Fig. 696
1, disarticulation at the tarsometatarsal joint, showing length of flaps; 2, disarticulation of the big toe in continuity. (Mignon.)
This operation sometimes leaves the foot in a bad equinus position; accordingly it is wise to make tenotomy of the tendo Achillis, as well as to attach the dorsal or extensor tendons to the stump end. (See [Figs. 699] and [700].)
Amputations of the Foot (Tibiotarsal).
—The former favorite method of amputating the foot proper was that of Syme, illustrated in [Fig. 701]. This preserved the plantar surface and tip of the heel, thus forming a cutaneous hood, which was made to cover the lower ends of the tibia and fibula, whose malleoli were usually removed close to their terminations. The incision is made directly down to the bone, from the apex of one malleolus across the sole and up to the other. Then the foot is forced into extreme flexion and another incision carried directly across the dorsum, by which the upper ends of the first are joined. This permits opening the ankle-joint in front, after which the lateral ligaments are divided and the astragalus dislocated forward. The heel hood is next carefully separated from the calcis with the knife, and it and all the parts retracted from the ends of the leg bones, which are divided just above the articular surfaces, or the latter may be left and the malleoli alone removed. Now the heel hood is raised, made to cover the end of the leg, and united to the anterior incision, drainage being made by a small opening on the outer side of the tendo Achillis, as the plantar surface of the flap should not be opened ([Fig. 703]).
Fig. 697
Lisfranc’s tarsometatarsal disarticulation. (Farabeuf.)
Fig. 698