Should the amputations of the great toe be replanted?

Seventeen great toes, amputated at the distal phalangeal to the level of the MTP joint, were replanted between 1990 and 1998, at Izmir Hand and Microsurgery Hospital. Replantation in five out of six complete amputations, and seven out of eleven incomplete amputations were successful, and the overall survival rate was 76.4%. In failed replantations, the base of the proximal phalanx of the great toe was preserved during closing of the stump. Nine of 17 patients were available for review in the follow-up period of mean 3.5 years (range 1-6.5 years). Clinical and biomechanical evaluations of the operated feet were carried out in five patients who had replanted great toe, and in four patients who had amputated one. The uninjured sides were used as control group. The patients in the two groups had no significant subjective symptoms, nearly normal ROM of the MTP joint and protective sensation was achieved in the replanted great toes. With the numbers available, while radiographical parameters of the involved and the control sides demonstrated no significant differences in either groups, pedographical studies revealed consistent changes in weight-bearing distribution of the feet with amputated great toes. Although the great toe amputation causes no disturbance in gait, it alters the load distribution of the foot.