• Over 130,000 amputations performed in 1997
  • 68% of amputees carry diagnosis of diabetes
  • Goals of amputation are to optimize function and minimize morbidity

Reasons to amputate:

  • Peripheral vascular disease associate with diabetes
  • Infection
  • Trauma
  • Frostbite
  • Burn
  • Tumor

Types of lower extremity amputations:

  • Toe
  • Ray – phalanges with all/part of metatarsal
    • 5th ray most common, useful
    • multiple ray amputations often narrow foot too severely
  • Midfoot amputation
    • Transmetatarsal
    • Lisfranc – through tarsometatarsal joints
  • Hindfoot amputation – Chopart
    • talus and calcaneus preserved
  • Syme
    • talus and calcaneus removed with preservation of heel fat-pad to cover distal tibia/fibula
    • fat-pad migration poses problem to future weight bearing
  • Transtibial (below-knee amputation, BKA)
    • most commonly performed major limb amputation
    • 90% of amputees will successfully use a prosthesis
  • Transfemoral (above-knee amputation, AKA)
    • approx. 90% of amputees will walk with a prosthesis
  • Knee Disarticulation

Transmetatarsal amputation on right foot and metatarsophalangeal toe amputation on left.

Chopart Amputation:
Talus and Calcaneus are retained.

Syme Amputation


  • Most distal level possible performed
  • Adequate soft-tissue required for closure without tension
  • Flap thickness and flap location
  • Distal muscle stabilization
  • Periosteum preservation (in adults)
  • Neuroma prevention by clean transection of major nerves
  • Early post-op ambulation with use of rigid dressings (casting)

Complications & Outcomes:

  • Wound failure – wound healing is often complicated by diabetes and vascular disease
  • More proximal amputations required in 5-10% of cases
  • Infection – predisposed by amputation of infected or traumatic limb
  • Phantom sensation
  • Almost universal among amputees
  • Telescoping = sensation that amputated limb is retracting toward stump
  • Phantom pain
  • Experienced by 60-70% amputees
  • Many treatments described, including psychological support.
  • Back Pain
  • As or more common than phantom limb pain

Transfemoral amputation: Gottschalk techique of anchoring of adductor magnus to lateral femur