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Figure 3 A, AP radiograph of foot with hallux valgus and OA. B, Weight-bearing AP view of the forefoot shows hallux rigidus (or OA) of the metatarsophalangeal joint of the great toe. Note the joint space narrowing (black arrow), subchondral sclerosis, and medial and lateral osteophytes (white arrows). With OA of the hip, the patient often walks “toes out,” with the limb externally rotated, and tilts or lurches to the affected side with each step. Patients often have pain that radiates to the groin or to the anterior knee as well as pain on internal rotation.

In elderly patients, toe amputations often indicate a foot at high risk for ulceration or pressure problems from standard shoes because of poor vascular perfusion and difficulty healing minor injuries and wounds. Therefore, shoes for these individuals should include extra depth and extra width and, often, custom-molded insoles to accommodate and protect a high-risk foot. Following trauma, patients are typically most comfortable in shoes with a more rigid sole and wide toe box to minimize pressure on the amputation site.

High risk of postoperative respiratory complications Sleep apnea/airway Patient with history of difficult airway best done in hospital setting Patient with rheumatoid arthritis on gold, methotrexate, or other immunosuppressants may require cervical spine clearance. Patient with sleep apnea may be safe for outpatient surgery if normal body habitus, but require longer postoperative observation period. Sleep apnea with morbid obesity should be treated in hospital. Diabetes Most often OK for outpatient unless in combination with other diseases.