Strong Heart and Vascular Center

 

Division of Vascular Surgery

Toe and Forefoot Amputation

Diagnosis

You have a problem necessitating amputation of one or more toes or your forefoot. This is typically due to dead tissue. If three or more toes are lost, a transmetatarsal amputation (TMA) is usually the best option. Both amputations are usually well tolerated and walking is usually normal after some practice.

Today's Visit

It is critically important that you have enough blood flow to heal the proposed amputation, and this will be determined by laboratory testing. Many patients in this situation have already had blood supply restored.

Other Treatment

Ensuring adequate blood supply is critically important, and this may require (or have already required) a bypass or stenting. Occasionally there are options to heal certain wounds without removal, but these are usually very time consuming and have a low success rate. Since amputation of one or more toes, even the forefoot, is usually very well tolerated in terms of both safety and ability to walk, this is usually the most convenient option for the patient. We usually do not recommend operation unless all other options have been exhausted, and will discuss any other possible methods for saving the tissue with you prior to any decisions being made.

Surgery

Surgery itself is safe and is usually performed under modified local anesthetic (ankle or toe block). Depending on your surgery, general health, and what sort of help you have at home, you can go home the afternoon of surgery or stay in the hospital for 1-2 days. The critical postoperative maneuver is to STAY OFF THE FOOT ENTIRELY until cleared by your surgeon. We will help you with physical therapy and equipment needed, and pain control.

After The Procedure

Unless same-day discharge is planned ahead of time, you will be in the hospital for 1-2 days. During this time the physical therapists will see you to help you with strategies for getting around. It is absolutely critical that you STAY OFF THE FOOT ENTIRELY until cleared by your surgeon - at least two weeks - this means that you should not even touch it to the ground, even for a moment. The foot may swell as well, so you should keep it elevated AT OR ABOVE YOUR HEART whenever possible, especially during the first few days. If you go home with a dressing, you can remove it 36-48 hours after the operation, after which you can shower normally. You should not, however, soak the foot until cleared by the surgeon. If staples or sutures are present they will be removed a few weeks following the procedure. You will see your physician 2-4 weeks after surgery, and should not drive or touch the foot to the ground until you receive specific instructions to do so.