From the Research
Midfoot amputation in non-diabetic patients is a viable option for limb preservation, and the procedure should be performed by removing part of the foot through the midtarsal joints (Chopart amputation) or through the tarsometatarsal joints (Lisfranc amputation), as recommended by the most recent study 1.
Procedure and Post-Operative Management
The procedure involves removing part of the foot through the midtarsal joints (Chopart amputation) or through the tarsometatarsal joints (Lisfranc amputation). Post-operative management includes:
- Wound care with regular dressing changes using sterile technique and appropriate antimicrobial dressings if infection was present
- Pain management typically consists of multimodal analgesia including acetaminophen 1000mg every 6 hours, NSAIDs like ibuprofen 400-600mg every 6 hours if not contraindicated, and short-term opioids such as oxycodone 5-10mg every 4-6 hours as needed for breakthrough pain
- Physical therapy should begin as soon as medically appropriate, usually within 1-2 weeks post-surgery, focusing on maintaining joint mobility, strengthening, and eventually gait training with appropriate prosthetics
Complications and Rehabilitation
Patients should be monitored for complications including:
- Wound dehiscence
- Infection
- Phantom limb pain
- Equinus deformity (which is particularly common in midfoot amputations due to unopposed pull of the Achilles tendon) Psychological support is essential as patients adjust to altered body image and functional changes. Unlike diabetic amputations, non-diabetic patients may have better healing potential but still require comprehensive rehabilitation to achieve optimal functional outcomes, as noted in 2 and 1.
Key Considerations
- The level of amputation is determined by multiple factors including degree of tissue loss, vascular status, the ability to preserve function, surgeon experience, and pertinent patient factors 1
- Midfoot amputations are viable options for limb preservation in cases of forefoot infection, vascular disease, trauma, or malignancy to avoid major lower-extremity amputation 1
- Each level of midfoot amputation has limitations to consider, including wound healing problems, soft-tissue contracture, or need for revisional amputations, but some of these facets can be addressed perioperatively 1