Saturday, April 01, 2023
DIABETES Diabetic Foot Problems FOOT HEALTH

Can You Walk Without Toes: What Happens When You Lose a Toe

If you are about to undergo a toe amputation secondary to an infection, injury, or even frostbite, it can be very nerve-wracking! You may be wondering whether you will be able to walk afterward. 

So can you walk without toes? In general, you can walk without toes. However, walking without toes will impact your foot biomechanics by increasing pressure points in other areas of your feet, decreasing speed, and also decreasing the number of steps you take. 

In this article, we’ll discuss how toe amputations can affect walking.

What Are Toes For?

Toes play a significant role in the biomechanics of your feet. They help disperse pressure throughout your feet when standing and walking. 

They also help with propulsion (push-off) when walking, and assist in maintaining balance and stability. 

The absence of toes can significantly impact foot biomechanics and lead to changes in gait, walking speed, stride length, and ankle joint range of motion. 

When one or more toes are absent, you can naturally expect to experience some changes when standing and walking. 

metatarsophalangeal joint on a sawbone

What Is the Toe Joint?

The toe joint, also known as the metatarsophalangeal joint, is an important component of the foot biomechanics.

It helps to maintain balance and stability during walking. It is the connection point between the toe and the metatarsal bones.

During a toe amputation, the toe is removed at the metatarsophalangeal joint.

How Many Toes Do You Need to Walk?

Walking without any toes is possible, contrary to popular belief!

Although toes contribute to the biomechanics of the foot, they are not necessary for walking. Many amputees can walk without toes with the help of the right shoes, fillers, and custom inserts. 

When walking, your ankle, knee, and hip joints work together to propel your body forward, and the movements of these joints are primarily responsible for walking. 

Therefore, even if you have lost one or more toes, you can still walk with the help of appropriate shoes and inserts. 

Can You Walk Without A Big Toe?

It is still possible to walk without a big toe with the use of corrective footwear. However, there will be some negative effects after undergoing a big toe amputation.

The big toe plays a crucial role in foot biomechanics. It takes on twice the total pressure of the other four toes (1). It acts as a rigid lever to help propel the foot forward (2)

If you undergo a big toe amputation, you may develop a callus underneath the first metatarsal head due to compensation. 

The first metatarsal head is the first knuckle bone under the ball of your foot.

Due to the inability of the body to use the big toe to propel you forward, you may notice excess pressure in the metatarsal region, causing things like callus formation. In some cases, this can lead to an ulcer. 

If you have neuropathy in your foot, you are at a much higher risk of developing an ulceration. 

After a big toe amputation, you will need to see your foot doctor to get fitted for custom orthotics.

Custom orthotics that are appropriately padded can help redistribute pressure throughout the foot and can help prevent things like calluses and ulcers. 

Is It Possible to Walk Without Both Big Toes?

Although you can walk with big toe amputations in both feet, double big toe amputation can significantly impact a person’s ability to push off when they walk, resulting in a slower gait.

It can also be difficult to maintain balance. When both big toes are amputated, it can cause an uneven distribution of weight on the remaining toes and metatarsals, leading to increased pressure in other areas of the feet.

It’s important to wear custom inserts to evenly redistribute pressure throughout the foot if you undergo amputation of both big toes. 

Can You Walk Without Pinky Toes?

The fifth digit (pinky toe) helps with stability and support of the outer portion of the foot.

Although it is possible to walk without pinky toes, the absence of a pinky toe can make the outer foot vulnerable to irritation against shoe gear.

Not only that, increased pressure under the ball of the foot can cause tenderness.

Can You Walk Without Toes on Both Feet?

When all the toes are amputated, it is called a “transmetatarsal amputation”. Although you can walk after a transmetatarsal amputation, you may lose plantarflexion power in the ankle.

Plantarflexion motion of the ankle assists in propulsion during walking. 

You will also notice that you walk slower and decrease the number of steps you take.

Amputation of the toes doesn’t just affect the foot and ankle. It can affect other joints in the body, such as the hip joint. 

In his study, Mueller et al compared amputee patients with a control group. They found that in amputees, the hip flexor muscle had to work harder and faster to help propel the foot forward during walking (3)

Missing toes in both feet can affect balance and place you at higher risk for falls. Physical therapy should be done to help improve balance, strength, and gait. 

You will need to undergo physical therapy three times a week for a month before you can comfortably walk without all your toes.

If you have a transmetatarsal amputation and are diabetic, you will need to get fitted for a prosthetic. The prosthetic can be placed inside of a diabetic shoe and can help disperse pressure throughout the whole foot when walking. 

