FOOT AMPUTATION

Toe Amputations

Amputation is done through phalanx leaving its bas

Scar shuould be on the dorsum

Plantar flap should be longer

Marginal flap should be left for great and little toes.

Save the head of the first meta tarsal.

AMPUTATION OF DISTAL PHALANX OF

GREAT TOE
Long plantar flap is taken
Not injuring digital vessels
Amputation of the phalanx
Flap sutured on the dorsum

REMOVAL OF GREAT TOE

Base of the proximal phalanx is preserved
Long plantar flap is taken to cover the head of
the first metatarsal bone.
Sesamoid bones are always preserved.
Incision: Half inch distal to metatarso
phalangeal joint
Dorsal racquet incision.

Incase of lateral four toes, amputation is performed

through a short dorsal racquet-shaped incision.

Transmetatarsal Amputations
Amputation through the metatarsals
causes loss of push-off in the absence
of a positive fulcrum in the ball of the
foot which is chiefly responsible for
impairment of gait.
No prosthesis is required other than a
shoe filler.

Transverse incision is made middle or

proximal thirds of metatarsals.
Peroneal nerve branches are identified and
traction is applied and transected.
Terminal branch of dorsalis pedis is
preserved.
A bevelled cut is made in metatarsal heads
by angling the saw at 30 degrees
A plantar flap is incised and myodesed to
the metatarsals.

Custom shoe insert for

transmetatarsal amputation

Midfoot Amputations
Lisfrancs Amputation- amputation at the
level of tarsometatarsal joint.
Choparts Amputation- amputation at the
level of calcaneocuboid and talonavicular
joint
Pirogoffs Amputation- calcaneus is
rotated forward to be fused to the tibia after
vertical section through its middle

LIS FRANCS AMPUTATION

Disarticulation through the tarsometatarsal joint .
Transverse incision is made middle or proximal
third of metatarsals.
Terminal branch of dorsalis pedis artery is ligated.
Lisfrancs joint is disarticulated.
Metatarsal are removed.

Severe equinus defromity after

lisfrancs amputation

CHOPART AMPUTATION

Amputation of the foot by a mid tarsal

disarticulation.

Subtalar fusion and elongation of tendo achilles

Choparts amputation

Pirogoff amputation
Anterior part of
calcaneum is cut across and
raw bone is fixed to the raw
undersurface of tibia.
Calcaneal tuberosity
-weight bearing area.
Amputation of the foot at
the ankle, part of the
calcaneus being left in
the stump.

Symes Amputation
Ankle disarticulation,removal
of malleoli and anchoring heel
pad to the weight bearing area.
Two points 1.75 cm below
lateral malleolus and 2.5 cm
below medial malleolus are
joined infront of the ankle and
also vertically across the heel
pad

Anterior incision
deepened-talus and
calcaneum are removed
leaving all soft tissue in the
flap.
Medial and lateral malleoli
along with a thin slice of
tibia removed.

Symes prosthesis

Disadvantages :
i.

Posterior migration of heel pad

ii. Skin slough resulting from overly vigorous

trimming of Dog ears.
iii. Cosmesis- the stump is large and bulky
(bulbous) because of the flair of the distal
tibial metaphysis which is covered with
heavy plantar skin.

BOYDS
AMPUTATION
Talus is excised
Calcaneum is advanced
and attached to the raw
undersurface of tibia
Stable load bearing
surface

THANK