Amputation toe

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In addition to the common indications for any amputation (e.g., infection, arteriosclerosis with gangrene, etc.), specific indications for toe amputations exist as well. For example, the fifth toe (the most commonly amputated toe) is usually removed for being overriding on the fourth toe. This toe can be amputated with impunity and this is usually preferred over reconstructive procedures because it is easy and definitive. Complications of toe amputations with regards to gait are minimal. For example, any single toe can be removed with little gait or stance disturbance. This is true for amputation of the great toe during standing or walking at a normal pace. However, if the patient walks rapidly a limp appears from the loss of the normal push-off provided by the great toe. With amputations of all toes, the patients gait is likewise normal with slow, but impaired with rapid locomotion. Additional complications specific to the toes include a severe hallux valgus deformity seen in amputations of the second (see below).

Diagnostic Images

Osteomyelitis

The below images show both the pre-operative and post-operative left foot of the same patient. The pre-op film demonstrate osteomyelitis of the distal first phalanx that was treated with a great toe amputation. (Courtesy of A. Gentili MD)

Before amputation
After amputation

Hallux Valgus

Second toe amputation with resultant hallux valgus deformity. This is a common complication of second toe amputations and occurs because the great toe tends to drift toward the third to fill the gap left by the amputation. (Courtesy of A. Gentili MD)