This document describes the Chopart amputation procedure, which removes the forefoot and midfoot while preserving the talus and calcaneus bones. It notes that this is an unstable amputation due to loss of tendon insertion points, often requiring a prosthesis extending to the patellar tendon level. The technique involves excising the Achilles tendon, creating skin flaps, disarticulating the transverse tarsal joints, and transferring the anterior tibial tendon for fixation. Post-op, the patient wears a splint and ankle-foot orthosis to prevent equinus deformity. Complications can include progressive equinovarus, which a modified procedure aims to address through additional steps like tendon transfers and flap

1. CHOPART AMPUTATION
DR.PONNILAVAN

2. Chopart Amputation
• Francis Chopart first described disarticulation thru midtarsal joint.
• Chopart amputation removes the forefoot and midfoot, saving talus
and calcaneus.
• Unstable amputation, noting that most of the tendons which act
around the ankle joint have lost their insertion into foot and the heel
remains unstable;

3. • has a pronounced tendency to go into equinus and must usually be
fitted with a prosthesis that extends upto the patellar tendon level
• if the ankle joint is in a neutral position and good ankle motion
is present, AFO derivatives or boot type prostheses may be required;

4. Chopart Amputation:Technique
To avoid contamination, begin by making a posteromedial incision and
then perform a tenotomy of the Achilles tendon.
Excise 2 cm of tendon, and attempt to preserve the sheath of the
Achilles tendon.
Handle the soft tissue with care.

5. Chopart Amputation
• Mark the skin incision preoperatively, creating a “fishmouth” flap on
the plantar surface.
• Begin the incision at the transtarsal joints medially and laterally.
• Extend the flaps in a dorsal and plantar direction, creating adequate
skin flaps for coverage

6. Chopart Amputation

7. Chopart Amputation
• Identify the anterior tibial and
extensor hallucis longus tendons
resect them distally, and prepare
them for transfer

8. Chopart Amputation
• Identify the transverse tarsal (calcaneocuboid and talonavicular)
joints, and disarticulate them by releasing the dorsal and plantar
ligaments

9. • Transfer the anterior tibial tendon to the lateral aspect of the neck of the
talus, using a bone tunnel with a biotenodesis screw or by creating a
trough in the talus and using a suture anchor or staple to secure fixation

10. • Close the wound by approximating the fascial
layers plantarly and dorsally and then the skin
in a tension-free manner. Place a drain as
needed after hemostasis has been obtained
and the wound copiously irrigated

11. Post op
• The dorsiflexion rigid dressing is changed
intermittently to check the wound. Sutures
are kept in place for 4 to 6 weeks to allow for
adequate healing. The splint must be worn for
6 to 8 weeks to prevent equinus contracture
of the hindfoot. The patient will need an
ankle-foot orthosis in a rocker-sole shoe (e.g.,
running shoe) for ambulation

12. complication
Progressive equinovarus deformity
- transfer of the anterior tibial tendon has an insufficient moment arm
to prevent this
- initial release of the tendo achilles may reduce this problem;
- with all amputations of the foot, there will be some loss of
normal arch of the foot

13. The modified Chopart's amputation
A modified Chopart's amputation has been designed to overcome the
complications of the traditional Chopart's amputation of plantar flexion
and skin breakdown over the anterior talus and calcaneus.

14. Modifications
• Contouring of the talus and calcaneus;
• Transfer of the anterior and posterior tibialis tendons and the
extensor communis and hallucis to the neck of the talus and
sustentaculum tali;
• Anterior advancement of the plantar flap; and
• Lengthening of the tendo Achillis.

15. SOURCE
• CAMPBELL
• ROCKWOOD

16. THANK YOU