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Reattaching Severed Toes

6K views 12 replies 10 participants last post by  Raspberry 
#1 ·
Another thread here involves a debate on which boots to wear and many stated that toes are "easily reattached" if severed (particularly in reference to the use of steel toe boots). I wanted to provide some facts on toe replantation (reattachment of a severed toe) in a thread that anyone could easily search for - I think it has relevance outside of just choosing which boots to wear in that other thread. My sources are all published papers in medical journals (references included).

First off, I couldn't find a lot of papers on toe replantation. This isn't just me being inept, as one paper states "Traumatic amputation of the big toe is uncommon and only a few articles have been published on its replantation." Big-toe replantation in a three-month-old child: case report. J Reconstr Microsurg. 2004 Jul;20(5):373-5. There don't seem to be any big studies of it, just small studies and mostly case studies (reports of a single patient). "Although successful replantations involving digits, hands, and upper and lower extremities have become fairly routine, replantations of big toe amputations have been extremely sparse and only a few article have been published."

In general, whether or not your toe would even be eligible for replantation isn't really known. There are no clear-cut indicators of sucess for this surgery (prev paper states age, socialcultural status, type of injury and the patient's expectations/demand, and "Patient demand and expectation are the most important criterian in making a decision for big-toe replantation"), you and your doctor have to more or less "guess" at whether it will work or not. If you suffer a great toe (big toe) amputation then you will probably get a replantation attempted, for other toes it depends on your age and whether you want it.

As to how sucessful the proceedure is, in Should the amputations of the great toe be replanted? (Ademoglu et al., Foot and Ankle International Volume 21, Issue 8 , 2000, Pages 673-679) "Seventeen great toes, amputated at the distal phalangeal to the level of the MTP joint, were replanted between 1990 and 1998, at Izmir Hand and Microsurgery Hospital. Replantation in five out of six complete amputations, and seven out of eleven incomplete amputations were successful, and the overall survival rate was 76.4%." So while the odds aren't horrendeous, they're not great either.

The one good thing is that for patients who had sucessful surgery, they "had no significant subjective symptoms, nearly normal ROM [range of motion] of the MTP joint and protective sensation was achieved in the replanted great toes."

Now another point is that replantation of digits requires a SKILLED plastic surgeon who can sucessfully anasthamose (reconnect) all the tiny blood vessels and nerves that have been severed. You're only going to find such surgeons at major academic medical centers in the bigger cities. If you're going to a rural hospital it's unlikely anyone will have the training to attempt such a proceedure.

Hope that helps.
 
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#5 ·
i'm tempted to conclude that toe amputation is so rare that it really isn't a good reason to buy boots.  crushed and road-rashed ankles are probably the really important things to consider when buying boots.
 
#6 ·
ridesideways said:
i'm tempted to conclude that toe amputation is so rare that it really isn't a good reason to buy boots.  crushed and road-rashed ankles are probably the really important things to consider when buying boots.
I wouldnt say crushed or road-rashed is still really the reason.............. I say the real reason is to keep your foot pointing in the proper direction.... meaning, I would really hate to have a get-off, and try to stand up , and find my foot is pointed south, when I am trying to go north..... if you get my drift....
 
#7 ·
ridesideways said:
i'm tempted to conclude that toe amputation is so rare that it really isn't a good reason to buy boots. crushed and road-rashed ankles are probably the really important things to consider when buying boots.
That's entirely possible - we also should consider that the lack of papers on it could be due to many other factors though: 1) Low patient demand - many patients may not be willing to go through the emotional and physical trial of major surgery and also pay thousands and thousands of dollars to reattach a toe, I don't think toe amputation affects quality of life as much as say fingers 2) Low research focus - there aren't that many plastic surgeons around and since finger amputation is probably considered a greater priority, more plastics folks probably want to focus their research elsewhere. I have no idea what the actual reasons are, sorry.

That reminds me - my friend lowsided in sneakers and received a mean looking laceration from his ankle upwards and was on crutches for a couple weeks. Seeing that was enough to convince me that boots were a good idea.
 
#10 ·
drbuff123 said:
Anyone ever see the ripleys believe it or not where they cut off the guys big toes and made thumbs out of them.
Is that for real?


Your big toe is an extremely important part of your ability to balance yourself and move effectively. I'd say your thumb is more important, but it's a tremendous loss to lose a big toe. It's also a tremendous risk to take that the surgery may not work and you'll lose both.
 
#11 ·
drbuff123 said:
Anyone ever see the ripleys believe it or not where they cut off the guys big toes and made thumbs out of them.
my dads coworker back then had two of the tip of his finger crushed by heavy machinary while at work. he chopped off two of his small toes to attach on his finger. I was always wierded out when i saw his hand. looks like ET. lol
 
#12 ·
I had my radial arm saw accident when I was a teenager, almost 40 years ago, it happened either in the summer of 67 or 68. to was 2 years almost after the accident before I even developed the ability to make a complete fist with my left handover time, I have developed dexterity almost like nothing ever happened, my pinky finger works perfect but is 3/8" shorter (width of dado blade) on the middle segment. My ring finger, it got partially into my knuckle, so that finger isn't shorter, the doctor somehow reconstructed the knuckle. that's the only think that doesn't work perfect, but close to it. it has enlarged the knuckle enuf that it's not comfortable for me to wear a ring on that finger.

Over time, I have even got most of my nerve feelings back, that has only been recent, 7 years ago, when I fisrt got my Sv, I could not feel those 2 fingers getting cold, now, I can
 
#13 ·
Ben Jammin' said:
Your big toe is an extremely important part of your ability to balance yourself and move effectively. I'd say your thumb is more important, but it's a tremendous loss to lose a big toe. It's also a tremendous risk to take that the surgery may not work and you'll lose both.
Definitely. There's a reason slave owners cut off slaves' toes. Ask anyone who's ever had turf toe how much it affects them. I always laugh at the dumbass football media who make fun of that injury because it's the toe. I got it once when I had my toe bent back as a running back. I played through it, just not well... at all. It was less pain to play through a back injury.
 
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