Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Amputation of the Foot or Toe

(Toe Amputation; Foot Amputation)
by Editorial Staff and Contributors
Definition

Surgical removal of a toe, foot, or part of a foot

Reasons for Procedure

Amputation is most often done to:

  • Remove dead or damaged tissue, such as gangrene may cause
  • Treat infections
Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have an amputation, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Continued spread of gangrene, requiring amputation of more areas of your foot, toes, or leg
  • Contracture deformity
  • Difficulty healing
  • Infection
  • Limp (depending on which toe has been removed)
  • Nerve damage
  • Phantom limb pain (a painful sensation that the foot or toe is still there)
  • Stump pain (severe pain in the remaining tissue)

Factors that may increase the risk of complications include:

  • Poorly controlled diabetes
  • Advanced age
  • Bleeding disorders
  • Heart problems or high blood pressure
  • Infection
  • Kidney failure
  • Obesity
  • Poor blood circulation
  • Smoking
  • Smoking
What to Expect
Prior to Procedure

Before the surgery, your doctor may do some of the following: Talk to the doctor about the medicines you are taking. You may be asked to adjust the dose or stop taking certain medicines, such as:

  • Blood tests
  • Bone scan to see if the bone is infected
  • Tests to evaluate blood circulation and help the doctor determine how much of the foot or toe needs to be amputated
  • X-ray of toe and foot
  • Blood-thinning medicines, such as:
    • Clopidogrel (Plavix)
    • Ticlopidine (Ticlid)
    • Warfarin (Coumadin)
  • Aspirin or other anti-inflammatory drugs (may need to stop up to one week before)

In the days leading up to your surgery:

  • Arrange for a ride to and from the hospital.
  • Arrange for help at home after the surgery.
  • The night before, eat a light meal. Do not eat or drink anything after midnight.
  • You may be asked to shower the morning of your procedure. You may be asked to use a special antibacterial soap.
Anesthesia

Based on your surgery and general health, you may have:

  • General anesthesia —You will be asleep.
  • Local anesthesia—The area that is being operated on will be numbed.
  • Spinal anesthesia —Medicine is delivered to the spine to numb the lower body.
Description of the Procedure

You will be given IV fluids and antibiotics. Your foot will be washed with an antibacterial solution. The surgeon will make an incision into the skin around the area. The blood vessels will be tied off or sealed with an electrical current. This will prevent bleeding. The involved bones will be removed.

The ends of the remaining bone(s) will be smoothed. The remaining skin and muscle will be pulled over the open area. It will be closed with stitches. A sterile dressing will then be placed over the incision.

If there is an active infection, tubes may be left in place to allow fluids to drain. In some cases, the skin will not be closed but will instead be packed with a moist dressing.

Immediately After Procedure

You will be taken to a recovery room. There, you will be monitored for any negative effects from the surgery or anesthesia. You will be given pain medicine. You may also receive antibiotic medicines.

How Long Will It Take?

20-60 minutes

How Much Will It Hurt?

Anesthesia prevents pain during surgery. The area will be painful after the surgery. You will be given medicine to help control the pain.

Average Hospital Stay

The usual length of stay is 2-7 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care
At the Hospital
  • A physical therapist will likely assist you in walking at first.
  • The toe or foot will be wrapped with a bulky dressing. This will protect it from injury.
  • You will be encouraged to get up and begin walking as soon as the wound allows.
  • Your foot will be kept elevated.
At Home

When you return home, do the following to help ensure a smooth recovery:

  • Be sure to follow your doctor’s instructions about activity and medicines.
  • If you are a smoker, you should quit .
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • You may be advised to begin an exercise, physical therapy, or rehabilitation program.
  • You may need to wear a cast, a special postoperative shoe, or a regular shoe with the foot box removed until the stitches are taken out. Stitches will be removed in about three weeks.
Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Chalky white or blackish appearance of foot, other toes, or leg
  • Cough, shortness of breath, or chest pain
  • Decreased sensation, numbness, or tingling in the rest of your foot, toes, or leg
  • Joint pain, fatigue, stiffness, rash, or other new symptoms
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or that persist for more than one day after discharge from the hospital
  • Pain that you cannot control with the medicines you have been given
  • Pain, burning, urgency or frequency of urination, or blood in the urine
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Signs of infection, including fever and chills

In case of an emergency, call for medical help right away.

Last reviewed: September 2011 by Lawrence Frisch, MD, MPH.

RESOURCES:
CANADIAN RESOURCES:
References:
  • Armstrong DG, Lavery LA. Diabetic foot ulcers: prevention, diagnosis and classification. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/980315ap/armstron.html . Accessed June 9, 2008.
  • Baima J, Trovato M, Hopkins M, deLateur B. Achieving Functional Ambulation in a Patient with Chopart Amputation. American Journal of Physical Medicine & Rehabilitation . 2008;87(6):510-513. Canale ST, Daugherty K, Jones L eds. Campbell's Operative Orthopaedics . 9th ed. Philadelphia, PN: Mosby-Year Book; 1998.
  • Canale ST, Daugherty K, Jones L eds. Campbell's Operative Orthopaedics . 10th ed. Philadelphia, PN: Mosby-Year Book; 2003.
  • Parrett B, Pribaz J, Matros E, Przylecki W, Sampson C, Orgill D. Risk Analysis for the Reverse Sural Fasciocutaneous Flap in Distal Leg Reconstruction. Plastic and Reconstructive Surgery . 2009;123(5):1499-1504.
  • Sales CM, Goldsmith J, Veith FJ eds. Handbook of Vascular Surgery . Sudbury, MA: Quality Medical Publishing; 1996.
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