[Amputation and exarticulation of the lesser toes].

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.