Understanding Digital Amputation in Podiatry

‘Amputation’ can be a very frightening word for anyone. It is the process of removing extremity or an appendage from the body. For many people, the word brings up thoughts of battlefield triage or radical treatments from the early days of medicine. However, amputation is still a part of modern medical practice, because it is sometimes necessary to ensure optimal patient health.

There are different levels of amputation. In addition to full limb amputation (arm or leg), this procedure can also be performed on the upper or lower extremities. In podiatry, digital amputation refers to the removal of all or part of a toe (or toes).

Digital Amputation Indications

Digital amputations are the most common class of amputation of a lower extremity. Most patients that undergo digital amputation are diabetics suffering from peripheral neuropathy.

In the United States, every year about 73,000 amputations of the lower limb unrelated to trauma are performed on people with diabetes. Repetitive trauma from ill-fitting shoes and constant weight-bearing often leads to ulceration and infection. In diabetics, these injuries are slow-healing, and often worsen with time. If left untreated, tissues in the skin, muscle, tendons and even bones may die, making amputation necessary. Amputation is carried out to prevent further complications. Other conditions that can lead to amputation include trauma, tumor, ischemia/gangrene, congenital abnormalities, osteomyelitis, and septic arthritis.

Amputation is not the first treatment option for a podiatric surgeon. According to Podiatry Institute, up to 85% of amputations may be prevented or avoided through early treatment and proper patient education. As a matter of fact, before a patient is scheduled for surgery (amputation) he/she must have exhausted all possible treatments, including wound therapy, surgical debridement, and antibiotics.

The goal of digital or partial forefoot amputation is:

  1. To preserve the foot and the functionality of the foot.
  2. To maintain a functional stump preventing a higher level of amputation in the future
  3. To enable the patient to return to normal activity (lifestyle) with minimal disability

Digital amputation is considered a treatment choice when an infection or necrotic tissue does not spread to the web space of the foot. It is also effective in treating non-healing, open and infected lesions.

Digital amputation is preferable and recommended over higher-level amputations. Distal amputations are more functional and have many physiological benefits such as energy preservation during ambulation.

During digital amputation, podiatrists are concerned about a patient’s skin, muscle function, blood vessels, nerve endings, infected tissues and bony prominences. Adequate care is taken to make sure minimal trauma to the skin and to make sure functional muscles are preserved. Blood vessels are delicately handled to prevent hematoma. Diseased tissues are also removed at the time of amputation to prevent infections or further complications. Care is taken to cover bony prominences in weight-bearing areas.

Postoperative Management

Post-operative management of patients is important following digital amputation. The essence of postoperative management is providing a conducive environment for wound healing and avoids complications because of less than ideal post-op conditions.

In the first three to five (3 to 5) days after surgery, patients are encouraged to limit their activities, and to rest their legs so as not to develop hematomas. Proper management will also reduce any chance of dehiscence (rupture of the incision area) or infection in the patient’s feet.
The use of surgical shoes is an excellent idea before progressing to normal footwear.

Houston Podiatric surgeon Gabriel Maislos, DPM, FACFAS, reminds all patients suffering from diabetes or peripheral neuropathy to have their feet checked regularly by a board-certified foot care specialist. While toe amputations are common, regular examinations and treatment can help you manage underlying conditions successfully – possibly avoiding this type of procedure.If you’d like to schedule an appointment with Dr. Maislos, call our office at (713) 541-3199 or fill out our appointment request form. We accept most major medical insurance and offer affordable cash pricing for uninsured individuals.

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Author
Houston Foot and Ankle

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