[Amputation and exarticulation of the lesser toes]

Abstract

Objective: Amputations and exarticulations of the toes may be necessary due to several reasons. The goal is to remove necrosis or infection prior to its spread to the midfoot region. From a functional or cosmetic point of view, amputation/exarticulation of a single toe plays no major role. However, this can be different with exarticulation of several toes.

Indications: Necrosis, trauma, infection, tumor, deformity.

Contraindications: Conditions where amputation/exarticulation of a toe is insufficient, e. g., in progressing peripheral arterial disease.

Surgical technique: The toe can either be amputated through the distal phalanx or exarticulated in the metatarsophalangeal joint.

Postoperative management: Orthopedic shoes or orthotic devices are rarely necessary when a single toe is amputated/exarticulated. However, concomitant deformities of the foot have to be thoroughly addressed. If more than one toe is amputated, silicone spacers may be necessary to prevent the remaining toes from deviating.

Results: Amputations and exarticulations of the toes are frequent and the procedure is technically simple. However, the complication rate is high due to typical indications making amputation necessary.

Keywords: Amputation; Complications; Exarticulation; Toe.