Amputation at various levels of foot.

1. DEFINITION
AMPUTATION-
SURGICAL ABLATION OF
BODY PART THROUGH ONE
OR TWO BONE.
DISARTICULATION-
SURGICAL ABLATION OF
BODY PART THROUGH JOINT.

2. INDICATION
OF
AMPUTATION
:
• PERIPHERAL VASCULAR
DISEASE
• TRAUMA
• BURNS
• FROSTBITE
• INFECTION
• TUMORS
• NEUROPATHY
• CONGENITAL LIMB
DEFICIENCY

3. SALVAGIBILITY OF A LIMB
VARIOUS SCORING SYSTEM-
• PREDICTIVE SALVAGE INDEX
• LIMB SALVAGE INDEX
• LIMB INJURY SCORE
• MANGLED EXTREMITY SEVERITY
SCORE

4. SCORE<6- SALVAGEABLE; SCORE>7- HIGHLY PREDICTIVE OF

5. PRE-OP CARE:
• NUTRITIONAL STATUS OF THE
PATIENT
• LIMB PERFUSION
• SERUM ALBUMIN OF ATLEST 3.5
G/DL
• TOTAL LYMPHOCYTE COUNT
>1500/ML
• HEMOGLOBIN >10 GM/DL
• DIABETES CONTROL
• PRE OPERATIVE COUNSELLING
• REHABILITATION ASSESSMENT

6. INTRA-OP
CARE:
• AVOID EXCESSIVE PRESSURE ON SKIN
EDGES.
• THICK SKIN FLAP.
• BONY PROMINENCES SHOULD BE
REMOVED.
• CONTROLLING HEMOSTASIS.
• CLOSURE SHOULD BE DONE
WITHOUT TENSION AT MARGIN.
• PRESERVE AS MUCH LENGTH IS
POSSIBLE.

7. POST-OP CARE:
• DRESSING LIKE HYDROCOLLOID,
HYDROGEL, ALGINATE ETC.
• BIOLOGICAL DRESSING LIKE
ALLOMATRIX AND GRAFTJACKET
REGENERATIVE TISSUE MATRIX.
• VACCUM ASSISTED CLOSURE IS ALSO
BENEFICIAL IN LARGER WOUND
• MEASURES TO PREVENT
CONTRACTURES
• TO MAXIMIZE FUNCTION AND MINIMIZE
COMPLICATION OF THE AMPUTED LIMB
PEDORTHIST, ORTHOTIST AND

8. GOALS OF
AMPUTATION:
• ABLATION OF DISEASE
TISSUE
• RECONSTRUCTION
• PROVIDE PHYSIOLOGICAL
END ORGAN
• OPTIMIZE PATIENT
FUNCTION AND REDUCE
MORBIDITY.

9. AMPUTATION OF FOOT:
 TOE AMPUTATION OR
DISARTICULATION
 METATARSAL PHALANGEAL
DISARTICULATION
 TRANSMETATARSAL
AMPUTATION
 LISFRANC AMPUTATION
 CHOPART AMPUTATION
 SYME AMPUTATION
 BOYD’S AMPUTATION

10. TOE AMPUTATION:
• AMPUTATION OF GRAET TOE:
 WHILE STANDING OR WALKING NORMALLY- FUNCTIONALLY
NO EFFECT.
 WHILE RUNNING- LIMP APPEARS.
• AMPUTATION OF 2ND TOE:
 CAUSES SEVERE HALLUX VALGUS. TO PREVENT SCREW
FIXATION IS USED.
• AMPUTATION OF ALL TOE:
 WHILE SLOW WALKING- LITTLE DISTURBANCE.
 WHILE RAPID GAIT- DISABLING.
 INTERFERES IN SQUATING AND TIPTOEING.
 NO PROSTHESIS IS REQUIRED OTHER THAN SHOE FILLER.

11. TERMINAL SYME
AMPUTATION:
• INDICATION: HALLUX TERMINAL
ULCERATION, CHRONIC INGROWN
NAILS WITH PARONYCHIA, HALLUX
TUFT OSTEOMYELITIS OR TRAUMATIC
INJURY TO TIP OF HALLUX.
• REMOVING DISTAL ASPECT OF DISTAL
PHALYNX OF HALLUX RETAINING
EXTENSOR HALLUCIS LONGUS AND
FLEXOR HALLUCIS LONGUS INSERTION.

12. AMPUTATION AT BASE
OF PROXIMAL PHALYNX

13. METATARSAL PHALANGEAL DISARTICULATION:
• LONG PLANTAR AND SHORT
DORSAL SKIN FLAP.
• FOR 1ST METATARSAL INCISION
STARTING MEDIALLY AND CURVE IT
DISTALLY OVER THE LATERAL AND
POSTERIOR ASPECT.
• FOR 5TH METATARSAL INCISION
STARTING LATERALLY AND CURVE
IT DISTALLY OVER MEDIAL AND
POSTERIOR ASPECT.

14. TRANSMETATARSAL
AMPUTATION:
• RAY AMPUTATION-
TOE AMPUTATION
WITH HEAD OF
METATARSAL.
• GILLIES’
AMPUTATION-
TRANSMETATARSAL
WITH PROXIMAL TO
NECK OF

15. PROSTHESIS FOR TOE AMPUTATION

16. MIDFOOT AMPUTATION
• AMPUTATION THROUGH
MIDFOOT INCLUDE
LISFRANC AMPUTATION AT
TARSOMETATARSAL JOINTS
AND CHOPART
AMPUTATION AT
TRANSVERSE TARSAL
JOINT.
• MIDFOOT AMPUTATION
LEAD TO SEVERE
EQUINOVARUS DEFORMITY.

