Abstract
Objective: Assess patient performance and quality of the stump after amputation at the Chopart (midtarsal) joint, with double-bundle transfer of the tibialis anterior muscle tendon to the talar neck. Methods: This study evaluated the medical records of 5 patients who underwent Chopart amputation with double-bundle transfer of the tibialis anterior tendon to the talar neck, assessing pre and postoperative performance and gait. Results: The patients were operated on between January 2008 and December 2018, and the data obtained from the survey allow us to conclude that, after the proposed procedure, all patients reported an improvement in walking, besides noting a significant reduction in the degree of stump equinus. Conclusion: The surgical technique described in this article produced a significant improvement in patient performance as assessed by the AOFAS hindfoot score, and prevented the formation of ulcers in the anterior region of the stump. Level of Evidence IV; Therapeutic Study; Case Series.
Highlights
Nowadays, due to the exponential increase in auto accidents and greater survival of diabetic patients, amputations of the foot due to high-energy trauma and complications of diabetes mellitus are increasingly present in the lives of orthopedists
We performed a review of the medical records of patients operated on between July 1, 2008 and December 31, 2018 and selected 5 patients, all male, with a mean age of 52 years, ranging from 34 to 73 years, who underwent Chopart amputation with double-bundle transfer of the tibialis anterior tendon to the neck of the talus
All patients had ulcers in the anterior region of the amputation stump prior to the procedure, while none of them experienced a further episode of ulceration after the procedure
Summary
Due to the exponential increase in auto accidents and greater survival of diabetic patients, amputations of the foot due to high-energy trauma and complications of diabetes mellitus are increasingly present in the lives of orthopedists. Partial foot amputations aim at maintaining the greatest possible length of the lower limb, facilitating and reducing energy expenditure in gait[1]. In these amputations, the most proximal level that manages to preserve the height of the lower limb is amputation at the midtarsal (Chopart) joint complex (talonavicular and calcaneocuboid joints)(2,3). The most proximal level that manages to preserve the height of the lower limb is amputation at the midtarsal (Chopart) joint complex (talonavicular and calcaneocuboid joints)(2,3) For many years, this surgical technique did not have many advocates due to the equinus deformity that forms after this procedure. Stretching and/or tenotomy of the calcaneal tendon, combined with transfer of the tibialis anterior tendon to the neck of the talus, are recommended to minimize this complication[1,3,5,6,7,8]
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