Amputation of the Foot or Toe

Prior to Procedure

Your doctor will likely do at least some of the following:

• Blood tests
• X-rays of toe and foot
• Bone scan to see if the bone is infected
• A prolonged period of debridement, antibiotics, and wound care in an attempt to heal your wounds non-operatively
• Possible angioplasty or bypass procedures to improve the circulation
• 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
  • Angiogram
  • Magnetic resonance angiography (MRA)

In the days leading up to your surgery:

• Arrange for a ride to and from the procedure.
• Arrange for help at home after returning from the hospital.
• 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.

During Procedure

IV fluids, sedation, anesthesia, antibiotics

Anesthesia

General, local, or spinal

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. The remaining skin and muscle flap are pulled over the open area and closed with stitches. A sterile dressing is placed over the incision.

If there is an active infection, drainage tubes may be left in place to allow fluids to drain. The skin is not closed if there is an active infection. Instead, the area will be packed with a moist dressing, which is changed daily.

Surgical Amputation of Left Great Toe

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After Procedure

• Pain medications
• Possibly antibiotics
• Foot should be kept elevated
• The toe or foot is wrapped with a bulky dressing to protect it from trauma

How Long Will It Take?

20-60 minutes

Will It Hurt?

Anesthesia prevents pain during surgery.

Possible Complications

• Difficulty healing
• Collection of blood (hematoma)
• Infection
• 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 the wound allows.
• 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, to help reduce your risk for further complications.
• If you have diabetes, work to control your blood sugar tightly.
• If you are a smoker, you should quit.
• You may need to take a blood thinner, such as aspirin.