Amputation of toe

by Greg
(Dewsbury, West Yorkshire, United Kingdom)

On December third 2011 I crushed my right foot in a roller dish feed of a rag pulling machine, it crushed my steel toe cap and squashed my toes, after the initial operation to stop bleeding and try to save my toes, they decided after six days to amputate my great toe at its base and also amputated second and third toes at first knuckle joint nearest my foot, due to narcotic tissue they degloved my foot and debrided and put under negative pressure (vacumn pump)for three weeks, further debriding was carried out twice more in this time, on December 30th they grafted skin from my thigh onto my foot. The original skin left on my foot, which starts from the internal side of my fourth toe up to the bottom of my ankle and the same on the sole, my heel skin is intact and the planter skin below 5th 4th and what were my 3rd and 2nd toe is intact, the planter skin under what was my great toe, (the ball of my foot) has been removed and has been grafted with the skin off my thigh.

My question is will I ever be able to load bear on the ball of my foot, or will I only be able to put weight on my 5th toe side of my foot, with all the implications of this causing back and joint problems.I am bathing my foot daily and moistening grafted skin with E45 cream and bandaging, it has nearly stopped exuding fluid from my instep, my amputated great toe joint has over granulation which I am putting hydrocortisone cream on, I find though when I walk on it (as advised by the hospital to not put my full weight on it) with the aid of a walking stick it is hurting my knee joint this I think is due to not being able to bear weight on the ball of my foot.
The hospital will arrange for physio in due course, but I have not got an appointment with them for a week so hence my question.

RESPONSE

Hi Greg,

It has been less than a month since your operation so I would suspect at this point you would not be able to bear full weight in the affected area. Assuming normal healing without complications, this situation should improve.
Theoretically, the purpose of the great toe is to allow for "push-off" during the gait cycle, meaning just before your foot swings forward, the big toe is the last part of the foot to leave the ground and in doing so exerts a force off the ground to help propel the body forward.
In spite of this, over the years I have had a few patients who have lost their big toes, and some of the lesser toes for various reasons and in most cases their overall gait is not affected to any great extent.
At this point in time I can understand why your knee may hurt and that is because you are walking in a somewhat altered gait in an effort to diminish the pressure on your forefoot. Keep in mind that skin grafts need time to "take" and that excessive pressure on the graft can cause it to fail.
Having said that, once the graft has healed, you should be able to start ambulating in a more normal gait. How normal will depend on certain factors such as your age, overall health status and your weight (not overweight). At some point in time you should be able to bear weight on the full ball of your foot, but will have to make a minor adjustment in the "toe off" portion of your gait.

Marc Mitnick DPM
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