How is decreased stability managed following transmetatarsal amputation (TMA)?

Updated: Apr 29, 2021
  • Author: Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth); Chief Editor: Erik D Schraga, MD  more...
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Answer

Rehabilitation must be addressed. TMA results in the loss of some of the area normally used for weightbearing. Consequently, load distribution on the foot becomes unbalanced, and the remaining foot tissues are subjected to a higher-than-normal mechanical load. The healing foot is therefore under increased pressure, which is detrimental to skin healing, as well as to the biomechanics of motion. It should also be noted that neuropathic patients have a decreased level of stability and an increased incidence of falls.

Mechanical problems after TMA are due to the decrease in plantarflexion; thus, the patient typically experiences this instability when mobilizing. Decreased plantarflexion reduces the overall "support movement," which is defined as the sum of hip, knee, and ankle extensor movements and represents the total limb pattern involved in pushing away from the ground. [5]

The solutions to these mechanical problems are as follows:

  • Regular sensory check for patients with diabetes, neuropathy, or both - Patients with reduced sensation need extensive education regarding care
  • Use of orthotic devices - Temporary postoperative devices include plaster of Paris (if the foot is not weightbearing), walking splints or boots, definitive footwear (after the surgical wound has healed), custom-made footwear (eg, steel implants in the soles of shoes), and shortened shoes

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