Some insurances will cover a pair of diabetic shoes with 3 pairs of custom inserts every year if you have diabetic neuropathy in your feet. You will need to visit your foot doctor for a prescription.

Can You Stand On the Ground Without Toes?

You can stand on the ground without toes. However, there will be excess stress that disperses through the remaining foot and ankle while standing. This can cause pain and make it difficult to stand on the ground for extended periods. 

Neuropathic patients, in particular, are especially at risk of developing sores and ulcers as their reduced ability to feel pain can cause them to be unaware of pressure points on their feet.

In these cases, custom plastazote inserts can help. 

Plastazote is a foam material that can be easily molded to your foot, making it an ideal material for custom orthotics. 

The benefit of custom plastazote inserts is that they provide support and cushioning for your feet while also redistributing pressure points. You can obtain custom plastazote inserts from your foot doctor’s office.

Can You Maintain Balance Without Toes?

Maintaining balance without toes can be challenging, as toes play an important role in helping to disperse pressure throughout the feet.

According to a study done by P.Ku in Gait & Posture,  people with lower extremity amputations experienced greater imbalance compared to those without amputations (4). 

So although you can balance without toes, it can be negatively affected with an amputation.

walking

What Kind of Shoes Should You Buy After Losing a Toe?

After a toe amputation, it is important to choose shoes that will provide adequate support and cushioning.

People with amputation should choose shoes that have a wide and deep toe box. This will prevent rubbing and irritation.  You should also look for shoes with a sturdy sole that will provide a good grip and prevent slipping. 

Make sure you get your feet measured using a Brannock device so that you can ensure you are wearing the right size. 

Check out this video on how to use a Brannock device:

Is Losing a Toe A Disability?

Losing a toe can impact a person’s ability to walk and perform certain tasks. Whether it is a disability will depend on the individual person and how many toes are gone.

Losing a toe may be considered a disability if it significantly limits a person’s ability to perform essential job duties or daily activities.  

It’s important to speak to your foot doctor to understand the potential impact of toe loss on your individual circumstance. 

Can You Drive Without Toes?

A frequently asked question is whether you can drive without toes. You can drive without toes if you wear appropriate shoes and inserts

If an individual is missing one or more toes, they can still operate the foot pedals by using the balls and heels of their feet.

A pedal extender can be used to position the foot correctly on the pedal. Make sure you speak to your doctor before you start driving after having the toe(s) removed.

Can You Run Without Toes?

Running without toes can be tough, but it is definitely possible. Due to lack of push off, the runner will need to take more steps and decrease their stride while running.

They should focus on placing pressure in their midfoot when coming down on the foot. The runner must wear appropriate shoes and inserts while running to prevent pain in other areas of the feet.

Conclusion

In conclusion, toe amputations have an impact on walking, balance, and stability. However, with the right shoes, fillers, custom orthotics, and physical therapy, people with amputations can learn to adapt and improve their gait and balance.

It’s important to consult with a foot doctor and a physical therapist to determine the best course of action and minimize disability. 

While losing toes can be a difficult experience in life, it is still possible to maintain an active lifestyle with the right support and care. 

Related article:

Toe amputation Surgery- What To Expect

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walking pin

References

  1. Tanaka T, Hashimoto N, Nakata M, Ito T, Ino S, Ifukube T. Analysis of toe pressures under the foot while dynamic standing on one foot in healthy subjects. J Orthop Sports Phys Ther. 1996 Mar;23(3):188-93.https://pubmed.ncbi.nlm.nih.gov/8919397/
  2. Motawea, Mohamad & Kyrillos, Fady & Hanafy, Ahmed & Albehairy, Ahmed & State, Omnia & Tarshoby, Manal & Gawish, Hanan & El-Nahas, Mamdouh. (2015). IMPACT OF BIG TOE AMPUTATION ON FOOT BIOMECHANICS.. International Journal of Advanced Research. 3. 1224-1228.https://www.researchgate.net/publication/289247726_IMPACT_OF_BIG_TOE_AMPUTATION_ON_FOOT_BIOMECHANICS
  3. Mueller MJ, Salsich GB, Bastian AJ. Differences in the gait characteristics of people with diabetes and transmetatarsal amputation compared with age-matched controls. Gait Posture. 1998 May 1;7(3):200-206.https://pubmed.ncbi.nlm.nih.gov/10200385/
  4. Ku PX, Abu Osman NA, Wan Abas WA. Balance control in lower extremity amputees during quiet standing: a systematic review. Gait Posture. 2014 Feb;39(2):672-82.https://pubmed.ncbi.nlm.nih.gov/24331296/

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Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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