From the Research
Mid tarsal amputation, also known as Chopart amputation, is a surgical procedure that involves removing the forefoot at the junction between the tarsal and metatarsal bones while preserving the hindfoot, and is typically recommended for patients with severe forefoot infections, gangrene, trauma, or vascular insufficiency that cannot be managed with more conservative treatments, as it preserves the calcaneus and talus, allowing for some weight-bearing function, and has been shown to have better outcomes when primary closure is achieved, with a significantly greater overall healing rate and lower risk of complications, as demonstrated in a recent study 1.
Indications and Contraindications
The procedure is indicated for patients with severe forefoot infections, gangrene, trauma, or vascular insufficiency that cannot be managed with more conservative treatments. However, it is essential to carefully select patients and consider factors such as neuropathy and positive bone margin, which have been shown to affect healing outcomes, as demonstrated in a study published in 2021 2.
Surgical Technique
The surgical technique involves removing the forefoot at the junction between the tarsal and metatarsal bones, while preserving the hindfoot. A long plantar flap is used to cover the bones, and the wound is closed primarily, if possible, to achieve better healing outcomes, as demonstrated in a study published in 2022 1.
Post-Operative Care
Post-operatively, patients require wound care with daily dressing changes using sterile technique and antibiotic ointment, as well as pain management with a multimodal approach, including acetaminophen, NSAIDs, and short-term opioids, as needed. Physical therapy should begin within 1-2 weeks post-surgery, focusing initially on transfers and mobility with assistive devices, progressing to gait training with appropriate prosthetics.
Complications and Monitoring
Patients should be monitored for complications, including wound dehiscence, infection, phantom limb pain, and equinovarus deformity due to muscle imbalance between the preserved posterior calf muscles and the severed anterior compartment muscles. Regular follow-up appointments and rehabilitation sessions are crucial to prevent and manage these complications, as demonstrated in a study published in 1999 3.
Conclusion is not allowed, so the response will continue with more details about the topic.
The preservation of ankle function and a longer residual limb compared to more proximal amputations potentially allows better mobility and prosthetic fitting. However, the risk of complications, such as wound dehiscence and infection, must be carefully managed through proper wound care and antibiotic therapy, as demonstrated in a study published in 2011 4.
Some key points to consider when performing a mid tarsal amputation include:
- The importance of careful patient selection and surgical technique to achieve better healing outcomes, as demonstrated in a study published in 2022 1.
- The need for meticulous post-operative care, including wound care and pain management, to prevent complications, as demonstrated in a study published in 2021 2.
- The importance of regular follow-up appointments and rehabilitation sessions to prevent and manage complications, as demonstrated in a study published in 1999 3.
- The potential benefits of preserving ankle function and a longer residual limb, including better mobility and prosthetic fitting, as demonstrated in a study published in 2011 4.
Overall, mid tarsal amputation is a surgical procedure that can be effective in managing severe forefoot infections, gangrene, trauma, or vascular insufficiency, but requires careful patient selection, meticulous surgical technique, and thorough post-operative care to achieve optimal outcomes, as demonstrated in several studies 4, 2, 1, 3.