Physiotherapy in Acute Postoperative Fifth Toe Amputation with VAC: A Case Report

Nissa Mahadi Mahdivikia; Arin Supriyadi; Danur Setiawan

doi:10.24843/mifi.000001802

Authors

Nissa Mahadi Mahdivikia Professional Physiotherapy Program, Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, Central Java, Indonesia. Author
Arin Supriyadi Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, Central Java, Indonesia. Author
Danur Setiawan RSO Prof. Dr. Soeharso Surakarta, Jawa Tengah, Indonesia. Author

DOI:

https://doi.org/10.24843/mifi.000001802

Keywords:

Amputation, Negative Pressure Wound Therapy, Physical Therapy Modalities, Postoperative Care

Abstract

Background: Fifth toe amputation following severe trauma often results in open wounds requiring surgical management, including debridement and Vacuum-Assisted Closure (VAC). In the acute postoperative phase, patients are at risk of pain, edema, and functional limitations, highlighting the need for early physiotherapy intervention.

Objective: This study aimed to evaluate the safety and early clinical effects of physiotherapy in a patient undergoing fifth toe amputation with VAC during the acute postoperative phase.

Methods: A case report was conducted on a 39-year-old male with a left foot crush injury who underwent debridement, fifth toe amputation, and VAC placement. Physiotherapy was administered over three consecutive sessions (postoperative days 1–3), representing the acute postoperative phase, including passive and active-assisted range of motion exercises, isometric contractions, ankle pump, breathing exercises, and limb elevation. Outcomes included pain (Numeric Rating Scale), range of motion (goniometry), muscle strength (Manual Muscle Testing), and edema (limb circumference).

Results: Pain remained stable (rest: 3/10; movement: 7/10; palpation: 8/10). Ankle range of motion improved from 5°–0°–15° to 10°–0°–20°. Proximal muscle strength remained stable (MMT 3+ to 4−). Edema decreased from a 2 cm to 1.5 cm difference (−25%). No adverse events were observed.

Conclusion: Early physiotherapy following fifth toe amputation with VAC appears safe and may support maintenance of function, limited mobility improvement, and edema reduction without increasing pain. Further studies are needed to confirm these findings.