or toe is still there)
• Stump pain (severe pain in the remaining tissue)
• Continued spread of gangrene, requiring amputation of more areas of your foot, toes, or leg
• Depending on which toe has been removed, you may walk with a limp

Average Hospital Stay: 2-7 days

Postoperative Care:

• You'll be encouraged to get up and begin walking as soon as possible after your operation
• You may need to wear a cast, a special postoperative shoe, or a regular shoe with the footbox removed until the stitches are taken out
• The stitches will be removed in about three weeks
• You may be advised to begin an exercise, physical therapy, or rehabilitation program
• Depending on how much of your foot has been amputated, you may need to be fitted with a prosthetic foot, which will require that you undergo physical therapy to learn how to walk on it
• If you have diabetes, ask your doctor about appropriate foot care, so that you can avoid further complications

Outcome

Hopefully, the amputation will stop the spread of gangrene and will allow the remaining toes, foot, and leg to stay healthy.

Call Your Doctor If Any of the Following Occurs

• Signs of infection, including fever and chills
• Redness, warmth, swelling, increasing pain, excessive bleeding, or discharge at 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
• Cough, shortness of breath, chest pain, or severe nausea or vomiting

SOURCE:

Campbell's Operative Orthopaedics, 9th ed. Mosby, Inc., 1998.

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Last reviewed March 2001 by Medical Review Board