CHAPTER VI
PARTIAL AMPUTATIONS OF THE FOOT
This name should be applied to amputations in which the mobility of the ankle joint is retained, i.e. Chopart's amputation (midtarsal disarticulation), Lisfranc's amputation (tarso metatarsal disarticulation), amputation of several toes with their metatarsal bones, or amputation of all five toes.
1. The amputations of Chopart and Lisfranc.—Chopart's amputation has a grave defect: the anterior muscles have not sufficient leverage to oppose this gastrocnemius and soleus, and the posterior tarsal bones tilt forward so that the patient walks, not on the lower surface of the os calcis and the plantar skin, but on the head of the astragalus and of the os calcis and on a painful cicatrix. If certain precautions are taken (careful preservation of the fibrous plantar flap and suture to it of the anterior tendons) this defect is not invariably present, and it is an exaggeration to say that Chopart's amputation "has never given anything but disappointment." It should, however, only be practised if the technique is well understood, and even then it is rarely indicated, because it demands almost as much plantar skin as Lisfranc's amputation.
Nevertheless I have seen some good Chopart stumps the result of operations by myself or by other surgeons; they should be fitted like the stumps resulting from Lisfranc's operation.
With regard to the latter, they can be easily and comfortably fitted, provided that the scar is dorsal and is not stretched over prominent bones.
If the first cuneiform is not well covered it can simply be removed, no functional disability results. It is mainly upon the plantar surface of the stump that pressure is borne, but pressure comes also upon the anterior surface when the foot is tilted downwards.
