Modified Chopart’s Amputation; Is It an Alternative to Below Knee Amputation?

Abstract

Aims: To evaluate short term results of both modified Chopart’s amputation & below knee amputation in the management of unsalvageable forefoot in diabetic patients. Settings and design: Prospective non-randomized study. Patients and methods: This study was conducted at the vascular surgery unit, Zagazig university hospital between December 2011 and December 2014. The patients were divided into two groups. The 1st group included 19 patients who underwent below knee amputation (BKA). The 2nd group included 15 patients who underwent modified Chopart’s amputation. Two cases in the first group were excluded because they were missed during follow-up period; the remaining 17 cases included 13 cases of infection and 4 cases of ischemia in the first group while there were 12 cases of infection and 3 cases of ischemia in the second group. The Arabic version of the RAND-36 Survey from the RAND Medical Outcomes Study was used at 12 months postoperatively. Results: In the 1st group who underwent BKA, 2 patients were excluded from the study because they were missed during follow-up, the remaining 17 patients completed the study; they were 10 males and 7 females with a mean age of 51.2 ±10.5 years. The 2nd group included 15 patients who underwent modified Chopart’s amputation; they were 9 males and 6 females with a mean age of 47.9 ±11.05 years. The demographic data were not statistically significant between the two groups. The mean follow up of the patients in both groups was for 17.3 ±1.9 months. Six month walking distance and rehabilitation time were significant between the two groups. The RAND 36 questionnaires in this study showed significant difference between the modified Chopart’s and BKA group in the physical function, emotional role limitation and social function, but the two groups were comparable in the other items. Conclusion: Modified Chopart’s amputation showed better physical function, emotional role limitation and social function according to the RAND 36 questionnaires in the management of unsalvageable forefoot in selected patients but it isn’t a replacement for higher amputations like BKA. Future long term follow up studies with larger sample sizes is needed to further evaluate this technique.