What Are Midfoot and Charcot Amputations?
An amputation is the surgical removal of a portion of a limb that cannot be saved due to severe disease or deformity. It is usually considered after other treatment options have failed.
Midfoot and Charcot amputations 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) side to side and move it up and down. With a Charcot amputation, the patient loses the ability to move the hindfoot side to side, but will still be able to move it up and down.
By preserving as much of the foot as possible, these amputations allow for a smaller artificial limb. Frequently the patient can wear a regular shoe with a space filler insert for the missing part of the foot.
Diagnosis
Patients who need midfoot amputations often have foot infections that won't heal, pressure sores, or painful deformities that cannot be fixed. Amputations also are performed 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.
Treatment
Antibiotics are given just before the start of surgery. A tourniquet is often used to help 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, several tendons, nerves, and vessels will be cut and the joints opened at the level of the amputation. Your surgeon will remove the diseased portion of the foot in one piece. The tourniquet is deflated. The wound is carefully closed with multiple layers of stitches, and the limb is put in a protective splint.
The procedure may be performed as outpatient surgery, but some patients may stay in the hospital overnight for monitoring.
Recovery
The protective splint remains on the leg for about 2-3 weeks, 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.
Risks and Complications
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.
What kinds of things can help healing after amputation surgery?
It is important to protect the limb and incision after surgery. If you are given a brace or cast to wear, you should wear this exactly as directed. It takes only one accidental bump to open
the incision. If this happens, it could delay healing by several weeks or even months. It may even require additional surgery.
If you are a smoker, you should stop. Smoking has been associated with
numerous complications, including wound healing problems,
bone healing problems, heart and lung disease, pain, and even arthritis. The risks of surgery are sometimes so high that some surgeons will hold off on performing an amputation until a patient has stopped smoking entirely. Proper nutrition and medical
management of chronic disease, particularly diabetes, also is helpful.
Original article by Sourendra Raut, MD
Contributors/Reviewers: Raymond Walls, MD
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