Podiatric Surgery Cross Over Toe: Amputation
Version No
Version Date
Review Date
1.0
01.04.2013
01.04.2015
Crossover toe
deformity
Digital Amputation
Aims of Surgery

To reduce pain and deformity.
Advantages of this
operation



Localised procedure
Improve footwear fit
Reduce risk of ulceration
Specific risks of this
operation



Worsening of bunion
Crowding / deformity of remaining toes
Increased pressure to remaining toes
OVERVIEW
Operation time
Usually between 5-15 minutes, longer for multiple toes.
Incision placement
At the base of the affected toe joint.
Stitches
Non absorbable.
Will I have plaster cast?
No
Is this a Day Procedure?
Yes, you can usually go home the same day (you will usually be admitted for half a day).
Estimated time off work
Non-manual work approximately 4-6 weeks. Manual work 6-8 weeks
dependant upon recovery.
Chief Executive Tracy Allen
Chair Prem Singh
Indications for the
procedure
The main indication for any operation is pain and limitation or disability.
Commonly in this instance:

Prominent toe joints

Callus and corns to the top side or end of toe. Callus / corn on ball of foot

Difficulty with shoe fit despite wearing sensible footwear
Alternative
Treatments
Symptoms can be managed by using painkillers or avoidance of provocative
factors temporarily or permanently as necessary/practical e.g:
Activity modification

Correct fitting or accommodative footwear

Use of protective and cushioning shields, splints and or insoles / orthoses
General Risks of
Surgery
The general risks of foot surgery are outlined in the Pre-operative Information
booklet with which you will have already been provided.
You should read this leaflet in conjunction with the Pre-operative
Information booklet / sheet.
More information
by:


Speaking with your Consultant or one of his / her team.
Reading the information provided.
Amputation of lesser toe
The Operation
The operation is usually performed under a local anaesthetic. This being the case you will be awake;
you can eat normally and take your normally prescribed medications on the day of operation. The
local anaesthetic is administered via injections around the area of the toe and the ankle. The
operation takes about 5 to 15 minutes longer for multiple toes, although you can expect to be in the
day surgery unit for about 3 hours. This is to allow you an opportunity to rest post operatively and for
us to provide you with discharge information and packs as required. For your safety you must have a
competent adult at home for the first day and night after surgery.
First 2-4 days
This is the worst time for pain but you will be given painkillers to help. You must rest completely for
2-4 days with your foot elevated just above hip level. You may be advised to keep the circulation
going by gently drawing circles in the air or wiggling your toes. You should restrict your walking to
going to the bathroom only. If you have been given crutches you must use them in the way shown.
You may be able to bear a little weight on the foot carefully using just the heel. You can get about a
little more after 3-4 days.
One week after surgery
You may need to attend for your foot to be checked and re-dressed. You may start to do a little more
within pain limits. Pain may mean you are doing too much.
Two weeks after surgery
You must attend clinic again for removal of stitches. For absorbable stitches this normally means just
trimming the ends. Stitches on the sole of the foot may need to stay in about a week longer. You
should no longer need the bandage and you should be able to get around without crutches. Your foot
will still be quite swollen but you should be able to get a roomy shoe on. You should bring a lace up
broad fitting and supportive shoe (ideally a trainer) with you. Provided that the wound is well enough
healed you should be able to get the foot wet. You will be advised on an incremental return to activity
and may also be advised on scar care.
Between 2-6 weeks after surgery
The foot starts to return to normal and you can return to shoes. The foot will still be quite swollen
especially at the end of the day. You may be able to return to work but may need longer if you have
an active job. If in doubt, please discuss this with a member of the team. You may return to driving if
you can perform an emergency stop. You must check with your insurance company before driving
again. Whilst normal activity will be resumed, sport should be avoided.
Between 8-12 weeks after surgery
The foot should continue to improve and begin to feel more normal again. There will be less swelling.
Sport can be considered after 3 months depending on your recovery.
Six months after surgery
You will have a final review between 3-6 months following surgery. The swelling should now be slight
and you should be getting the benefit of surgery.
Twelve months after surgery
The foot has stopped improving with all healing complete.
Please note if a complication arises, recovery may be delayed.
References:
O’Kane C and Kilmartin TE (2006) Review of amputation of the second toe in the presence of asymptomatic
hallux valgus for the treatment of hammer or cross over toes.
Comments, concerns or complaints? If you have any comments, concerns or complaints and
would like to speak to somebody about them please telephone: 01773 525119
Are we accessible to you? This publication is available on request in other formats (for example,
large print, easy read, Braille or audio version) and languages.
For free translation and/or other format please call 01773 824171 extension 5587, or email us at:
[email protected]
Please call if you require
any further information
01246 514018
Summary of Patient Satisfaction Returns
Total number of episodes in cohort*
Centre(s) included in this report:
34
AD1198
Number of PATSATs returned:
AD1298
30
AD2600
These data relate to all submitted episodes carried out between 01/01/2001 and 201/01/2010 where valid surgical procedure
codes were recorded.
Q2 Were the risks from surgery
explained?
Q3 Did you know what to do if you
needed assistance?
Q4 Did you have a problem after
surgery?
No
0
0%
No
1
3%
No
Not sure
0
0%
Not sure
0
0%
Yes, minor
5 17%
25
86%
Yes
24
83%
Yes, serious
0
0%
4
14%
Not stated
4
14%
Not stated
0
0%
Yes
Not stated
24 83%
Q4a If ‘yes’ to Q4, what did you do?
Q4b If ‘yes’ to Q4, how was speed of
response?
Q4d If ‘yes’ to Q4, how was the
problem dealt with?
Not applicable
Not applicable
24
83%
25
86%
Not applicable
Waited
1
3%
Earlier appointment
3
10%
Verbal advice
0
Called out podiatrist
Slow to respond
3
10%
Poorly
0
0%
Satisfactory
0
0%
Cannot tell as still being
managed
0
0%
0%
Fast to respond
0
0%
Satisfactorily
0
0%
0
0%
Not stated
1
3%
Excellently
4 14%
Called out GP
0
0%
Not stated
1
A&E
0
0%
Other
1
3%
Not stated
0
0%
Q5 Was your pain medication adequate
after surgery?
Completely ineffective
Q6 When could you get back into
your shoes?
24 83%
3%
Q7 Do you still have discomfort from
your original problem?
1
3%
By 2 weeks
7
24%
At rest
0
0%
Some discomfort but I coped
13
45%
By 4 weeks
9
31%
When standing
1
3%
Excellent/Minimal pain
11
38%
By 6 weeks
8
28%
Standing for long period
1
3%
4
14%
By 8 weeks
1
3%
Occasional twinges
7 24%
By 12 weeks
0
0%
No discomfort at all
15 52%
By 6 months
0
0%
Not stated
After 6 months
0
0%
Still can’t wear shoes
0
0%
Not stated
4
14%
Not stated
Q8 How is your original problem?
5 17%
Q9 Would you have surgery under the Q10 Was the outcome in question
same conditions again?
1 met?
Deteriorated
0
0% Yes
24
83% Not at all
0
0%
A little worse
0
0% No
1
3% In part
0
0%
The same
2
7% Not stated
4
25
86%
Better
5
17%
4
14%
18
62%
4
14%
Much better
Not stated
Mean PATSAT score:
81.21
14% Completely
Not stated