A transmetatarsal amputation is a surgical procedure to remove the forefoot in cases where the tissues in a patient's foot have been injured beyond repair. It is more extreme than a toe amputation, but preserves more of the foot than a full foot amputation, and can help the patient remain more mobile after the surgery. This procedure is recommended when it is clear that other treatment options for managing the tissue death and damage will not be effective.
In a transmetatarsal amputation, a surgeon cuts across the bones in the front of the foot, at an angle and location determined by the nature of the condition leading to the need for amputation. A skin flap is created and wrapped around the stump. The patient does not require a prosthesis, although one may be worn to fill the shoes for more comfort. Commonly, gait changes occur after an amputation because the patient lacks the ability to push off with the front of the foot, and patients may develop pain as a result of their altered gait, especially if they are not provided with physical therapy sessions to learn to walk more comfortably.
A very common reason to need this procedure is complications from diabetes. Patients with diabetes can develop poor circulation in the feet, leading to ulcerations and tissue death. In extreme cases, amputation may be the best treatment option. Other reasons can include severe trauma such as a crush injury to the forefoot, infection, and vascular disease. In all cases, the doctor will thoroughly evaluate the patient to determine the best approach to take for amputation.
After a transmetatarsal amputation, patients can experience varying pain levels. It is usually necessary to keep weight off the foot for comfort at first and there is a risk of developing neurological problems like pain signals that make the patient feel like the missing part of the foot is still there. Some patients develop unusual complications like severe neurological pain caused by growth at the nerve ends, and this may lead to the need for a second surgery.
Patients may experience emotional distress after a transmetatarsal amputation. This can be especially common in diabetic patients, who may feel like they failed to care for their feet properly and thus that they are at fault for the amputation. Amputation can illustrate the consequences of poor diabetes management and may lead to depression, making it important to provide patients with tools for taking charge of their diabetes care to prevent future complications and help them adjust emotionally to the amputation.