Midfoot and Charcot amputations both involve the removal of the toes and half of the foot, leaving behind the heel and ankle joints. A midfoot amputation leaves slightly more of the foot, allowing the patient to turn the hindfoot (back of the foot) in and out and move it up and down. With a Charcot amputation, the patient loses the ability to move the hindfoot in and out.
The main goal of these procedures is to remove a portion of a limb that is causing problems not corrected with other methods. Amputations allow a faster return to regular activity.
By leaving as much of the foot as possible, these amputations allow for a smaller artificial limb. Sometimes the patient only needs a regular shoe with a space filler for the missing part of the foot. This may allow for more normal limb movement.
Patients who need amputations typically have foot infections that won't heal, pressure sores, or painful deformities that cannot be fixed. Amputations also are done to manage severely mangled foot injuries that cannot be repaired.
If there is no life-threatening illness, the decision to amputate is deeply personal and requires a lot of thought. You should always consult with your foot and ankle orthopaedic surgeon to discuss alternatives. Make a decision only after you have carefully considered all of your options.
Antibiotics are given just before the start of surgery. A tourniquet is used to minimize blood loss. Incisions are made with the goal of preserving as much of the skin and muscle as possible. This allows for easy wound closure and adequate padding of the remaining limb.
Through these incisions, structures are cut, and a portion of the foot is removed in one piece. The tourniquet is deflated. All major bleeding is stopped and the wound is closed with multiple layers of stitches. The limb is put in a protective splint.
Patients typically stay overnight in the hospital so they can be monitored for any excess bleeding or pain.
The protective splint remains on the leg until the incisions have healed adequately. The splint is then removed and the process of stump shrinking begins. This is a natural healing process in which the swelling and tenderness are reduced. In order to mold the stump and help the shrinking, the post-operative care team may use different types of compression bandages.
This also is when the patient begins working with a prosthetist. They will closely monitor the stump shrinking process. Once the stump swelling has decreased, a mold is taken of the stump so an artificial limb can be made. This whole process can take
8-10 weeks. Once complete, rehabilitation begins so the patient can regain walking and movement ability.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Specific problems that can occur with amputations include slow wound healing, infections, nerve pain, pressure points from the stump, and phantom limb pain. Patients with certain medical or lifestyle conditions, including diabetes, smoking, and steroid use, have a higher risk of problems after surgery.
Original article by Sourendra Raut, MD
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