Distal Symes amputation of the 5th toe – A case series highlighting treatment of tip of toe pathologies including neuropathic ulceration with chronic osteomyelitis, gangrene, phalangeal fracture nonunion, and adducto varus hammertoe with Lister's corn

Abstract

Distal Symes amputation is commonly performed on the hallux and central toes but this procedure is not generally associated with the 5th toe. We present a case series of four patients who underwent distal Symes amputation to successfully treat tip of 5th toe pathologies including diabetic neuropathic ulceration with chronic osteomyelitis, painful 5th hammertoe associated with fracture non-union through the distal interphalangeal joint synostosis, tip of toe gangrene, adducto varus hammertoe associated with Lister's corn. A pictorial demonstration of surgical technique is provided to assist surgeons with patient selection and surgical planning. Distal Symes amputation of the 5th toe is a versatile procedure that can be performed to successfully to manage tip of 5th toe pathologies without the need to perform partial 5th ray amputation. This procedure is highly conducive to being performed in a clinic-based procedure room under local anesthesia and we have seen high patient acceptance due to quick recovery, pain relief, and improved cosmetic appearance when compared to complete digital or partial ray amputation.

Keywords

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