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FOOT AMPUTATIONS

Toe AmputationsAmputation is done through phalanx leaving its base.

Scar shuould be on the dorsum

Plantar flap should be longer

Marginal flap should be left for great and little toes.

Save the head of the first meta tarsal.AMPUTATION OF DISTAL PHALANX OF GREAT TOE

Long plantar flap is taken

Not injuring digital vessels

Amputation of the phalanx

Flap sutured on the dorsum

REMOVAL OF GREAT TOE

Base of the proximal phalanx is preserved

Long plantar flap is taken to cover the head of the first metatarsal bone.

Sesamoid bones are always preserved.

Incision: Half inch distal to metatarso phalangeal joint

Dorsal racquet incision.Incase of lateral four toes, amputation is performed through a short dorsal racquet-shaped incision.

Amputation through the metatarsals causes loss of push-off in the absence of a positive fulcrum in the ball of the foot which is chiefly responsible for impairment of gait.

No prosthesis is required other than a shoe filler.

Transmetatarsal AmputationsTransverse incision is made middle or proximal thirds of metatarsals.

Peroneal nerve branches are identified and traction is applied and transected.

Terminal branch of dorsalis pedis is preserved.

A bevelled cut is made in metatarsal heads by angling the saw at 30 degrees

A plantar flap is incised and myodesed to the metatarsals.

Custom shoe insert for transmetatarsal amputation

Lisfrancs Amputation- amputation at the level of tarsometatarsal joint.

Choparts Amputation- amputation at the level of calcaneocuboid and talonavicular joint

Pirogoffs Amputation- calcaneus is rotated forward to be fused to the tibia after vertical section through its middleMidfoot AmputationsDisarticulation through the tarsometatarsal joint .

Transverse incision is made middle or proximal third of metatarsals.

Terminal branch of dorsalis pedis artery is ligated.

Lisfrancs joint is disarticulated.

Metatarsal are removed.

LIS FRANCS AMPUTATIONSevere equinus defromity after lisfrancs amputation

Amputation of the foot by a mid tarsal disarticulation.

Subtalar fusion and elongation of tendo achilles

Chopart amputationChoparts amputation

Anterior part of calcaneum is cut across and raw bone is fixed to the raw undersurface of tibia.

Calcaneal tuberosity -weight bearing area.

Amputation of the foot at the ankle, part of the calcaneus being left in the stump.Pirogoff amputation

Ankle disarticulation,removal of malleoli and anchoring heel pad to the weight bearing area.

Two points 1.75 cm below lateral malleolus and 2.5 cm below medial malleolus are joined infront of the ankle and also vertically across the heel pad

Symes Amputation

Anterior incision deepened-talus and calcaneum are removed leaving all soft tissue in the flap.

Medial and lateral malleoli along with a thin slice of tibia removed.

Symes prosthesis

Disadvantages :Posterior migration of heel pad

Skin slough resulting from overly vigorous trimming of Dog ears.

Cosmesis- the stump is large and bulky (bulbous) because of the flair of the distal tibial metaphysis which is covered with heavy plantar skin. BOYDS AMPUTATIONTalus is excisedCalcaneum is advanced and attached to the raw undersurface of tibiaStable load bearing surface

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