Toe Amputation Surgery Abroad

(Toe amputation package cost includes all the medical and logistic costs at the destination)

Amputation becomes necessary when the blood supply to the toe is interrupted. There are several clinical conditions when amputation surgery of the toe is recommended including advanced cases of diabetes mellitus, infections, and injuries.

In most of these conditions, it is advocated to remove the infected or necrotic tissue affecting the toe. The procedure is conducted by a vascular surgeon.

Many US natives travel abroad for seeking affordable healthcare. As published by the ForeignPolicy.com, a government survey estimates an astounding 300,000 Americans may travel overseas yearly for various medical services.¹

The reasons for this astounding number include:

• Affordability
• Skilled surgeons
• Quality healthcare abroad
• Clean and modern hospitals
• Opportunity to travel to exotic locations

Did you know?

Out of people with health insurance, 20% of working-age Americans reported having problems paying medical bills in a recent study.² The problem is worse for uninsured individuals and this number jumps to 53%.

The financial burden is significantly lessened and even eliminated in some cases by opting for medical tourism. India, South Korea, Jordan, Mexico, and Turkey offer toe amputation surgery at affordable rates.

Options for Toe Amputation Surgery Abroad

With the government taking an active interest in promoting medical tourism in the country, the country has experienced substantial improvement in quality standards and medical care protocols.

Toe Amputation Surgery Facts

• It doesn’t require prosthesis
• It may restrict the speed of movement
• It would marginally affect the gait of the patient
• Amputation of the toe doesn’t result in significant morbidity
• It is a simple surgical procedure which requires a minimum hospitalization of two days depending upon the patient’s condition

Why is Amputation of Toe Required?

• In people with underlying conditions like diabetes mellitus, peripheral vascular disease, etc., when the toe gets infected and ulcerated, it is best to amputate it to prevent the spread of infection and gangrene.
• The underlying medical condition limits the possibility of bypass surgery to the leg artery to improve blood supply. Even laser surgeries to stretch the arteries are futile.
• Antibiotics to control infection spread will not be adequate, as the infection will spread very fast causing gangrene of the surrounding tissues.
• Ulceration of the foot caused due to diabetes attributes to 85% of all non-traumatic amputations of the lower extremities.
• Some other cases requiring toe amputation surgery are local trauma or injury, ostemomyelitis, peripheral vascular disease, tumors, frostbite or congenital anomalies.
• Other leading non-traumatic conditions requiring amputation of the toe include congenital anomalies like hammer toe, claw toe or mallet toe which result in ulceration and infection of the toe.
• Amputation of toe is also required in individuals with impaired nerve functions, which may result in deep cracks in the skin which facilitate access of microbes into the skin causing chronic infections and ulcerations.

Preparing for Amputation Surgery

• Prior to the toe amputation surgery, a set of blood tests and imaging investigations (X-ray of the toe or the foot and bone scan) would be required. The tests are aimed at allowing the doctor to evaluate the blood circulation and the extent of amputation required.
• A detailed medical history evaluation of the patient is conducted prior to the procedure to assess the patient’s health and ability to withstand the procedure.
• Aspirin and other anti-inflammatory drugs need to be stopped at least a week prior to the scheduled surgery. Blood thinners like Clopidogrel, Warfarin, Ticlopidine, etc. need to be stopped along with the anti-inflammatory drugs.
• On the previous night of the day of the scheduled surgery, the patient is suggested to have a light meal and refrain from eating or drinking anything after midnight.

What Happens During the Procedure?

• The procedure is preferably conducted under general anesthesia. However, depending upon the patient’s condition, a spinal or local anesthesia may also be used. It is a minor amputation procedure which may last for 30 to 40 minutes depending upon the extent of amputation.
• The procedure involves the amputation of the toe or the foot depending upon the severity. The commonest technique used is a ‘Ray amputation’, where the toe and a small portion of the corresponding metatarsal bone are removed.
• Depending upon the extent of amputation done, the procedure is further classified into distal amputation (where only the distal phalangeal bone is removed), intermediate amputation (which involves the removal of the proximal inter-phalangeal joint) or proximal amputation (which involves the removal of the toe up to the meta-tarso-phalangeal joint).
• Occasionally a forefoot amputation is conducted when more than one toe is affected by gangrene. In forefoot amputation all the toes and the ball of the foot are removed.
• The procedure involves the removal of a considerable amount of debris in order to avoid any form of subsequent secondary infection.
• The wound may be kept open if too much of skin is removed or if the infection is severe. The healthcare team will take precautions to protect the wound and promote quick healing

A success rate of 70% for ray amputation has been reported by Wong et al.⁸

Post-Operative Care

• The patient is advised to take pain reliving tablets and a course of antibiotics (which may have been started prior to the surgery) to reduce pain and avert chances of an infection.
• Cold fomentation would be helpful for the first few hours after the amputation surgery. For the first two days and most of the first week, the patient is advised to restrict movement.
• Stitches are removed about two to three weeks after the procedure. After the removal of the stitches patients are advised to wear sport shoes for up to two months after the procedure to facilitate the process of healing
• Some patients may complain of an unusual sensation at the site of the location. It is best for the patient to apply face cream and massage the site with light hands to reduce scar sensitivity.

Did you know?

Hippocrates styled the use of ligatures for amputation surgery, but this technique was forgotten during the Dark Ages. Ambroise Pare, a French military surgeon, reintroduced it in 1529. As a result, amputations became popular (as a form of life-saving surgical procedure) again.⁹

Risks or Problems Associated With Toe Amputation

• Post-operative infection at the site of amputation is a common problem. This may result in increased pain and swelling at the site and antibiotics are normally given to prevent this.
• The healing may be delayed in some patients with poorly controlled diabetes or infections
• The scar tissue may thicken or may become tender which would take about ten to twelve months to recover
• Occasionally the patient may feel a numb patch of skin around the wound which would resolve within a couple of months after the surgery.