My 64 year old father, who has type 1 diabetes, recently had his second vascular by-pass surgery for his legs. He originally went in to have his big toe checked out. He let an ulcer go too far and has been diagnosed with gangrene in the big toe. Yesterday, the doctor told him he has a week for it to show improvement or they will have to amputate it. If they amputate, what can my father expect as far as what it will be like for him to walk? Do they have prosthetic toes?

As bad as it sounds, there is a tough choice here. On the one hand, it is terrible to lose any part of your body due to disease or trauma. On the other hand, when your father has a gangrenous toe, especially when it involves bone, the possibilities of healing it without spread of the infection and risk to structures farther up on the foot have to be weighed against the loss of function. If bone is involved, it is very very hard to cure it and the risks, especially if the area involved is large, are great.

There are many ways to rehabilitate. The most common includes special shoes and gait training with a physical therapist and the medical care team. Your father also needs very careful instructions about looking at his feet each day, taking even small sores as big risk, and having regular follow-up. Good care of the sugars will help with healing.

JTL