I am continuing on from last week's discussion on toe amputations. Today I will describe the procedure, as well as what a toe amputation or amputations mean to walking and shoe fitting.
Toe amputation surgery is a relatively simple procedure. There are essentially three different levels the toe can be amputated at, usually corresponding with one of the three joints found in the toes, including the base of the toe. The decision of where to amputate the toe at depends mainly on the location and extent of dead tissue, as well as where strong healthy skin exists to allow for a strong skin flap to exist at the end of the amputation stump. In the best case, the skin on the bottom of the toe is used to create the end of the stump, since this skin is thicker and stronger. Occasionally it is not possible to use this skin, especially if the skin on the bottom is diseased. The skin on the top or the sides will need to replace this skin as the tip of the stump. Contrary to popular belief, the toe is not simply 'chopped off' in an amputation. There is great finesse taken in how the toe is removed, as a rough procedure will not result in good healing. Sometimes only part of the toe is taken, sometimes all of the toe is removed. If there is tissue damage and bad skin all the way to the base of the toe, the bone behind the toe, called the metatarsal, may protrude too far out the hole created by the toe removal. In this case, some of the metatarsal bone needs to be removed to allow the skin to close over this site.
After a toe amputation, the ability to walk, balance properly, and wear shoes should not be compromised. This is even true if more than one toe is amputated, or if even all the toes are amputated. The toes provide some push-off power when walking, but it is still possible to walk essentially normally without them. If several toes are amputated all the way to their base, it may be necessary to create a spacer pad at the end of the foot to protect the amputation stumps and any remaining toes from excessive rubbing motion in the shoe. The spacer pad uses a specialized foam material to reduce this pressure, and is custom made from a mold of the foot. A deep shoe is needed to provide more protection to the end of the foot. Toes on the either side of a single amputated toe can and do cross over and above the space created by the amputated toe, and a shoe must accommodate for this movement by having more depth. Otherwise, walking and shoe use should be relatively unaffected.
Well, I hope you have enjoyed yet another year of The Diabetic Foot. I will be taking a holiday break from blogging for the next two weeks. Look for new posts starting the first week of January, 2012. Happy Holidays everyone!
Scott R. Kilberg DPM
www.inpodiatrygroup.com - foot surgeon, podiatrist in Indianapolis
myachingfoot.blogspot.com - foot pain explained
YouTube videos on foot problems
A foot doctor in Indianapolis Noblesville Fishers Carmel Westfield and Fortville Indiana.
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6 comments:
My husband is having his left great toe amputated tomorrow morning and we are concerned about the procedure. He is a diabetic, previously had MRSA (6 years ago) and is on a PICC line receiving Vancomycin at home. He has infection in the bone which recently became exposed. We have been treating a diabetic ulcer on the bottom of this toe for 2 years at a wound clinic and I am concerned about the recovery as well as making sure the doctor does take all that is necessary of this toe. The surgery is being completed as an out patient procedure, is this common? Everything that I am finding online indicates at least an overnight stay at the hospital. I guess I am wondering what the likelihood is that he is going to have additional surgeries due to complications from this wound and infection. The top bone in his toe is completely detached from the second bone, there is not a tendon holding or connecting the two any longer. The open sore is all the way down to the underside base of the toe right now, I do not understand how they are able to just take the toe and not part of the joint on the foot.
I am glad that I came across this blog tonight, it has provided me with some additional insight and perhaps you can provide me with more. Thank you!
Thanks for the great information!
dmae-
The choice of whether to perform the surgery as an in or outpatient is up to the surgeon and the severity of the surrounding skin infection. I often amputate toes on an outpatient basis, but will admit to the hospital if needed. Toe amputation recovery is usually uneventful unless the infection persists or there is circulation issues to the stump. You will simply have to wait and see how it recovers, and trust in the surgeon. The metatarsal bone behind the toe may not need to be involved in the amputation if it is otherwise healthy, this depends on your husband's specific situation. I wish your husband the best tomorrow, and hope he recovers quickly.
My dad (aged 68)is a diabetic who underwent amputation of 4 toes (excluding the great toe) following a necrotic gangrene on the 7th of Jan'2012. Initially, only 2 of his toes had turned black but slowly they kept spreading...Now, after successfully amputating the toes, even his great toe is slowly turning black....im really very anxious and worried as to why this is turning black when his blood sugar is under control (on insulin and diet). really have no idea as to what could be the cause...is there no way this could be treated without having to remove the great toe also....plz do reply as to wat can be done...
Your dad's black toes may be due to poor arterial circulation, which has little to do with healthy blood sugar control- if the toes are not getting enough blood the tissue will turn black and die. This needs to be corrected by a vascular surgeon to prevent further tissue destruction if it is present. Unfortunately, some otherwise healthy diabetics do also get progressing diabetic skin infections that lead to gangrene.
Sir, thank you for the information...now i understand that this could be due to poor arterial circulation and needs to be corrected by a vascular surgeon..thank you once again..
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