To Amputate A Toe Or Not?

[NeylasMom]

Zuri has dislocated his toe multiple times and did it again recently. The last time it happened, I did discuss the possibility of removing the toe with his orthopedist, but decided to see how things went with it healing and staying in place rather than amputating. Each dislocation means weeks of restricted exercise for healing, which has a bad impact on his LS and I'm also constantly restricting his activity in general (namely in the dog park) to try to prevent it from happening again. For both of those reasons, I am pretty sure I want to have the toe removed at this point.

 

Zuri is going to be 9 tomorrow and other than being in the earlier stages of LS is happy and healthy. He still enjoys going on hikes and being off lead although he can't do as much as he used to (we're still trying to build his core strength back up). He recently had a dental so while I hate the idea of anesthesia again so soon, I at least know he handled it like a champ and have the protocol from OSU that I can pass on.

 

Any thoughts/experiences regarding amputating for this reason that anyone can share? I am going to get the earliest appt I can with my ortho to discuss all of this with him of course, but thought I'd get feedback here in the interim. Also curious how long the healing process is - that concerns me both because of his LS and also because we're on a 3rd floor condo with multiple sets of stairs. This is the outside toe on his front left foot btw. Thanks!

[dmdsmoxie]

If you get rid of the toe you get rid of the problem.

[krissn333]

It might just be time. Is it an outer toe? He'll never miss it.

 

PS - there's a facebook group called Three-toed greyhounds...those people will have a WEALTH of advice and information as well as people who will chime in here (there are several GTers who are members of that group as well).

[inugrey]

I've always heard they hardly miss the outside toes. Those are more for stability than support. Inu lost one of his inside toes. I sometimes still wonder if that was the right decision. I seem to have blocked out the details of how long it took, but I have this definite memory that it seemed to take a long time for him to recover. We also have a whole lot of stairs to navigate.

 

Overtime it looked like his outside toe ended up taking on some of the weight. I say I still wonder if I made the right decision but I can also say he never had pain in that area again. So in the end mission accomplished.

 

eta: I talked to Dr. Radcliffe about amputating an outside toe because of the corn. He said basically "get rid of the toe"

Edited July 8, 2013 by inugrey

[greysmom]

Aside from the risk of anesthesia, toe amps are relatively easy and will certainly solve the problem. Two weeks post-surgery, barring any complication, he'll be good to go. The whole issue of inside toe vs outside toe vs weight bearing vs non-weight-bearing is really not important. I've seen greys with only two toes on a foot and it doesn't seem to impact their life in any significant way. The dog's foot *does* change shape over time to accommodate the loss.

 

However, I will throw this out there. A greyhound friend of ours had a chronically dislocated toe. It never bothered him, wasn't painful, and didn't impact any other toe by rubbing or getting in the way. His owners chose to just leave it as it was and not do any surgery. They never restricted his activities either. His dislocated toe was sort of floppy and looked weird, but he really didn't seem to have any issues playing or running in the yard or doing anything he wanted to do with it.

[oldrunners]

My second grey, lo these many moons ago, had only 3 toes on one rear foot. Since there was no scaring or malformation of the foot, I believed it to be congenital. He did just fine, but freaked out many a groomer when they got to that foot to trim nails!

[Guest greybookends]

Daytona had only one toe on one of her rear feet. She did just fine.

[Guest Adrianne]

 

However, I will throw this out there. A greyhound friend of ours had a chronically dislocated toe. It never bothered him, wasn't painful, and didn't impact any other toe by rubbing or getting in the way. His owners chose to just leave it as it was and not do any surgery. They never restricted his activities either. His dislocated toe was sort of floppy and looked weird, but he really didn't seem to have any issues playing or running in the yard or doing anything he wanted to do with it.

 

Chevy has a toe that dislocates pretty frequently--every couple of months or so. It freaked me out the first couple of times it happened, and I wrapped his foot & kept him quiet for days & days. But we just roll with it now. He hates being quiet, and he won't leave wrap on unless he's also muzzled. When it happens now, he holds his foot up, hops over to me, I pop it back in place, give him an aspirin, and he's good to go. He doesn't limp, and it doesn't slow him down at all.

 

Is there a particular activity Zuri is doing that causes the dislocation? Chevy's happens when he does circle zoomies. Not every time, but not with any other activity.

