From the Guidelines
Mid tarsal amputation is recommended for patients with severe forefoot infections, gangrene, trauma, or vascular insufficiency that cannot be managed with more conservative treatments or distal amputations, as it preserves as much foot length as possible while removing all non-viable tissue. This procedure is typically performed at the level of the tarsometatarsal joints (Lisfranc's joint) or through the navicular and cuboid bones (Chopart's joint) 1. The goal of mid tarsal amputation is to remove all infected or non-viable tissue, while preserving the ankle joint and heel, allowing for better mobility and function compared to more proximal amputations.
Indications for Mid Tarsal Amputation
- Severe forefoot infections that cannot be managed with antibiotics or more conservative treatments
- Gangrene or vascular insufficiency that cannot be managed with revascularization or more conservative treatments
- Trauma to the foot that results in significant tissue damage or loss
- Failed previous attempts at more conservative treatments, such as debridement or distal amputations
Post-Operative Care
- Pain management with medications such as acetaminophen (500-1000mg every 6 hours), NSAIDs like ibuprofen (400-600mg every 6-8 hours), or opioids like oxycodone (5-10mg every 4-6 hours) for severe pain in the first few days
- Wound care involves regular dressing changes, typically daily or every other day, using sterile technique
- Physical therapy should begin as soon as medically appropriate, usually within 1-2 weeks, focusing on strengthening, range of motion, and gait training
- Patients will need custom footwear or prosthetics to accommodate the altered foot biomechanics and prevent complications like equinus deformity
Potential Complications
- Wound healing problems
- Phantom limb pain
- Altered gait mechanics
- Infection or osteomyelitis of the remaining bone or tissue
According to the most recent guidelines, offloading devices should be used to promote healing of foot ulcers, and mid tarsal amputation should be considered for patients with severe forefoot infections or gangrene that cannot be managed with more conservative treatments 1. However, the decision to perform a mid tarsal amputation should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.
From the Research
Mid Tarsal Amputation Overview
- Mid tarsal amputation, also known as Chopart amputation, is a surgical procedure that involves removing a portion of the foot at the midtarsal joints 2.
- This type of amputation is typically performed to treat severe foot injuries, infections, or gangrene, and is often considered a last resort to save the limb 3, 4.
Surgical Techniques and Considerations
- The procedure involves removing the affected portion of the foot and reshaping the remaining tissue to create a functional residual limb 2, 4.
- The surgical technique and level of amputation are critical in determining the outcome and functional ability of the patient 3, 5.
- Revascularization, wound healing, and ambulatory status are important factors to consider when evaluating the effectiveness of mid tarsal amputation 5, 6.
Outcomes and Complications
- Mid tarsal amputation can result in significant complications, including wound infection, failure to heal, and the need for further amputation 3, 6.
- However, with proper patient selection, surgical technique, and post-operative care, satisfactory limb salvage and functional outcomes can be achieved 2, 5, 4.
- Studies have shown that mid tarsal amputation can be an effective way to salvage the limb and improve functional ability in patients with severe foot injuries or infections 3, 5.
Patient Factors and Healing
- Patient factors, such as diabetes, neuropathy, and peripheral arterial disease, can affect the healing process and outcome of mid tarsal amputation 3, 6.
- A clean margin bone specimen and the absence of neuropathy are important factors in determining the healing status of the amputation site 6.
- Revascularization and wound healing are critical in determining the success of mid tarsal amputation, and careful patient selection and management are essential to optimize outcomes 5, 6.