17. LISFRANC AMPUTATION
• TARSOMETATARSAL
DISARTICULATION.
• LEAD TO SEVERE EQUINOVARUS
DEFORMITY. TO PREVENT
EQUINOVARUS DEFORMITY-
 PRESERVE INSERTION OF TIBIALIS
ANTERIOR AND PERONEUS LONGUS
AT MEDIAL CUNEIFORM AND
PERONEUS BREVIS AT THE BASE OF
5TH METATARSAL.
 BASE OF 2ND METATARSAL SHOULD

18. CHOPART
AMPUTATION:
• DISARTICULATION OF TALO-NAVICULAR
& CALCANEO-CUBOID JOINTS.
• TO PREVENT EQUINOVARUS DEFORMITY-
 ONE OR MORE DORSIFLEXORS MUST BE
TRANSFERRED.
 DECREASE STRENGTH OF ACHILLES
TENDON.
 POSITION THE STUMP IN SLIGHT
DORSIFLEXION AND RIGID DRESSING FOR 6
WEEKS.
 ALTERNATIVELY, ANKLE ARTHRODESIS
MAY BE DONE IMMEDIATELY.

19. CHOPART FRACTURE
• TRANSFER TIBIALIS ANTERIOR
TENDON TO LATERAL ASPECT OF
NECK OF TALUS, USING BONE
TUNNEL WITH BIOTENODESIS
SCREW AND USING A SUTURE
ANCHOR OR STAPLE TO SECURE
FIXATION.
• TRANSFER EXTENSOR HALLUCIS
LONGUS TO ANTERIOR PROCESS
OF CALCANEUS.

20. PROSTHESIS FOR CHOPART
AMPUTATION

21. HINDFOOT AND ANKLE AMPUTATION
• GOAL IS TO PRODUCE END
BEARING STUMP AND ENOUGH
SPACE BETWEEN END OF
STUMP AND GROUND FOR
CONSTRUCTION OF SOME
TYPE OF ANKLE JOINT
MECHANISM FOR ARTIFICIAL
FOOT.
• TYPES-
 SYME AMPUTATION
 BOYD AMPUTATION
 PIROGOFF AMPUTATION

22. SYME
AMPUTATION
• BONE TRANSECTION AT DISTAL TIBIA AND
FIBULA 0.6 CM PROXIMAL TO PERIPHERY OF
ANKLE JOINT AND PASSING THROUGH THE
DOME OF THE ANKLE CENTRALLY.
• THE TOUGH DURABLE SKIN OF HEEL FLAP
PROVIDES NORMAL WEIGHT BEARING SKIN.
• SARMIENTO MODIFIED SYME PROCEDURE BY
TRANSECTING TIBIA AND FIBULA 1.3 CM
PROXIMAL TO ANKLE JOINT AND EXCISION OF
MEDIAL AND LATERAL MALLEOLUS TO PRODUCE
LESS BULBOUS STUMP AND ALLOW USE OF MORE
COSMETIC PROSTHESIS.

23. SYME’S AMPUTATION
• CAN BE DONE IN-
1. ONE STAGE- ORIGINAL / CLASSIC SYME'S
AMPUTATION.
2. TWO STAGE- IN CASE OF GROSS
INFECTION OF FOREFOOT.
3. MODIFIED AMPUTATION- MODIFIED TO
GET A LESS BULBOUS AND MORE
COSMETIC STUMP BY REMOVING
METAPHYSEAL FLARE OF TIBIA AND
BEVELING DISTAL END OF FIBULA.

24. SYME’S AMPUTATION
SINGLE LONG POSTERIOR FLAP, BY BEGINING INCISION AT DISTAL TIP OF LATERAL
MALLEOLUS PASSING ACROSS ANTERIOR ASPECT OF ANKLE JOINT UPTO ONE FINGER
BREADTH INFERIOR TO MEDIAL MALLEOLUS, EXTENT IT DIRECTLY PLANTARWARD
ACROSS THE SOLE TO THE LATERAL ASPECT AND END IT AT STARTING POINT.
DIVIDE CAPSULE OF ANKLE JOINT. DIVIDE TENDO ACHILLES TENDON.
REMOVE THE ENTIRE FOOT. TRANSECT TIBIA AND FIBULA 0.6 CM PROXIMAL TO
THE JOINT LINE. HEEL PAD IS USED TO COVER THE STUMP.

25. SYME’S AMPUTATION

26. SYME’S AMPUTATION

27. SYME’S PROSTHESIS
• PROSTHESIS CONSIST OF MOLDED PLASTIC SOCKET WITH
REMOVABLE MEDIAL WINDOW TO ALLOW PASSAGE OF
BULBOUS END OF STUMP THROUGH ITS NARROW SHANK.

28. BOYD’S AMPUTAION
• TO PRODUCE EXCELLENT END BEARING STUMP AND
ELIMINATES THE PROBLEM OF POSTERIOR MIGRATION
OF THE HEEL PAD THAT OCCURS AFTER SYME
AMPUTATION.
• IT INVOLVES
 TALECTOMY,
 EXCISION OF ANTERIOR PART OF CALCANEUS, DISTAL TO
PERONEAL TUBERCLE.
 FORWARD SHIFT OF CALCANEUS AND CALCANEO-TIBIAL

29. PIRIGOFF AMPUTATION
• INVOLVES ARTHRODESIS
BETWEEN TIBIA AND PART
OF CALCANEUS.
• CALCANEUS IS SECTIONED
VERTICALLY, REMOVING
ANTERIOR PART AND
ROTATING POSTERIOR
PORTION WITH HEEL PAD
FORWARD AND UPWARD
90* TO MEET DENUDED
DISTAL END OF TIBIA.