Edited July 8, 2013 by Adrianne

[Guest abbysmom]

My first grey, Abby, had an outside toe that would dislocate. Eventually, it would happen almost weekly, and I decided it was time to amputate. She never missed the toe. I don't remember how long the recovery took, but that, in itself, is a good thing--it was not particularly long or troublesome. I'm glad I had it done, and would certainly consider doing that again should dislocation become a chronic event. I wish you and Zuri the best of luck!

[NeylasMom]

It might just be time. Is it an outer toe? He'll never miss it.

 

PS - there's a facebook group called Three-toed greyhounds...those people will have a WEALTH of advice and information as well as people who will chime in here (there are several GTers who are members of that group as well).

Thanks, I didn't know this existed. I'll check it out.

 

However, I will throw this out there. A greyhound friend of ours had a chronically dislocated toe. It never bothered him, wasn't painful, and didn't impact any other toe by rubbing or getting in the way. His owners chose to just leave it as it was and not do any surgery. They never restricted his activities either. His dislocated toe was sort of floppy and looked weird, but he really didn't seem to have any issues playing or running in the yard or doing anything he wanted to do with it.

Unfortunately it is painful for Zuri. He cries when it happens and then the toe swells up and bruises. This time the next toe over was also swollen and bruised. With Deramaxx that will go down, but then he's left with a hard swelling on the inside of the toe for at least several weeks and more crying if it pops out again. I can wrap it to keep that from happening, and am going to use a therapaw on walks, but that presents its own challenges.

 

 

Is there a particular activity Zuri is doing that causes the dislocation? Chevy's happens when he does circle zoomies. Not every time, but not with any other activity.

It's always when he's running full out, generally when he's focused on something and not paying attention to where he's going, but immediately after it happens, it will of course pop out with the slightest encouragement (trotting around in our condo with a toy for instance) unless I keep it wrapped.

 

Can anyone think of a reason why I shouldn't remove the toe (other than the outrageous sum of money my ortho is going to charge me )? I know people always say toe amputation is no big deal and I always kind of cringe because one, it is still surgery and two, there is always a risk with anesthesia, but I think I feel a lot better in this case because Zuri did well with the anesthesia for his dental and my ortho is one of the best of the best so to speak so Z would be in really really good hands.

 

Basically, the more I think about it, the more I think it's the right decision for us. We have our appt next Friday though so I'll be able to get all of the info from the vet then.

[CherylB]

I just went through a middle toe amp with Remy. He was experiencing chronic pain like your boy (different cause), and we decided that removing the problem would be best for him long-term. I understand how hard can be to make the decision. He is now 3 1/2 weeks post-op and doing great! Because of the toe, he had stopped playing, coming upstairs with me, and running in the yard and many other quirky little things that make him Remy. Now he's back at it again, and it's great see him happy and pain free.

 

That said, I would not characterize the procedure as no big deal. It's not a huge deal, but not a small one, either. For us, the recovery took three weeks, and there were times when he struggled and it was hard on him and us. Now that it's behind us, I know we did the right thing. But in that first week after surgery, I questioned my decision. I wouldn't change anything, though.

[NeylasMom]

That said, I would not characterize the procedure as no big deal. It's not a huge deal, but not a small one, either. For us, the recovery took three weeks, and there were times when he struggled and it was hard on him and us. Now that it's behind us, I know we did the right thing. But in that first week after surgery, I questioned my decision. I wouldn't change anything, though.

Do you mind sharing what your struggles were? You can PM me if you'd prefer.

 

I did have a foster who had to have a metal plate and screws from a broken leg removed and was able to manage his recovery, mainly with the use of an x-pen and separate walks and Zuri is crate trained (and crated when I leave the house) so I'm most concerned about the fact that we don't have an option to not do stairs at all, but I honestly don't know what other difficulties might pop up.

[krissn333]

It sounds like, given the particulars of Zuri's specific situation, that amputation is the best option from a quality of life standpoint. Sure, post-surgical care is obviously important, but, you are knowledgeable enough that you'll do just fine. I'm sure the three-toed greyhound group will have helpful tips on bandaging, managing the fact that there's no way you can avoid having him do stairs, etc.

 

I met a dog this past weekend who'd had a weight-bearing toe removed (second one in from the outside on his left rear foot). From what I understand, recovery from these is a little bit more difficult than an outer toe. That being said, this guy's looked AWESOME and if I hadn't been sort of inspecting him I probably would not have noticed. It looks as though the surgeon was able to mate the webbing of the outermost toe with the webbing of the remaining weight-bearing toe. He seems to have a bit more stability with that setup. It's fascinating. Or maybe I'm just weird

[CherylB]

 

Do you mind sharing what your struggles were? You can PM me if you'd prefer.

