Most toe and partial foot amputations are due to complications from diabetes. Frostbite and injury makes up a lesser percentage of amputations. The type of amputations include Toe or Ray amputations, Transmetatarsal, Lisfranc, Chopart, and Symes amputations.
Toe and partial foot amputations change gait and balance. The remaining part of the foot must also be protected. A desirable outcome after any amputation is that the limb will still bear weight as well as offer normal propulsion while wearing a prosthesis.
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 1st 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.
Chopart amputation: This amputation removes the forefoot and midfoot, saving the talus and calcaneous (heel).
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.
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
How We Help:
Arch Supports:
- Arch support with metatarsal lift under a plastazote cushion where possible
- Toe fillers for 1st toe and other amputated areas (but not if amputations are only on toes 2-5)
- Custom plastazote arch support with metatarsal lift as possible
Shoes:
- Extra depth, double or triple depth shoe with high toe box, firm heel counter, rocker sole and connecting shank
- For Smart footwear, wear stable heel to rocker soles where balance is still good. Regular rocker soles if balance not so good. Also, shoes with titanium springs
- Do not go barefoot
- Do not wear pumps or high heels
Other:
Copper, bamboo or silver socks that wick moisture away from the skin and prevent infection
Activities:
- Regular exercise program that promotes increased strength and circulation in lower extremities. If unable to ambulate safely, use arm ergometer.
- 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)
This information does not constitute a diagnosis of your condition and does not take the place of a doctor’s care. The information has been compiled from sources available to the general public and referenced below. Copyright 2005-2010 Carole Romig
Sources Image: gentilli.com, podiatry.curtin.edu.au Text: D. Janisse, CPed, Editor, Introduction to Pedorthics, gentilli.com, podiatry.curtin.edu.au