This document discusses amputation surgery and partial foot amputations. It describes the most common reasons for partial foot amputations as trauma, peripheral vascular disease, infection, and congenital deformities. It notes the advantages of partial foot amputations include a full end bearing stump, limited functional loss, and the ability to walk short distances without a prosthesis. The document outlines the levels of partial foot amputations and provides steps for fabricating a below knee prosthesis, including measuring, trimming, gluing, shaping, and fitting the prosthesis.

3. Amputation Surgery
 Indications
 The most common reasons for this level of amputation
are,
 Trauma (mines, motorbikes, burns etc)
 Peripheral vascular disease (limited gangrene)
 Infection (very localized)
 Congenital deformities (mostly with overgrowth to
reduce size)

4.  This level of amputation has some general advantages.
They are,
 A full end bearing stump
 Limited functional loss
 Lets the patient walk for short distances without a
prosthesis
 Proprioceptive properties of the sole of the foot are
kept intact in most cases
 Relatively easy for patient to balance especially on
uneven ground
 The usual psychological aspects of an amputation are
probably reduced because of the limited loss of
function and appearance

5.  General surgical problems of this amputation are,
 Poor wound healing, because of the limited blood
supply
 Distal skin cover must be from the plantar surface
and with no tension
 For the more distal levels there are often problems
with pain and contractures (e.g. varus equinus
deformities)
 Bony overgrowth may become sharp and cause
problems

6.  The levels of partial foot amputations are as listed below
and shown
1 -Toe amputation
 Distal phalanx (1)
 Disarticulation of Proximal Inter Phalangeal joint (hallux
only) ( 2)
 Disarticulation of toes (3)
2- Trans metatarsal amputation
 Distal metatarsals (4)
 Proximal metatarsals (5)
 Lisfranc amputation or Tarso metatarsal disarticulation (6)
 Chopart amputation or (Talonavicular / calcaneocuboid
disarticulation( 7)

8.  Casting;
 Modification/Rectification;
 Soft socket fabrication
 Moulding;
 Cutting
 1st fitting
 Hard socket fabrication
 Finishing;
 Final fitting

13.  Measurement of EVA
foam:
 1 Circumference 2 cm
above the head of the
fibula.
 2 Circumference
middle of the
calcaneus.
 3 Length of plaster
cast.

14.  Trim a 10 mm strip on both lateral sides of the
EVA foam to zero millimeters;
 Apply Neoprene contact glue twice on both
trimmed sides.
 Once the glue is dry, join the two surfaces to
form a cone.
 Dust the plaster positive and the inside of the
EVA cone with talcum powder to facilitate
sliding.

15.  Heat the EVA cone in an oven for about 5
minutes at 120°C and then pull it over the
plaster positive.
 To keep the EVA foam in the same shape as the
plaster positive, secure it with elastic bandages
or place it under vacuum until it has cooled
down.

18.  Apply two layers of Neoprene contact glue to
the trimmed section and to the 12 mm EVA
foam socket cap;
 Apply two layers of Neoprene contact glue to
the trimmed section and to the 12 mm EVA
foam socket cap

20.  Glue layers of 12 mm EVA foam corresponding
to the length of the sound foot measured before
casting;
 Pre-shape the forefoot with a knife
 Use the footprint taken before casting to
determine the correct foot rotation.
 Check the anterior/posterior and the
lateral/medial alignments against the
measurement card (e.g. heel height

29.  During fitting and gait training, fix the
proximal part of the prosthesis with tape.
 Modifications can still be made to the
alignment, especially to correct the eversion or
inversion of the foot, and to the heel height by
adding EVA foam on the sole.
 If the prosthesis is too long, compensate for the
difference in length either inside the shoe or on
the sole of the sound leg.