Welcome to Smart Feet!

AMPUTATED TOES AND FEET

Most toe and partial foot amputations are due to complications from diabetes. Frostbite and injury makes up a lesser percentage of amputations.

Toe and partial foot amputations change gait and balance. The remaining part of the foot must also be protected. The type of Pedorthic care differs by the kind of amputation, which include:

Toe and "ray" amputations: Each of the 5 toes has a metatarsal bone connecting to the other, referred to as "rays." The most common amputation is that of one of the joints of the toes or the entire toe.

If the surgery and treatment of the amputated joint are not successful, the next part of the "ray" is amputated. A first ray amputation is an amputation of the big toe and 1^st metatarsal bone.

Transmetatarsal amputation: When all the toes must be amputated at the metatarsals, it is called transmetatarsal amputation.

Lisfranc amputation: When the amputation takes place at the tarsometatarsal articulation (commonly called the Lisfranc joint), it is called a Lisfranc amputation.

Symes amputation: This amputation removes the foot at the malleoli (ankle bones) and forward rotation of the heel pad over the end of the residual tibia

A desirable outcome after any amputation is that the limb will still bear weight as well as offer normal propulsion while wearing a prosthesis.

Other names or similar foot conditions:

• See above types

Symptoms:

• With ambulating, there will be gait and balance issues
• "Phantom limb" pain where the amputated part was is not an uncommon side effect of amputations
• With prosthetic involvement, there can be issues with pain and proper articulation into the prosthesis.

Signs to look for:

• This is an observable phenomena

Possible Causes:

• Complications from diabetes or other circulatory disorder
• Injury
• Frostbite

Goals:

• Create optimal foot motion
• Improve balance and gait

• Move foot forward with as little lateral movement as possible

• Protect tissues

Solutions:

Arch Supports:

Arch support with metatarsal lift under a Plastazote cushion for toe amputations

• Extra depth shoes with firm heel counter, long medial support, steel shank, high toe box and rocker soles (may need to be custom molded)
• Do not go barefoot
• Do not wear pumps or high heels

Other:

Toe fillers made of plastazote for amputations beyond the toes

Activities:

• Regular exercise program that promotes increased strength and circulation in lower extremities
• Regular stretching program of gastrocnemius and soleus muscles, Achilles tendon and arch structures
• Rotation of weight bearing and non-weight bearing exercising, such as walking (weight bearing) and swimming or bicycling (non-weight bearing)