Not ready for a toe amputation?
No one wants a toe amputation, but sometimes it is necessary to get better. Cases where toe amputations must happen is severe infection, chronic pain or gangrene where there is no blood or life in the tissue. Keeping an infected, painful or dead toe can slow you down or make you very sick.
There are some cases where a toe amputation is debatable so that’s what I’ll be exploring here.
First off, I’m not saying to debate with your doctor on what they think is best for you. You should be given options and a timeline on how urgent your situation is. You never want to delay care because of something you saw online. Your doctor is your best resource.
Now that that’s out of the way, I do want to talk about a case I have encountered where the patient was recommended a toe amputation and where I thought I could help.
Case 1: A painful pinky toe
This patient had difficulty walking because of a deformed but painful baby pinky toe. Her original doctors recommended either a complete reconstructive surgery of her entire foot or amputating the painful little toe. The justification for amputating the baby toe is that it offers a faster recovery, so I can see why this was offered. It is not unusual to offer this to older patients who just want to get back to walking without pain.
But the question asked was, is there anything else to alleviate the pain without amputating the toe?
Generally speaking, if there is no active infection, then we have time to try a few more things like
custom shoes
killing the nerve
minimally invasive surgery
Custom shoes tend to get very costly, but it’s the most conservative thing we can do. Next, in some cases killing the nerve might be viable but in this particular case killing the nerve without addressing the obvious deformity wouldn’t have been enough. It might actually make things worse. Pain is protective after all. You need sensation to feel where your toes are and have balance with walking. Plus, if you develop a cut or sore on your feet, your pain sensors will alarm you to pay attention.
What I ended up offering was a minor office procedure (minimally invasive surgery or MIS) to straighten the toe. First I numb the toe, then introduce a tiny knife to cut the tendon releasing the deformity causing the pain. No sutures are needed and the procedure is completed in 5 minutes.
The skin incision took just a few days to heal and the patient was back to walking without pain and without an amputation. A year after the procedure, the patient remains active and pain free.
It’s opportunities like this that gives me great joy in being a podiatrist. Minimally invasive foot surgery is my go to technique for toe deformities. Why it’s not offered more often will remain a mystery but I’m sure happy this patient found me.
If you have a toe deformity and was offered a toe amputation but would like a second opinion, I offer in-office or virtual visits. Let’s explore your options.
