How To Achieve Improved Results With The Chopart Amputation
Keys To Addressing Post-Op Complications
The difficulties with the longevity of a fully successful, rather than acceptable, outcome of the surgical procedure itself include the progressive development of equinovarus. We have seen that development despite the lengthening of the Achilles and routing the anterior tibial tendon through the talar neck. In an effort to counterbalance the varus pull of the transferred anterior tibial tendon, the podiatry department of the Miami Veterans Affairs Medical Center (VAMC) instructs its providers to transfer the peroneal tendons to the lateral wall of the calcaneus instead of just “letting them fly.” When the patient presents at the amputee clinic, the talus and calcaneus remain after the Chopart amputation. The talus receives lateral and medial support from the fibula and tibia bones of the lower leg respectively, and allows dorsiflexion and plantarflexion movement as an ideal outcome. The subtalar joint joins the talus with the calcaneus permitting, ideally, medial and lateral movement of the lower leg over the heel and inversion and eversion moments of the residual foot. In short, the remaining hindfoot affords the amputee multiaxial movement and moments when it is fitted and aligned with a prosthetic, orthotic or hybrid “prosthosis” best suited to the need. That multiaxial movement is what separates the more sophisticated and costly prosthetic feet from those that are more suitable for lower activity level, below or above the knee amputees.