Indications
- Diabetic foot infection and gangrene
- Peripheral vascular disease
- Trauma
- Tumours and congenital deformity
Classification
Levels
- Toe and ray amputation
- Transmetatarsal amputation
- Lisfranc tarsometatarsal disarticulation
- Chopart midtarsal disarticulation
- Syme ankle disarticulation
Management
General principles
- Assess perfusion with ABI, toe pressures and transcutaneous oxygen
- Optimise glucose control and nutrition
- Preserve length while removing all nonviable tissue
- Plantar skin is preferred for weightbearing flaps
- Staged open amputation for infection, closing later
Toe and ray
- Great toe amputation affects push off
- Second toe amputation allows hallux valgus to progress
- Single lesser ray resection preserves a functional foot
Transmetatarsal
- Long plantar flap
- Bevel metatarsals plantarly to avoid pressure points
- Achilles lengthening reduces equinus and ulceration
Lisfranc
- Preserve or reattach tibialis anterior and peroneus brevis to balance the foot
Chopart
- Tendency to equinus and varus
- Achilles tenotomy or lengthening
- Transfer tibialis anterior to the talar neck
Complications
- Wound breakdown
- Equinus and varus deformity
- Recurrent ulceration
- Need for revision to a higher level
- Phantom limb pain
Prognosis
- More distal levels need less energy to walk
- Syme preserves end bearing through the heel pad
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.