Surgeon Questions Gangrene

For a diabetic patient with gangrene in one toe, is foot amputation the only option?

My father is a diabetic and has been diagnosed with a gangrene in one toe. The doctors have suggested foot amputation, but before this extreme step I would like to know if it is the only option.

12 Answers

This is always the question, and the answer is not simple, but here is the start:
First off, he needs a vascular workup and an angiogram, if the workup shows that there are adequate blood vessels, then a bypass may be in order, but a foot is not always able to be saved. The other thing is to get involved with a wound clinic that has hyperbaric oxygen, sometimes this treatment will aid in the salvage of a foot. I have not seen what the foot looks like and there are times when only amputation is the correct treatment, if the infection is too extensive. The problem with diabetes is that the small blood vessels are destroyed and the foot is numb and the damage/infection is usually sever before it is discovered the key to foot salvage is oxygen delivery to the foot and control of the infection.
I wish you luck with this, but start with a good wound clinic or a vascular surgeon.
I will be very honest. Gangrene is a bad thing to have and what you see I will say is not where it most likely not where it ends at. The gangrene is going to be higher up in his foot. That doctor will check foe a safe place to do the amputation and after that it will be how he takes care of himself as to if he will get OK. There are ways to never have to face this again if he eats and drinks what he is told to and if he smokes or drinks alcohol or soda pop he should stop now. I wish him well!!
Yes gangrenous toes do need amputation, however it is advisable to have the circulation to the leg looked at so that to predict good wound healing also needs excellent blood sugar control
If he has a gangrenous toe and has his foot amputated, it means his problem is more than a gangrenous toe. Advise you to discuss his case with his doctor before any surgery is decided.
No. The toe can be amputated. Even all of the toes can be amputated before the entire foot is amputated. It depends upon the extent of the infection.
It is difficult to answer this question specific to your father, but I can give you a general answer. Usually, if the gangrene is only in one toe, and it doesn't look like there's a chance of saving the toe, we will try to amputate only that toe and save the others. One exception to that would be that if the circulation to the entire foot is too poor, then it may not be possible to heal from the single toe amputation. In that instance, it might be better to amputate the entire foot at a level where the blood flow is known to be adequate. If you amputate only the toe and then the surgical site doesn't heal you could possibly be subjecting your father to additional surgery. Another exception might be the presence of infection. If only the one toe has gangrene, but there is a serious infection involving other parts of the foot or other toes, then going ahead with the bigger amputation might be the proper course.

I hope this information is helpful. Good luck dealing with what I know is a difficult situation. Let us know if you have additional questions.

Richard Graves, DPM
No definitely not. Such patients most often have peripheral arterial disease. That must be investigated before any surgery is contemplated. The usual process is to do an arterial duplex doppler and to follow this up with a CT Angiogram or MRI Angiogram. Often there are lesions and blockages in the arteries that are amenable to correction via endovascular procedures or even conventional surgical bypass. Doing such interventions often limits the extent of any amputation and guides the ultimate treatment. Treatability will be decided with conventional angiography in a Catheter laboratory. The father must consult with a Vascular surgeon who perfoms endovascular treatments as soon as possible.
Yes, after careful vascular evaluation.
This is a tricky situation because you have to balance the benefits with risks. The risk here is that the toe will cause the infection to spread (well beyond the foot in some cases) which will lead to a bigger amputation. Also, you need to know the blood supply to the foot; if not adequate, a simple toe amputation might not heal.
The benefit is that a foot amputation takes care of the infection and affords healthy tissue time to heal.
I suggest you discuss with the surgeon.
If kidney function is normal, get arteogram of the affected lower extremity with run off. It will give information whether only a toe is affected or the whole foot. Give IV antibiotics 1 hr prior to surgery.
With the information provided, it has to say if a foot amputation (or a below knee amputation) is what is being recommended. Gangrene typically does not respond to conservative measures alone such as antibiotics and wound care, and does require an amputation. The amount of infection in the toe and how far it extends up the foot are two factors that are considered when offering an amputation. If the blood supply to the foot is poor, no amount of care in the foot will be sufficient to heal a wound or a toe amputation, leading to a higher amputation in the future. No surgeon offers an amputation lightly or as an easy fix, so I would heed the advice of the surgeon.
Not enough information. You need to supply me with the arteriogram report. If you have been a smoker or diabetic for a long portion of your life, the chances that your vessels are occluded is likely the reason a toe amputation will not heal.