More On Foot Amputations

Question 1

Lisfranc joints

Answer 1

Disarticulated at tarsal/metatarsal joint

Question 2

Chopart amputations

Answer 2

Disarticulation at

• talonavicular
• calcaneocuboid

Question 3

This amputation maintains heel pad

Answer 3

Syme’s

Question 4

Who is most likely to get a partial foot amputation?

Answer 4

usu result from vascular problems with elderly people

Question 5

Shoes used to protect remaining tissue (partial foot amputation)

Answer 5

BEST

• neuropathic walker boot
• AFO

ADEQUATE

• shoe insert with extra depth
• post-op shoe

Question 6

What happen if the forefoot rocker is lost?

Answer 6

• decreased velocity
• increased energy cost
• increased vertical forces

Question 7

What type of contracture do partial foot amputees often get? What does this result in?

Answer 7

• PF

- Results in plantar pressure and pain (esp at 1st and 5th met heads, navicular, malleoli, and tibial crest)

Question 8

What often accompanies a toe filler with partial amputations?

Answer 8

Extended heel shank

Question 9

Aside from custom orthotics and toe fillers, what else may be used to help restore anterior support and controlled fulcrum for forward motion?

Answer 9

• UCBL orthotics (controls foot motion better than shoe alone)
• cosmetic slippers

Question 10

Risks associated with digit/partial ray amputation

Answer 10

• excessive pronation

- increased pressure on remaining rays

Question 11

Risks associated with ray/multiple ray amputation

Answer 11

• multiple central ray amputations don’t function well due to increased pressure on borders
• get generally increased pressure to remaining surface area

Question 12

Risks associated with transmetatarsal amputation

Answer 12

• increased pressure
• not particularly successful
• should be limited to intact vasculature

Question 13

Risks associated with Lisfranc and Chopart amputations

Answer 13

• increased pressure
• equinus and varus deformities
• skin breakdown

Question 14

Why does the pt get an equinus and varus deformity?

Answer 14

• pull of PF

- loss of DF and peroneal muscles

Question 15

Prevalence of Chopart and Lisfranc amputations

Answer 15

Not typically done

Question 16

Risks associated with Symes amputation

Answer 16

• poor cosmetics (cankles)

- not much room to attach foot

Question 17

Risks associated with hip disarticulation and hemipelvectomy

Answer 17

• scoliosis
• need good abdominals with hip disarticulation
• slow ambulation (requires 200% more energy)

Question 18

Risks associated with hemipelvectomy (women)

Answer 18

Pregnancy issues

• socket is suspended from iliac crests
• torque absorbers can be good

Question 19

Hip disarticulations and hemipelvectomies are usually done for this

Answer 19

Cancers

Question 20

General prosthesis for great toe amputation

Answer 20

Foot plate

Question 21

Prosthesis for amputation of lesser toes

Answer 21

Shoe filler

Question 22

When would arch support be needed with toe amputation?

Answer 22

Partial ray

Question 23

Digit/partial ray: sole

Answer 23

May have a steel shank

Question 24

General prosthesis: ray/multiple ray

Answer 24

• shoe filler

- well fit shoe, maybe with steel shank

Question 25

General prosthesis: Lisfranc, Chopart amputations

Answer 25

- shoe fillers | - metal shank + rocker sole

Question 26

What must be done if the pt gets a rocker sole on the amputation side?

Answer 26

Other shoe needs a lift 2˚ to rocker side

Question 27

Foot position with Symes

Answer 27

- usu locked | - possibly in slight DF to improve rollover

Question 28

Type of foot used with Symes?

Answer 28

- SACH is fine | - there are dynamic response feet available

Question 29

Socket concern with Symes amputation

Answer 29

- variable approaches to socket (e.g. Windows) | - 2˚ to flared distal end around malleoli

Question 30

Hemipelvectomy and hip disarticulation: socket

Answer 30

Need flexible sitting socket to be level

Question 31

Hemipelvectomy and hip disarticulation: hip joint

Answer 31

- anterior set to bias toward hip extension | - free motion hip with external stop

Question 32

Why would the hip joint need to be biased to extension for a hemipelvectomy or hip disarticulation?

Answer 32

Stability

Question 33

Leg/knee prosthesis for hemipelvectomy and hip disarticulation (swing phase)

Answer 33

- shorter leg to assist swing | - need swing assist knee

Question 34

Hemipelvectomy and hip disarticulation: foot choice

Answer 34

Often use a SACH foot

Question 35

hemipelvectomy prognosis

Answer 35

Don't expect to get good gait pattern