Chopart Amputation - Types, Advantages, Indications, Procedure, and Complications

Introduction

Francis Chopart was the first to report disarticulation through the midtarsal joint; the forefoot and midfoot are amputated, while the talus and calcaneus are preserved. Chopart amputations should not be performed for ischemia as they are a very unstable amputation with a strong tendency to go into the equinus (a condition where the ankle joint's ability to bend upward is restricted) and must typically be fitted with a prosthesis that extends up to the patellar tendon (the ligament connecting the kneecap and shin bone) level. The use of AFO derivatives or boot-style prostheses is an alternative if the ankle joint is in a neutral position and there is good ankle motion.

What Are the Types of Chopart Amputation?

The different types of Chopart amputation are:

• Four-Toe Amputation: The four-foot toes are amputated using this method.

• Lisfranc Amputation Surgery: The entire midfoot region, including the tarsal and metatarsal bones, is removed using Lisfranc amputation surgery.

• The Syme Amputation: It involves removing the entire lower leg below the knee, together with all of its bones, muscles, and nerves.

• Boyd Amputation: This technique does not involve cutting any bones or nerves in that region and is used to amputate the entire lower leg below the knee.

What Are the Advantages of Chopart Amputation?

The benefits of a Chopart amputation are:

• Low Postoperative Morbidity: Chopart amputation causes little tissue damage, and patients need fewer postoperative therapies, including dressing changes and physical therapy.

• Faster Recovery: Chopart amputations recover quickly, especially on the sides of the foot where the surgical cut was made. In comparison to longer surgical procedures, Chopart amputations also minimize the healing time and allow patients to be mobilized more rapidly.

• Improved Aesthetics: Since the surgery does not involve removing any skin from the heel, there are no unattractive scars or deformities left behind. Additionally, gait function and balance are greatly improved compared to longer surgical treatments because no muscles are destroyed during this type of surgery, making it ideal for active lives.

• Improved Prognosis: Chopart amputations have a better long-term prognosis than other types of amputations because of increased blood flow from arterial circulation in the residual limb after surgery (compared to below-knee amputations), which can have an effect on pressure ulcers over time due to improved limbal circulation, even though it requires more maintenance because of its short length.

What Are the Indications of Chopart Amputation?

The following are some circumstances where Chopart amputation may be indicated:

• When a foot or ankle joint has suffered a serious injury or infection and cannot mend or function normally, a Chopart amputation is performed.

• It is done to stop the surrounding tissue from suffering more harm, to lessen pain, and to increase movement.

• When various therapies have failed to address severe malformations like clubfoot, Chopart amputation can be helpful in certain situations.

• It may be carried out in some circumstances to lower the risk of infection or enhance the appearance of a limb.

What Is the Procedure for Chopart Amputation?

• The entire process takes two to three hours to complete and is performed under general anesthesia in an operating room.

• The midfoot's soft tissues and bones are first divided by the surgeon through a skin incision.

• The midfoot bones (metatarsals) are then removed, leaving a part of each metatarsal and the toe bones (phalanges) in place for future prosthesis attachment.

• The remaining structures required for the function and stability of the residual limb are then reattached, and the wound is stitched or stapled shut.

• The residual limb is then equipped with a temporary prosthetic device for movement while healing takes place, and a cast or splint is applied to preserve it during the healing process.

1. Before the Procedure: The following steps are undertaken by the healthcare workers before initiating the surgery:

• With the patient's consent, establish informed consent and properly record it.

• As per local protocol, ensure that the required preoperative antibiotic prophylaxis is administered.

• Get the right antibiotics, flushes, and dressings for post-procedure use and keep them in the patient's room or a common area.

• Complete a thorough blood workup, including hepatitis B/C antigen testing, to evaluate preoperative risks.

• If general anesthesia or sedation is required to manage discomfort during the procedure, do so.

• Install an IV catheter with the necessary access for intraoperative drugs.

• Set up the operating room (OR) with the supplies, equipment, and drapes needed to complete the procedure.

• Whenever there is a risk of bleeding, apply pressure to the artery before beginning the procedure.

2. During the Procedure:

• Start the patient off with local anesthesia and an intravenous sedative.

• To reveal the foot's bones, tendons, and ligaments, the surgeon will make an incision on the foot between the toes and the ankle.

• By inserting a saw, surgeons can cut away the foot's bones below the ankle joint and get rid of any damaged tissue, including muscles or tendons, that is impeding the healing process.

• Any arteries, veins, or capillaries (blood vessels) that may be leaking blood throughout the procedure will be clamped.

• Any exposed blood vessels and nerves will be tied carefully to minimize bleeding or infection after surgery.

• Any extra fluids that may have accumulated around the amputation site may be drained if necessary.

• The doctor will apply sterile bandages to the wound and antibiotic or antiseptic ointments.

• Throughout the procedure, the healthcare provider will keep an eye on the patient's vitals (such as heart rate, breathing rate, etc.) to make sure there are no issues.

3. After the Procedure: The following steps should be followed after the surgery:

• Dress the amputated site in sterile gauze.

• Use a bandage, tape, or other suitable material to tightly but not overly tighten the dressing's closure.

• Following surgery, routinely check the patient's vital signs and pain medication.

• Watch for any complications, such as an infection or blood clotting, by keeping an eye on the edema (swelling) in the amputation area.

• If necessary, apply pressure to the wound and, as directed by a medical practitioner, use compresses with sterile pads to halt the bleeding.

• Offer the patient emotional and psychological support both before and after surgery, especially when discussing rehabilitation objectives and other treatments that may be necessary after surgery, such as prosthesis fitting, in physical therapy sessions.

• Regular doctor visits should be part of follow-up care to adjust compression, and dressings, talk about any problems, finish wound care, and assess recovery through physical activities that were planned before surgery, like walking or climbing stairs with crutches or a cane.

What Are the Complications of Chopart Amputation?

Risks associated with this technique include:

• Infection: The danger of infection at the surgical site or elsewhere in the body exists with all types of surgery.

• Excessive Bleeding: If a surgery results in excessive blood loss, organ damage or anemia may result.

• Damage to Nerve and Veins: During surgery, it is quite easy to cause damage to the midfoot's sensitive nerves and veins, which can result in nerve discomfort, numbness, tingling, and even impaired circulation.

• Poor Circulation in the Foot: Without enough circulation, it may be difficult for the foot to recover from surgery fast and efficiently, which raises the possibility of further issues such as bone infection or skin necrosis (tissue death).

• Joint Instability: Because the foot's bones are being removed during surgery, there is a chance that the foot's remaining joints could become unstable as a result of the absence of support from neighboring bones. If this instability is not appropriately controlled by supportive footwear or custom orthotics, it may later result in more pain and disability.

Conclusion

In circumstances where a limb needs to be amputated, the Chopart amputation is a significant surgical technique. Chopart amputation is often very successful and is an efficient approach to give patients who need an amputation pain relief and enhanced function. However, there are potential dangers and consequences related to this procedure.