From the Research
Bilateral mid tarsal foot amputation typically allows for good functional outcomes with proper rehabilitation and prosthetic fitting, as evidenced by a case report where a patient achieved marked improvement in quality of life with the use of custom dynamic orthoses and physical therapist intervention 1. After this procedure, patients retain their heel and ankle joints while the forefoot is removed, preserving important weight-bearing structures. Most patients can achieve independent ambulation using custom-made prostheses that fit inside regular shoes. Rehabilitation should begin early with:
- Wound care
- Pain management (often including gabapentin 300-900mg daily or pregabalin 75-300mg daily for neuropathic pain) 2, 3
- Gentle range of motion exercises for the ankle to prevent contractures Physical therapy focusing on balance, strength training, and gait training is essential and typically continues for 3-6 months. Patients should expect to gradually increase walking distances, starting with short intervals using assistive devices like walkers or crutches before progressing to independent walking. The preserved ankle joint allows for more natural gait mechanics and better balance compared to more proximal amputations. Weight-bearing can usually begin around 4-6 weeks post-surgery once wounds have adequately healed. Regular prosthetic adjustments will be necessary, especially during the first year as the residual limb changes shape. Long-term success depends on proper skin care of the residual limb, regular prosthetic maintenance, and ongoing physical activity to maintain strength and cardiovascular health. The use of custom dynamic orthoses, as seen in a recent case report 1, can also lead to improved gait biomechanics, mobility, and quality of life, making it a valuable consideration in the rehabilitation process.