 

 

 

Remy has always been nervous walking on hard or slick surfaces, and the amputation seemed to make that worse for him. . I'm sure it hurt vs. the carpeted areas of our house; he didn't cry but would lie down and pant after walking to his food bowl, etc. We put throw rugs with rubber backing down, and that did help some. He also had difficulty pooping and would cry every time and pant/shake afterwards because it was hard for him to bear weight on that foot. Because it was a middle toe, the stitched incision area would "spread" every time he had to bear weight on the foot. Same thing with stairs, though we limited the number of times per day he had to do them. The combo of antibiotics and pain meds left him with no appetite, and it was a struggle to get him to eat. I pulled out all the tricks in the book, and he ate about half of his normal diet. We're still dealing with that, as he's on anticiotics for another week, but the appetitie is gradually getting better.

 

 

There were days he'd wake up bearing weight on the foot, then he wouldn't walk on it for two days, then be better again. His incision area developed minor infection, which I'm sure didn't help. He only finally seemed mostly back to normal this past weekend, 3 weeks post surgery.

 

Glad Press & Seal worked great for protecting the bandaged area when he went outside. Also, if you don't have a muzzle with a stool guard already, you might want to get one to be prepared to prevent him from messing with his bandage and licking his foot after the bandage comes off.

 

Of course recovery will vary by dog, so hopefully Zuri will have an easier time. It does sound like the right decision to me. Good thoughts for you boy, and let me know if you have any other questions.

[NeylasMom]

Thanks, I appreciate the details. We have Z's stomach of steel in our corner so I don't anticipate eating issues, but infection, and of course just being able to manage his pain adequately post surgery especially if he needs to weight bear to manage stairs are concerns. I will make sure to bring all of this up with my vet.

[greysmom]

You need to talk with your surgeon about making sure he takes the whole toe back up into the foot. You don't want to have a stub left over, hanging out so that it impacts the ground when he walks/runs.

 

Dude had a hard cup splint (I think it's called), and he was walking around on it three or four days after surgery, including doing stairs. They told us to keep the splint on for two weeks post-surgery. There were no bandage changes or anything. After about 6 days, I knew I should take it off, but when I called for advice, they said leave it on. When we took it off after 4 more days, he had developed pressure sores that needed twice weekly bandage changes for 6 more weeks. His surgery site was totally fine and healed well, but the splint was a nightmare. I learned to listen to my own intuition about my dog's health from this episode.

[CherylB]

Just checking in to see how Zuri is doing.

[Guest MnMDogs]

Mork is missing 2 weight bearing toes, one on front left and one on back right. One he lost before he came to me, and the other came off (due to severe keratinitis)about 3 - 4 years ago now. He really recovered very easily, even with 3 other feet that weren't so great (corns, arthritis). By 10 days or so, he was taking nice fast walks and seemed pain free.

 

We were obsessive about bandage changes, and I think the first one was within a day, the others were at least 2 times a week - I have a huge fear of not knowing what's going on under bandages, and we were also obsessive about keeping it dry with IV bags every time he went out.

 

If I remember correctly, the wrap came off at 2 - 3 weeks. It seemed like a very easy recovery, and I wish that we had done it sooner. But I'm pretty sure Mork is a special case, he recovers so easily from everything it's bizarre.

 

ETA - my vet didn't take it up to the foot. We had discussed it, but she thought it would be better to just take to the joint. She was able to pad that stump really well with fur, and he walks really well like that. The first toe amp was also taken only to the first joint, and it was obviously not done as well since he has favored that foot for the 9 years I've had him, and he still licks at it daily

 

Also, he just had a soft wrap. Those hard splints are a nightmare like greysmom said! When he broke his toe last year, he had a hard splint and frequent changes. Even with that, he developed a horrid pressure sore that took weeks and weeks to heal and it still looks like the skin is thinner there (from December)

Edited July 19, 2013 by MnMDogs

[NeylasMom]

Just checking in to see how Zuri is doing.

Thanks for checking in, he's doing well. The toe doesn't seem to be bothering him much at this point and I've been able to leave it unwrapped without having the toe pop back out so it seems to be well on its way to being healed. Our appointment is this afternoon. I'll report back after we're home.

[NeylasMom]

I started a new thread because I wanted to share the good news on his LS as well, so you can read the full report here:

http://forum.greytalk.com/index.php/topic/299944-zuris-a-report-card-from-his-ortho-ls-toe/

 

but the gist is that we are not amputating for now and hope not to have to by using a wrap preventatively.