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Amputations of the Foot & Ankle

  1. Infection (wet gangrene) in diabetic patients with neuropathy
  2. Dry gangrene due to vascular insufficiency in diabetes, collagen diseases.
  3. Trauma, eg. Lawnmower injuries, motorcycle injuries, frostbite, burns
  4. Tumour

  1. Amputation is a reconstructive procedure, not a failure
  2. Eliminate life threatening disease
  3. Create a mobile soft tissue envelope with proper contouring of cut bones to absorb shear and direct forces to make the interface with the prosthesis comfortable. Ideally formed by plantar skin, subcut tissue and investing fascia. Avoid split skin grafting on distal, lateral and plantar surfaces in adults as ulcers may occur. Split skin grafting suitable for dorsal surface.
  4. Prevent equinus contracture of the ankle joint in all transverse ablations proximal to MTP joints, by casting foot in slight dorsiflexion.

1. Level of disease   

If heelpad necrosed, then at least a transtibial amputation required

2. Blood flow   

Assessed by 

  • 1. Ankle brachial pressure measurement; 
  • 2. Transcutaneous oxygen measurement down to distal metatarsals
  • 3. Laser doppler velocimetry, which measures mean velocity of red blood cells. 
  • None of above completely accurate in predicting healing of stumps

3. Psychological state of patient   

A Syme amputation requires good post op patient compliance

4. Cosmetic requirements   

Partial foot amputations result in least disruption of body image

5. Functional requirements   

  • The partial foot amputee and the Syme amputee continue to bear weight in the residual foot in a manner that approximates normal in terms of proprioceptive feedback. 
  • In transtibial amputation a whole new feedback pattern needs to be interpreted.   
  • In partial foot amputation some of the heel lever mechanism is intact   

1. Nutritional status    - Should not affect level of amputation but deficiencies should be corrected as much as possible prior to surgery. An albumin level < 3.0g/dl reduces wound healing

2. Immune status   - Better healing if WCC > 1500/ mm3

3. Level of glucose control in diabetics

4. Stop smoking   - Try to get patient to stop smoking as there is decreased percutaneous oxygen in smokers compared to non smokers. Rate of infection of stump and reamputation 2.5 x higher than in nonsmokers.



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Accessory Bones
Adult Hallux Valgus
Amputations of the Foot & Ankle
Anatomy of the Foot & Ankle
Ankle Arthritis
Ankle Fractures
Ankle Instability
Ankle Sprains
Arthritis in Children
Arthrodeses of the Foot & Ankle
Arthroscopy of the Foot & Ankle
Bibliography
Biomechanics of the Foot & Ankle
BOFSS Syllabus for FRCS (Tr & Orth)
Bunionettes
Calcaneal Fractures
Compartment Syndrome
Diabetic Foot
Foot & Ankle Hyperbook
Foot & Heel Pain
Freiberg's disease
Hallux Rigidus
Hyperkeratotic Pathology of the Pla...
Lesser Toe Deformities
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Morton's Neuroma
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