- See:
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Syme's Amputation
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Diabetic Foot - Treatment Considerations
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Amputations in the Diabetic Patient
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Transmetatarsal Amputation
- Chopart Amputations:
- General Considerations:
- all viable plantar skin with normal or protective sensation should be preserved;
- intact longitudinal rays in a partial forefoot amputation should be preserved;
- ankle dorsiflexions should be preserved or transplanted, if necessary, to provide balanced motion at the ankle joint;
- stump end should be covered with plantar skin to prevent break down with wt bearing and toe off, or the end of the stump should by modified by
recognized plastic surgical techniques;
- skin grafting should be applied only to the non weight bearing border or dorsum of the foot;
- Ray Amputations:
- w/ ray amputations, the first metatarsal ray may be amputated, w/ only moderate loss of foot function;
- some argue that medial and lateral longitudinal forefoot amputations in diabetics are highly (80%) successful;
- others (Wagner) argue that only lateral longitudinal amputations are successful and that medial forefoot amputations should be abandoned due to a
higher rate of recurrent infection;
- if base of the fifth metatarsal is resected, peroneus brevis insertion should be reinserted into the cuboid;
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shoe orthotics
- steel shank to extend the foot lever and prevent deformity at the toe break
- rocker sole will help facilitate transition from foot flat to the toe-off phase of gait
-
Case Example: by
Jan Van Der Bauwhede MD
© 1993-1997
Jan Van Der Bauwhede MD
- Metatarsal Disarticulations:
- usually need a toe filler to keep the shoe from collapsing;
- since the arches are intact, wt bearing is sufficient but may be supplemented with an arch support;
- results in bony anterior section which can be difficult to fit
- arch often flattens out over time causingn further wt bearing problems;
- toe filler may be OK, but often molded arch support is added;
- extended steel shank may add protection during roll over;
- Prosthetic Considerations at Different Amputation Levels;
- Longitudinal Ray Amputations:
- usually lose balance and some wt bearing;
- in many cases no prosthesis is needed;
- molded arch support may help distribute wt bearing more evenly;
- Toe Amputations:
- usually need no prosthetic treatment;
- soft filler may be used but does little;
- loss of great toe eliminates push off, esp. at higher cadences;
The Modified Chopart's Amputation.
Resurrection of the amputations of Lisfranc and Chopart for diabetic gangrene.
Ankle-level amputation.
Amputations through the middle part of the foot.
Partial foot amputations in children. A comparison of the several types with the Syme amputation.
Partial amputation of the foot for diabetic or arteriosclerotic gangrene. Results and factors of prognostic value.
Amputations of the foot and ankle. Current status.
Prognostic value of systolic ankle and toe blood pressure levels in outcome of diabetic foot ulcer.
Amputations at the middle level of the foot. A retrospective and prospective review.
Amputation of the great toe. A clinical and biomechanical study.
The modified Chopart's amputation.
Congenital Chopart amputation. A functional assessment.
Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis. An amputation of the back of the foot.
Ray resection in the dysvascular foot. A retrospective review.
Minor forefoot amputation in patients with low ankle pressure.
Amputations through the middle part of the foot.
Results of minor foot amputations for ischemia of the lower extremity in ³ diabetics and nondiabetics.
Partial amputation of the foot for diabetic or arteriosclerotic gangrene. Results and factors of prognostic value.
Factors influencing the healing of distal amputations performed for lower limb ischaemia.
Ray resections in the insensitive or dysvascular foot: a critical review.
Sequelae of limited amputation.
Traumatic partial foot amputations in adults. A long-term review.
Traumatic partial foot amputation
Ankle-level amputation.
Survivorship of healed partial foot amputations in dysvascular patients.
The feasibility of hind foot amputation in selected sarcomas of the foot.
The Syme amputation: success in elderly diabetic patients with palpable ankle pulses.
Free composite groin flap and vascularized external oblique aponeurosis for traumatic avulsion injuries of the foot.
Resurrection of the amputations of Lisfranc and Chopart for diabetic gangrene.
Ankle-level amputation.
Amputations through the middle part of the foot.
Partial foot amputations in children. A comparison of the several types with the Syme amputation.
Partial amputation of the foot for diabetic or arteriosclerotic gangrene. Results and factors of prognostic value.
Amputations of the foot and ankle. Current status.
Transcutaneous Doppler ultrasound in the prediction of healing and the selection of surgical level for dysvascular lesions of the toes and forefoot.
Transcutaneous oxygen as a predictor of wound healing in amputations of the foot and ankle.
Transcutaneous Doppler ultrasound in the prediction of healing and the selection of surgical level for dysvascular lesions of the toes and forefoot.
Prognostic value of systolic ankle and toe blood pressure levels in outcome of diabetic foot ulcer.
Amputations at the middle level of the foot. A retrospective and prospective review.
Traumatic partial foot amputation.
Amputation of the great toe.
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