Link-Witzel operation for diabetics

Abstract

The inner Chopart's amputation for tuberculosis of the tarsal as performed by Link and Witzel at the end of the nineteenth century laid the groundwork for a foot-saving surgical procedure in cases of neuropathic osteoarthropathy with concomitant infection. The question was posed whether such an inner amputation can represent an alternative to the classic hindfoot amputation. Six patients with neuropathic osteoarthropathy, five of whom had diabetes mellitus,who had been operated between 1989 and 2002 were analyzed retrospectively. In all of the cases, surgery had been indicated by chronic osteomyelitis of the tarsal with concomitant, extensive, mainly plantar ulcerations. During the average follow-up period of 55 weeks, no recurrence of an ulcer or infection occurred and therefore no further proximal amputation was necessary. In addition to being provided with orthotics, the remaining five patients could be fitted with made-to-measure orthopedic shoes. In selected cases, the inner Chopart's amputation can represent a solution even in such problematic cases that cannot be solved by a typical hindfoot amputation. The surgical procedure according to Link and Witzel should thus not only be considered as an alternative to Chopart's amputation, but also as a further method to spare diabetics major amputations.