Toe amputation is an operation to remove part or all of a toe. It is performed for severe infection, non-healing ulcers (particularly in diabetic patients), irreparable deformity, frostbite injury, or tumour.
An incision is made around the toe at the planned level of amputation. The toe is removed through the joint (disarticulation) or by cutting through the bone (transmetatarsal if a ray amputation is needed). Skin flaps are fashioned to close the wound. The wound may be left partially open in cases of infection. The operation takes 20–45 minutes.
Amputation is recommended when the toe cannot be salvaged — due to osteomyelitis (bone infection) not responding to antibiotics, non-healing diabetic or vascular ulcers, gangrene, severe irreducible deformity causing skin breakdown, or tumour.
Wound care and antibiotics for infections, vascular assessment and revascularisation for ischaemic toes, offloading for ulcers, and orthotics for deformity. Amputation is considered when these measures fail.
Vascular assessment to ensure adequate blood supply for wound healing. If peripheral vascular disease is present, vascular surgery input is essential. Blood sugar control in diabetic patients. The amputation level is chosen to maximise healing potential.
Removal of the source of infection or non-healing tissue. Relief of pain. Most patients walk well after toe amputation — the foot adapts remarkably. Great toe amputation has a greater functional impact than lesser toe amputation.
Particularly in diabetic or vascular patients. The most common complication.
Minor changes in walking pattern, more noticeable with great toe amputation.
Increased pressure under adjacent areas of the foot.
If healing fails, a more proximal amputation may be needed.
Feeling that the amputated toe is still present.
Of the surgical wound.
Remaining bone may cause pressure problems in shoes.
Local digital block, ankle block, or general anaesthesia.
Post-operative shoe or boot until wound healing is confirmed. Daily wound checks in diabetic/vascular patients. Custom insoles to redistribute pressure. Most patients walk well within two to four weeks. Specialist diabetic foot follow-up if applicable.
Wound checks at one week, two weeks, and until healed. Diabetic foot team follow-up. Orthotics assessment.
Most patients walk well after toe amputation. Lesser toe amputations have minimal impact. Great toe amputation affects push-off strength and may require a shoe filler or custom insole.
When bone is infected (osteomyelitis), blood supply is insufficient, or tissue is dead (gangrene), salvage attempts risk spreading infection or prolonging non-healing wounds. Amputation removes the problem and allows healing.