Dressings consist of non-adherent fine mesh gauze (petrolatum, 3% Xeroform™ or Adaptic™), and a fluffy dry sterile compression gauze bandage. A surgical shoe is dispensed. The patient is instructed to rest at home, remain non-weightbearing and to elevate his feet for 48 h. He is then allowed partial weightbearing in a surgical shoe with crutches or a walker. The first postoperative dressing change is scheduled within 1 week. Dressings are changed weekly for 3-4 weeks postoperatively. Sutures are removed in 14-21 days, and the patient is allowed to return to his regular footwear as soon as the operative site is completely healed and swelling has subsided.
Amputation of the lesser toes can be performed by a transphalangeal approach or by disarticulating the toe at the metatarsophalangeal joint. Some authors have suggested leaving a 'button' of proximal phalanx intact over the metatarsal head. However, there is a need for caution. The residual portion of the proximal phalanx can cause discomfort and become a future site of ulceration. I have found that transphalangeal amputations often result in dorsiflexion of the residual phalangeal stump, with irritation of the skin over the prominent bone. For this reason I disarticulate the toe at the metatarsophalangeal joint.
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