How To Achieve Improved Results With The Chopart Amputation

Author(s): 
By Gordon Zernich, CP, Tomas Dowell, CPO/LPO, Gary M. Rothenberg, DPM, FACFAS, and Michael M. Cohen, DPM, FACFAS

What Advantages Does The Chopart Amputation Offer?

The Chopart disarticulation was first described by Francois Chopart (1743-1795), a French surgeon. Although the procedure was initially successful, it fell into disrepute because of the equinovarus deformity that developed as a result of unopposed action of the soleus-gastrocnemius muscles and the Achilles tendon on the calcaneus and the anterior tibial tendon medially.    More recently, some have advocated the Chopart disarticulation with appropriate tendon balancing over that of more distal levels such as the Lisfranc or short transmetatarsal. The rationale is that surgeons may obviate the potential equinovarus deformity via the surgical removal of the cuboid bone during the procedure.1 Accordingly, one may entertain this level as a more definitive level of choice over questionable healing or success in comparison to a more distal level. Surgical interventions have included transferring the anterior tibial tendon to the talus, and ankle and subtalar fusion using an intramedullary nail. This method affords rigid control to the rearfoot to prohibit posterior calcaneal extension.2    Other surgeons have attempted to limit the risk of plantarflexion contractures and skin breakdown by contouring the anterior talus and calcaneus bones, resecting several tendons to the neck of the talus and sustentaculum tali bones, closing the wound with an anterior placement of the plantar flap, and performing lengthening of the Achilles tendon.3 These are just a few examples of how bone fusions, tendon transfers and tenotomies have progressed over the decades to preserve and balance all or part of a complex foot structure consisting of 28 bones (about 13 percent of the bones in the body), 33 joints, more than 100 muscles, ligaments and tendons, and a network of nerves, blood vessels, skin and soft tissue.    While each patient and circumstance for amputation is unique, the Chopart level amputation also has its advantages over more proximal levels. It has been well documented that cardiac demand is increased in the patient with any level lower extremity amputation. In fact, this is often directly related to increased morbidity and mortality after amputation. Accordingly, we recognize that the more distal level amputation may ultimately increase longevity. Additionally, as with any level foot or leg amputation, the psychological aspect of preserving as much foot as possible cannot be understated. The surgeon will generally know within a few weeks post-op if the surgical wound will heal successfully. However, the long-term success will clearly be dependent upon the postoperative prosthetic department fitting and patient compliance with the device.

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