What is toe amputation?
Toe amputation is a common procedure performed by a wide variety of healthcare providers. One of the most common indications for toe amputation is patients with a diabetic foot. Most of these procedures are performed by a general or foot surgeon.
Toe amputation is usually performed as a last resort when medical treatment fails, or the toe cannot be salvaged. Systemic diseases such as diabetes and hypertension need to be managed, and they affect the blood vessels and nerves.
The method of toe amputation (disarticulation vs. osteotomy) and the level of amputation (partial or whole digit) depend on the extent of disease and anatomy. With any amputation, the degree of postoperative functional loss is usually expected and proportional to the amount of tissue amputated. The big toe is considered the most important of the toes in functional terms.
When is toe amputation done?
There are three broad indications for amputation of any body part:
- Dead loss
A “dead” toe is the one in which the blood supply is so completely compromised that infarction and necrosis (tissue death) develop with a nonviable tissue turning dry and black. A “dead” toe is most commonly observed as a complication of diabetes due to vascular disease. Other major risk factors for peripheral vascular disease are smoking, hypertension, hyperlipidemia, narrowing or spasm of blood vessels, or severe frostbite.
A “deadly” category results in systemic sequelae and can be deadly if not managed immediately. Malignancy may also require amputation, though infrequently.
A toe is a “dead loss” when it is diseased to the point where it is irreparable and is no longer functional.
When should toe amputation not be done?
The main contraindication for toe amputation is if the dead tissue is poorly demarcated and patchy. If the borders of the dead tissue area are unclear, the surgeon would not be able to demarcate the extent of the disease, affecting the results of surgery. Amputation of any body part is contraindicated if it results in a significant decrease in quality of life in case of a limited life expectancy.
How is toe amputation performed?
Prior to toe amputation, the surgeon performs a detailed clinical assessment and complete blood analysis. Moreover, they perform a thorough assessment of the status of nerves and blood vessels of both limbs.
- The procedure is performed under anesthesia and is relatively quick.
- The affected toe is completely amputated with a margin of normal, healthy tissue.
- The method of toe amputation (disarticulation vs osteotomy) and the extent of amputation (partial or whole digit) depend on the extent of disease and anatomy.
- The wound is left open. Dressing and wound cleaning are done regularly until the wound heals completely.
- The complete recovery period from the toe amputation surgery is two to four weeks.
What are the complications of toe amputation?
Some common complications encountered are as follows:
- Pain, swelling, and bruising
- Inadequate hemostasis (blood clotting), which causes bleeding
- Hematoma (blood clot)
- Inadequate amputation leading to spread of disease
- Failure to heal—this could be due to inadequate blood supply as well or due to ongoing infection
- Spread of infection to the rest of the body (tetanus)
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Warning symptoms of diabetes that men have and women do not include low testosterone (low-t), sexual problems, impotence (erectile dysfunction), decreased interest in sex, and retrograde ejaculation.
Type 1 and type 2 diabetes symptoms and signs that are the same in men and women include skin infections, numbness or tingling in the feet or hands, nausea, excessive thirst or hunger, fatigue, irritability, blurred vision, weight gain, weight loss, urinary tract infections (URIs), and kidney problems.
Treatment for type 1 diabetes is insulin, and treatment for type 2 diabetes are lifestyle changes like eating a healthy diet, getting exercise daily, and if necessary, diabetes medications.
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Symptoms of diabetes that are the same in women and men are excessive thirst and hunger, bad breath, and skin infections, darkening of skin in areas of body creases (acanthosis nigricans), breath odor that is fruity, sweet, or acetone, and tingling or numbness in the hands or feet, blurred vision, fatigue, tingling or numbness in the hands or feet, wounds that heal slowly, irritability, and weight loss or gain.
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Diabetes Treatment: Medication, Diet, and Insulin
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Type 1 diabetes is treated with:
- and a diabetic diet.
Type 2 diabetes is first treated with:
- weight reduction,
- a diabetic diet,
- and exercise.
When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
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Normal Blood Sugar Levels (Ranges) In Adults with Diabetes
People with diabetes can manage and prevent low or high blood sugar levels (hyperglycemia or hypoglycemia) by keeping a log of your blood sugar levels when you are eating and fasting and eat foods that are high in carbohydrates and sugar, for example, buttered potatoes, candy, sugary desserts, and fatty foods.
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Extremely high levels of blood glucose in the blood can be dangerous and life threatening if you have type 1, type 2, or gestational diabetes.
If you or someone that you are with has extremely high blood glucose levels, call 911 or go to your nearest Urgent Care or Emergency Department immediately.
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Type 1 vs. Type 2 Diabetes: Differences
Diabetes mellitus is a metabolic condition in which a person's blood sugar (glucose) levels are too high. Over 29.1 million children and adults in the US have diabetes. Of that, 8.1 million people have diabetes and don't even know it. Type 1 diabetes (insulin-dependent, juvenile) is caused by a problem with insulin production by the pancreas. Type 2 diabetes (non-insulin dependent) is caused by:
Eating a lot of foods and drinking beverages with simple carbohydrates (pizza, white breads, pastas, cereals, pastries, etc.) and simple sugars (donuts, candy, etc.)
- Consuming too many products with artificial sweeteners (We found out that they are bad for us!)
- Lack of activity
While the signs and symptoms of both types of diabetes are the same, which include:
- Increased urination
- Increased hunger
- Increased thirst
- Unexplained weight loss.
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