Toe and partial foot amputation: removing only what’s needed

What a partial foot amputation is

A partial foot amputation is limb-preserving surgery, an alternative to amputating the leg.⁠^[1] The levels, from smallest to largest:

• Toe. All or part of one toe.
• Ray. A toe together with part of its metatarsal, the long bone behind it.
• Transmetatarsal (TMA). The front of the foot is removed across all five metatarsals, keeping the heel and arch.
• Midfoot (Lisfranc or Chopart). Lisfranc passes through the joints where the metatarsals meet the midfoot; Chopart, through the joints just in front of the heel and ankle bones.⁠^[1,2]

Swipe sideways to see the whole drawing.

Dr. Ozturk, a Foot and Ankle Surgeon who is board certified in wound care (FAPWH), performs toe, ray, transmetatarsal and midfoot amputations for the feet that need one. Regular wound care, offloading and prompt treatment of infection remain the foundation, before and after any surgery. Below-knee amputation is outside a foot and ankle practice: if it is ever needed, a vascular or orthopedic surgeon performs it.

When it’s the right step

It is considered when part of the foot can no longer heal or has become the source of a spreading infection:⁠^[1,4]

• gangrene of a toe or the forefoot (see also dark, black or blue toes)
• a deep diabetic foot infection that has destroyed skin, tendon or joints
• bone infection too extensive to clear by removing a small piece of bone

When bone infection needs surgery, guidelines prefer removing a limited amount of bone and avoiding amputation if possible (see surgery for bone infection).⁠^[8] When that isn’t enough, a carefully planned partial foot amputation is still limb salvage: it removes the problem and keeps the foot.

When infection or gangrene comes with poor circulation, guidelines advise urgently involving a vascular specialist to plan when to drain the infection and when to restore blood flow.⁠^[3] We start with noninvasive circulation testing at our practice and coordinate with vascular specialists, who perform angioplasty or bypass (see restoring blood flow). With poor circulation, guidelines also advise considering revascularization before any amputation above the ankle.⁠^[7] If you’ve been told you need a larger amputation, a second opinion can help.

Why keeping length matters

In a classic study of prosthetic walking after above-knee, below-knee and ankle-level amputations, walking was better the lower the level; the authors advised amputating as low as possible when function is the chief concern.⁠^[9] A review of midfoot amputations found 85% of people could walk short distances without a prosthesis after a Lisfranc amputation and 74% after a modified Chopart, and advised considering these levels before a higher amputation.⁠^[2] Studies comparing partial foot and below-knee amputation directly are few, though, and one review found mobility and quality of life may be similar after either.⁠^[10]

The smallest operation isn’t always the one that lasts. Among 435 partial first-ray amputations (part or all of the big toe, or part of its metatarsal) in people with diabetes and nerve damage, about 1 in 5 later needed a higher amputation. The authors suggested a balanced transmetatarsal amputation as the first operation may serve some people better, though the data are too limited to be sure.⁠^[11]

How the operation is done

When there is time to plan, we check circulation, take X-rays at the practice and work with your other doctors on infection and blood sugar (see preparing for limb salvage surgery).

Spreading infection is different. For a moderate or severe diabetes-related foot infection, guidelines suggest considering surgery with antibiotics within 24–48 hours to remove infected and dead tissue.⁠^[8] Surgery may then be staged: first to clear the infection, later to close the foot (see surgery for diabetic foot infection).

In the operating room, Dr. Ozturk removes the tissue that can’t heal and shapes what remains so it can close and carry weight.

• Checking the bone edge. A sample of the remaining bone can be sent for culture. If it still shows infection, guidelines suggest considering up to 3 weeks of antibiotics after a minor amputation for diabetes-related bone infection.⁠^[8]
• Balancing tendons. Late sores at the end of the foot are common after a transmetatarsal amputation. One theory is that losing the tendons that lift the toes lets the Achilles tendon tighten over time, raising pressure on the end of the foot.⁠^[5] Dr. Ozturk can lengthen the Achilles tendon or calf muscle at the same operation when the foot needs it (see surgery that takes pressure off ulcers).
• Closing the wound. When a wound needs it, we use negative-pressure wound therapy (a wound VAC) or close it with a skin graft or local flap. In a trial of 162 people with diabetes, adequate circulation and amputation wounds up to the transmetatarsal level, more healed within 16 weeks with a wound VAC than with standard moist dressings (56% vs 39%).⁠^[12]

What the results show

• Toe and ray amputations. In a 2026 review of 46 studies in people with diabetes, a later major amputation was uncommon after toe and metatarsal amputations (0% to 10%). Overall, the studies reported a further minor amputation in 12% to 33%, with notably high rates after first-metatarsal amputation.⁠^[1]
• Transmetatarsal amputation. Pooling 22 studies (1,569 amputations), 67% healed and 15% needed a revision.⁠^[6] In one surgeon’s series, 189 of 230 healed after the first operation.⁠^[4]
• Midfoot amputations. The wound failed to heal in 20% of Lisfranc, 28% of modified Chopart and 46% of conventional Chopart amputations.⁠^[2] Across studies, 11% to 44% later needed a major amputation.⁠^[1]

Recovery and life afterward

You’ll keep weight off the foot while the incision heals; Dr. Ozturk tailors the plan to the level, your circulation and how the wound closes. See recovery after limb salvage surgery.

With diabetes and nerve damage or artery disease, a past amputation puts the foot in the highest risk group, so guidelines advise foot checks every 1–3 months and therapeutic footwear when ordinary shoes don’t fit.⁠^[7] We fit therapeutic shoes and custom inserts shaped to your new foot; see offloading boots and footwear and Ozturk Foot & Ankle’s diabetic foot care (external site). New pressure sores and other changes are covered in problems after a partial foot amputation.

Nerve pain can follow an amputation, and our sister practice, the Lower Extremity Nerve Institute, evaluates it. Two newer operations, targeted muscle reinnervation (external site) and a regenerative peripheral nerve interface (external site), may help prevent or treat it, though only one of 17 studies in a 2023 review was a randomized trial.⁠^[13]

Risks and limits

After transmetatarsal amputation, setbacks are common: pooled studies found infection in about 17%, separation of the wound edges in about 29%, and a later major amputation in about 24%.⁠^[6] Research on partial foot amputation for poor circulation is small and of limited quality; it suggests delayed healing and another amputation on the same leg are common.⁠^[10] That is why the level is chosen with you. Achilles lengthening carries its own risks: among 35 feet lengthened during a transmetatarsal amputation, 2 tendons ruptured and 1 heel ulcer formed.⁠^[5]

Questions to ask before deciding

• Which level do you recommend, and why not a smaller or larger one?
• Has my circulation been checked, and do I need a vascular specialist first?
• Will you balance the tendons at the same operation?
• How will the wound be closed, and how long will I keep weight off the foot?
• What shoes or inserts will I need afterward?

When to seek care

See us within a day or two for any foot wound that isn’t healing, especially if you have diabetes. After an amputation, also call promptly if the incision opens or a new sore appears.