A foot amputation is a procedure in which a surgeon removes the entire foot, a toe or multiple toes, or part of the foot. In all cases of foot amputation, the current state of the foot is threatening your health.
Common Reasons for Foot Amputation
Peripheral vascular disease due to atherosclerosis (hardening of the arteries) is the most common reason for limb amputation. Other reasons for foot amputation include poor blood flow, a wound or infection that does not heal or becomes worse, tumor, severe burn or frostbite, and trauma to the foot caused by an accident.
People with diabetes are particularly at risk for developing serious problems with their feet, and these problems can affect how they walk and even lead to amputation. Research from the Centers for Disease Control and Prevention shows that lower limb amputation in people with diabetes has greatly increased in recent years:
“In 2008 alone, more than 70,000 people with diabetes had a leg or foot amputated. Amputations in people with diabetes account for more than 60% of the amputations of legs and feet not resulting from an injury, such as from a car crash. People with diabetes were eight times as likely to lose a leg or foot to amputation as people without diabetes.” (Centers for Disease Control and Prevention, 2012)
Preparing for Foot Amputation
If you have been scheduled for a foot amputation, you will have an opportunity to mentally and physically prepare for it, in contrast to someone who loses a foot as a result of traumatic injury. You may be measured for artificial limb before surgery so that it will be ready during your recovery in the hospital. Your doctor will ask you to do certain things to reduce the risk of complications during surgery and improve your outcome after surgery:
- Provide a list of all the medicines and supplements (over-the-counter and prescription) you are taking.
- Describe any allergic reactions you may have had to anesthetic agents, drugs, latex, or tape.
- Reduce or stop any medications that might increase your risk bleeding or other complications, and follow your doctor’s instructions for taking medicines for any underlying condition, such as diabetes.
- Fast for eight hours before the procedure, generally after midnight.
- Refrain from drinking alcohol and smoking cigarettes.
You should also consider what kind of support you may need after being released from the hospital and what changes are needed in your home to make it safe for your return:
- Arrange for a family member, friend, or neighbor to help you. Or ask your doctor or nurse for help in setting up visits from a home health aide.
- Make sure that your house, especially the bathroom, will be safe for you to move around in. For example, tripping hazards such as throw rugs should be removed so that entering and leaving your home is not a problem.
- Consider counseling before surgery to help you adapt to the loss of your natural limb.
The Foot Amputation Procedure
The goal of the amputation is to remove the diseased or damaged part of the foot or limb and preserve as much healthy skin, blood vessel, and nerve tissue as possible. Before the procedure, an anesthesiologist will put you to sleep or numb your body below the spine. You will be connected to machines that monitor your heart rate, blood pressure, temperature, and brain function.
Your surgeon will carefully choose the incision site and determine how much tissue to remove. This will require multiple steps: checking for a pulse at a joint close to the site, making sure that your skin around the proposed incision still has sensitivity to touch, comparing the skin temperatures in the diseased/damaged part of the foot with those in a healthy limb, and noting places where the skin appears red (an incision made through reddish skin may be less likely to heal).
After the incision, your surgeon will decide whether more of your limb needs to be removed. The nerves will be divided and protected so that they are not exposed and painful, and the healthy major blood vessels with be divided using clamps to minimize bleeding. When cutting through muscles, your surgeon may either sew them to the bone or shape them, to make sure that your stump has a comfortable contour for your artificial limb. The procedure will leave enough healthy skin to cover your stump for better healing.
After the blood vessels are stitched and the clamps are released, any crushed bone is removed and uneven areas of healthy bone are smoothed to prevent pain once you receive your artificial limb. If necessary, your surgical team may place temporary drains to drain blood and other fluids.
The amputation site may be left open (open flap amputation) or may be sewn shut immediately (closed amputation). An open flap amputation is used when the risk of infection is high, whereas a closed amputation is usually done when the chance of infection is small. Your stump may be covered with a stocking to hold drainage tubes and wound dressings, or your limb may be placed in traction or a splint.
After Foot Amputation
It may seem like recovering from an amputation is a long and arduous process, but you can quickly regain your independence if you take some time to prepare and have a support system in place.
Recovery in the hospital. Your stay in the hospital may be about a week or two, depending on your situation. During that time, your wound dressings will be changed and your progress will be monitored. In about a week, your doctor will evaluate how well you are healing and what changes to medications you may need. He or she will also look for potential complications. The healing process after foot amputation can take about four to eight weeks.
Physical therapy. You may receive physical therapy soon after surgery. This may include gentle stretching for the first few days followed by exercises, such as rising up and sitting down while bearing weight on your unaffected limb. You may learn how to use a wheelchair. People receiving an artificial limb will begin to practice using the new limb before leaving the hospital.
Phantom limb sensation. Many people who have had amputations experience the sensation that the amputated limb is still there. This “phantom limb sensation” is often described as a tingling, numbness, or pressure. In some people, the sensation may be painful “phantom limb pain.” Although the cause of phantom limb pain is unclear, it can be treated in a variety of ways, including drug therapy, psychological counseling, and acupuncture.
Rehabilitation and prostheses. The type of rehabilitation and prostheses you will need depends on your medical team’s estimation of your future ability to walk or get around. Coverage for these varies among health insurance providers. Make sure you are aware of all the options available to you through your health insurance plan. Your plan may also cover durable medical equipment, such as walkers, crutches, wheelchairs, and shower or tub safety bars.
Mental health. Foot amputation is a significant, life-changing event that can be difficult to adjust to. A supportive environment is essential for amputees to help them cope with recovery and grief and avoid becoming exhausted or depressed. Many people with amputations have found support groups to be helpful. Your doctor may be able to recommend a mental health professional.
Complications of Foot Amputation
If you have an underlying condition such as diabetes or heart disease, the risk of complications from an amputation is increased. The risk of complication is also increased if you have had a serious traumatic injury. Potential complications associated with foot amputation include:
- Joint deformity (contracture)
- Bruising in which blood collects under the skin (hematoma)
- Death of the skin flaps (necrosis)
- Wound opening or infection
- Deep vein thrombosis and pulmonary embolism
Talking to Your Doctor
Here are some questions you may want to ask your doctor about foot amputation:
- When will I be able to return to work or school?
- How should I care for the wound?
- How will this affect my ability to function normally?
- How do I go about getting a prosthesis?