Should the amputations of the great toe be replanted?

Seventeen great toes, amputated at the distal phalangeal to the level of th e MTP joint, were replanted between 1990 and 1998, at Izmir Hand and Micros urgery 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%. In failed replantations, the base of the proximal phalanx of the great toe was preserved during closing of the stump. Nine o f 17 patients were available for review in the followup period of mean 3.5 years (range 1-6.5 years). Clinical and biomechanical evaluations of the op erated feet were carried out in five patients who had replanted great toe, and in four patients who had amputated one. The uninjured sides were used a s control group. The patients in the two groups had no significant subjective symptoms, near ly normal ROM of the MTP joint and protective sensation was achieved in the replanted great toes. With the numbers available, while radiographical par ameters of the involved and the control sides demonstrated no significant d ifferences in either groups, pedographical studies revealed consistent chan ges in weightbearing distribution of the feet with amputated great toes. Al though the great toe amputation causes no disturbance in gait, it alters th e load distribution of the foot.