AMPUTATION OF THE SECOND TOE IN THE PRESENCE OF HALLUX VALGUS

Abstract

Hallux valgus deformity may cause overriding of the second toe. Hallux valgus correction surgery in the elderly can be debilitating and patients may suffer a long period of morbidity. We show the outcomes of amputation of over-riding second toe caused by gross hallux valgus in the elderly. Eight patients underwent amputation of their overriding second toe, one of these patients underwent bilateral second toe amputations. All surgery was performed as a day case. Six patients had surgery under a local anaesthetic, two patients had surgery under a general anaesthetic. Patients selected had asymptomatic or minimally symptomatic hallux valgus with an overriding second toe and did not want hallux valgus correction surgery. A disease specific questionnaire using a Visual Analogue Scale (VAS) was implemented measuring pain, discomfort, deformity and walking distance. Patients were followed up for a minimum nine of months.

Eight patients (nine feet) underwent amputation of their second toe. There were seven females and one male. The age range was 63–90 years (median 83 years). All patients had a painful second toe on wearing footwear. Skin ulceration occurred on the dorsum of second toe in two patients. The mean VAS for pain, deformity, discomfort and walking distance before and after surgery are:- (before/after); pain = (7.00/0.94), deformity = (7.44/2.78), discomfort = (7.78/1.22) and walking distance = (6.89/6.44). There were no cases of post-operative infection, wound dehiscence, bleeding or deep vein thrombosis. One patient complained of a painful neuroma after one year.

Amputation of the second toe significantly reduces pain, discomfort and the appearance of deformity (p< 0.01), there was no difference in the patient’s walking distance after surgery. We recommend this type of surgery as an alternative to hallux valgus correction surgery in the elderly if the first ray is not causing significant symptoms.