Finger Amputations Are Surprisingly Common, and Toes May Be the Best Replacements 

Look, no one wants to lose a finger, but it happens more often than you’d think. And when it does, the stakes are naturally high, since fingers and thumbs are critical for nearly every task we do. That’s why replacing them (when amputation is unavoidable) is such a priority.

While prosthetics or attempts to reattach the lost digit are typical first-line solutions, surgeons are increasingly turning to an unlikely substitute that’s been with us all along: our toes.

A new study published in Plastic and Reconstructive Surgery compared long-term outcomes of toe transfer surgery to traditional digit replantation. The results? Patients who received a transplanted toe regained better overall hand function than those whose original finger was reattached, challenging long-standing assumptions in emergency medicine.

Reconstructing Fingers With Toes

Finger and thumb amputations are surprisingly common, with about 45,000 cases in the U.S. every year. For many, the result isn’t just cosmetic, it can lead to lasting disability, especially when the thumb is lost.

In urgent situations, surgeons often attempt to replant the severed finger. But that’s not always possible, and even when successful, results can be limited. Toe transfer surgery, where a patient's toe is used to reconstruct a missing finger or thumb, offers a viable alternative that is gaining a foothold.

Though not a new technique, toe transfers haven’t been widely studied using validated measures for hand function or patient satisfaction. This lack of data has meant that no formal guidelines exist to help clinicians decide when a toe might be the better option over replantation.

Read More: The Earliest Evidence of An Amputation is 31,000 Years Old

Better Hand Function with Toes

To fill that gap, two doctors followed 75 patients who underwent 126 toe transfers at the Canniesburn Plastic Surgery Unit in Glasgow, Scotland. Their outcomes were compared with 96 replantation surgeries in 52 other patients, all assessed five or more years post-op.

The difference was striking: patients who received toe transfers showed significantly better hand function than those in the replantation group. In fact, their improvement was three times greater than what experts consider a meaningful clinical difference.

The study looked at key functional measures like range of motion, the ability to perform a tripod pinch (holding a pencil), and nerve sensitivity. Across the board, toe transfer patients came out ahead. Their overall physical health-related quality of life also scored higher.

And what about the foot that gives up the toe? Surprisingly, foot function remained on par with the general population.

Rethinking the Gold Standard

"Our study provides the first evidence that toe transfer surgery provides better long-term hand function compared to attempted replantation of the amputated fingers," said Fu-Chan Wei, one of the doctors involved in the study, in a press statement. "The findings challenge current approaches to emergency replantation surgery after digital amputations."

They believe these findings question the assumption that emergency replantation is always the best option and suggest toe transfers be considered a viable alternative.

“These data provide the first evidence for the potential functional superiority of toe transfers over replantation in digital amputation,” Wei and co-author Steven Lo added, calling it “one of the largest validated outcome datasets of toe transfers to date.”

Beyond the operating room, they argue this approach could reshape national healthcare strategies, helping reduce the burden of one of the world’s most disabling injuries.

This article is not offering medical advice and should be used for informational purposes only.