More On Foot Amputations Flashcards
Lisfranc joints
Disarticulated at tarsal/metatarsal joint
Chopart amputations
Disarticulation at
- talonavicular
- calcaneocuboid
This amputation maintains heel pad
Syme’s
Who is most likely to get a partial foot amputation?
usu result from vascular problems with elderly people
Shoes used to protect remaining tissue (partial foot amputation)
BEST
- neuropathic walker boot
- AFO
ADEQUATE
- shoe insert with extra depth
- post-op shoe
What happen if the forefoot rocker is lost?
- decreased velocity
- increased energy cost
- increased vertical forces
What type of contracture do partial foot amputees often get? What does this result in?
- PF
- Results in plantar pressure and pain (esp at 1st and 5th met heads, navicular, malleoli, and tibial crest)
What often accompanies a toe filler with partial amputations?
Extended heel shank
Aside from custom orthotics and toe fillers, what else may be used to help restore anterior support and controlled fulcrum for forward motion?
- UCBL orthotics (controls foot motion better than shoe alone)
- cosmetic slippers
Risks associated with digit/partial ray amputation
- excessive pronation
- increased pressure on remaining rays
Risks associated with ray/multiple ray amputation
- multiple central ray amputations don’t function well due to increased pressure on borders
- get generally increased pressure to remaining surface area
Risks associated with transmetatarsal amputation
- increased pressure
- not particularly successful
- should be limited to intact vasculature
Risks associated with Lisfranc and Chopart amputations
- increased pressure
- equinus and varus deformities
- skin breakdown
Why does the pt get an equinus and varus deformity?
- pull of PF
- loss of DF and peroneal muscles
Prevalence of Chopart and Lisfranc amputations
Not typically done
Risks associated with Symes amputation
- poor cosmetics (cankles)
- not much room to attach foot
Risks associated with hip disarticulation and hemipelvectomy
- scoliosis
- need good abdominals with hip disarticulation
- slow ambulation (requires 200% more energy)
Risks associated with hemipelvectomy (women)
Pregnancy issues
- socket is suspended from iliac crests
- torque absorbers can be good
Hip disarticulations and hemipelvectomies are usually done for this
Cancers
General prosthesis for great toe amputation
Foot plate
Prosthesis for amputation of lesser toes
Shoe filler
When would arch support be needed with toe amputation?
Partial ray
Digit/partial ray: sole
May have a steel shank
General prosthesis: ray/multiple ray
- shoe filler
- well fit shoe, maybe with steel shank
General prosthesis: Lisfranc, Chopart amputations
- shoe fillers
- metal shank + rocker sole
What must be done if the pt gets a rocker sole on the amputation side?
Other shoe needs a lift 2˚ to rocker side
Foot position with Symes
- usu locked
- possibly in slight DF to improve rollover
Type of foot used with Symes?
- SACH is fine
- there are dynamic response feet available
Socket concern with Symes amputation
- variable approaches to socket (e.g. Windows)
- 2˚ to flared distal end around malleoli
Hemipelvectomy and hip disarticulation: socket
Need flexible sitting socket to be level
Hemipelvectomy and hip disarticulation: hip joint
- anterior set to bias toward hip extension
- free motion hip with external stop
Why would the hip joint need to be biased to extension for a hemipelvectomy or hip disarticulation?
Stability
Leg/knee prosthesis for hemipelvectomy and hip disarticulation (swing phase)
- shorter leg to assist swing
- need swing assist knee
Hemipelvectomy and hip disarticulation: foot choice
Often use a SACH foot
hemipelvectomy prognosis
Don’t expect to get good gait pattern
