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Being at the very end of the arterial tree and prone to trauma and infection, toes and feet are particularly susceptible to ischaemia. Ischaemic necrosis of these parts can be the first manifestation of critical peripheral arterial disease. In addition, diabetic patients are at an increased risk of toe and foot infection. It is, therefore, not uncommon for patients with critical ischaemia to require toe amputation.
The majority of these operations are performed in conjunction with limb revascularisation procedures such as angioplasty and bypass surgery. less commonly, these operations may be required in order to eradicate chronic resistant infection. Toe and foot amputation can be done under regional, or local anaesthesia.
Patients will be expected to avoid weight bearing for few days. gentle mobilisation will then follow. A shoe filling prosthesis may be required to compensate for the missing tissue.
In these procedures, wound infection is not uncommon as surgery is almost exclusively performed for infection or tissue loss. Pain can be a problem particularly when more than one toe is amputated. Failure to heal may occur if attempts at improving the blood supply fail. This will invariably be followed by a more proximal amputation. Unfortunately in approximately 75% of patients, a further more proximal amputation will be required within three to four years.
Admission: Day of Procedure Anaesthetic: Local Stay in hospital: 8-12 hours Time off work: 3-7 days First follow-up appointment: 2 weeks |
Transmetatarsal (forefoot) amputation.
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