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Prosthetic Management of Different Types of Partial Foot Amputation

This document discusses different types of partial foot amputations and their prosthetic management. It describes 7 types of partial foot amputations ranging from toe amputations to Syme's amputation, which is an ankle disarticulation. For each amputation type, it discusses the bones and joints involved, potential complications, prosthetic goals in managing the condition, and examples of prosthetic solutions used. The document provides an overview of evaluating each partial foot amputation case and designing an appropriate prosthesis to address the patient's functional requirements and minimize complications.

Healthcare◦
Prosthetic Management of different types of Partial Foot Amputation Rohan Gupta MPO 1stYear, 3rd Batch PDUNIPPD
Introduction • The foot consists of 26 bones: 14 phalangeal, 5 metatarsal, and 7 tarsal. • Toes are used to balance and propel the body. • Metatarsal Bones gives elasticity to the foot in weight bearing. • Tarsal Bones located between the bones of the lower leg and the metatarsals are extremely important for support and locomotion.
• The human foot is a strong and complex mechanical structure with function. • Due to their position and function, feet are exposed to a variety of potential infections and injuries, including athlete's foot, bunions, ingrown toenails, Morton's neuroma, plantar fasciitis, plantar warts and stress fractures. In addition, there are several genetic disorders that can affect the shape and function of the feet, including a club foot or flat feet.
Bones
Joints of Foot
Partial Foot Amputation 1. Toes Amputation 2. Ray Amputation 3. Transmetatarsal Amputation 4. Tarsometatarsal Disarticulation (Lisfranc Amputation) 5. Midtarsal Disarticulation (Chopart Amputation) 6. Pirogoff Amputation 7. BoydAmputation 8. Syme’s Amputation
Toe Amputation • A toe amputation is surgery to remove one or more toes
Ray Amputation • Ray amputations are the removal of an entire finger along with the corresponding metatarsal bones in the foot.
TransmetatarsalAmputation
Lisfranc Amputation • Amputation at the tarso-metatarsal junction
Chopart Amputation • Amputation is a midtarsal, talo-navicular, calcaneo-cuboid amputation. Only talus and calcaneus bones remain .
Pirogoff Amputation • It is a vertical calcaneal amputation (in this amputation, the lower articular surfaces of the tibia/fibula are sawn through).
Boyd Amputation • It is a horizontal calcaneal amputation (all tarsals removed except calcaneus/talus).
Syme’s Amputation • Syme’s amputation is an ankle disarticulation.
Causes of Amputation Infection Peripheral Neuropathy PVD Gangrene Trauma Congenital abnormality Frosbite
Prosthetic Management
Toe Amputation- Functional Requirement PROSTHETIC GOAL • To prevent Hyperextension of Metatarsophalangeal joint. • Comfortable shoe fitment Management • Cosmetic siliconeToes
Ray Amputation – Complications Lateral Ray Amputation • Hallux valgus deformity • Bunion Deformity 1ST & 5th Ray Amputation • ML Instability • Pressure problem in push off phase
Functional Requirement Prosthetic goal • To Redistribute the pressure • To Avoid problem of shoe fitting • To prevent deformity • For cosmetic Restoration Management • Cosmetic silicone Rays • Custom made insole with filler • Shoe with filler
TransmetatarsalAmputation • Barefoot walking after transmetatarsal amputation is impaired because of loss of the weight-bearing metatarsal heads. • Elimination of forefoot pronation and supination during gait. • A rigid rocker bottom (RRB) shoe may help reduce distal pressure and shear from a flexible-soled shoe wrapping around the end of the residual foot.
Prosthetic Goal • To provide maximum Flexibility to simulate pronation & Supination. • To prevent shoe hyper extension during push off. • Cosmetic Restoration. Management • Shoe with filler. • AFO with filler. • SCM Foot • Insole with filler. • Modified SMO.
Lisfranc Amputation • This procedure, first described by Lisfranc in 1815. • Removal of metatarsal bone from the tarsometatarsal joint. • A portion of the fifth metatarsal base is also retained to preserve the insertion of the peroneus brevis tendon.To help maintain a balanced residual foot, in addition to the peroneus brevis, the insertions of the peroneus longus and anterior tibial tendons are preserved.
Chopart Amputation • This disarticulation occurs through the talo navicular and calcaneo cuboid joints.
Complications- Chopart • Ulceration or skin breakdown. • Equinus contracture
Prosthetic Goal - Chopart • Prevent deformity. • Provide ant. Support. • To prevent DF motion during Loading. • Cosmetic Restoration.
Management - Chopart • AFO with Filler. • Modified SMO.
Chopart Plates Endolite • Selected by category according to the weight and impact of the user, this 100% carbon keel is designed to be a flexible and durable solution for the longest amputation levels and partial foot prostheses. Includes a 10mm heel height for compatibility. Ottobock • Available heel heights are 0” (0 mm), 3/8” (10 mm) and ¾” (20 mm) • Available in sizes 22 – 30 cm
Syme’s Amputation • Syme’s amputation is an ankle disarticulation (The removal of the foot through the joint) with removal of the malleoli (The two rounded protrusions on either side of the ankle) then forward rotation of the heel pad over the end of the residual tibia.
Complications – Syme’s Amputation • Height Adjustment. • End Bulbous Stump. • Donning Doffing Problem. • Lack of cosmesis.
Prosthetic Goals- Syme’s • Provision for Donning • Distribution & absorption of stress • Rotational Stability • Relief for the scar • Proper suspension • Absorption of shock • Cosmetic restoration
Socket – Syme’s CANADIAN (POSTERIOR OPENING) SOCKET DESIGN VAPC (MEDIAL OPENING) SOCKET DESIGN
BIVALVE DESIGN SLEEVE SUSPENSION DESIGN
Foot – Syme’sLP Symes IC20 pro by Ottobock Genesis II Low prof foot ankle
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