Chopart Amputation: Purpose, Procedure, Benefits and Side Effects

A Chopart amputation is a type of partial foot amputation which removes the heel and forefoot but preserves the midfoot.

• Four-Toe Amputation: This procedure is used to remove the four toes of the foot.
• Lisfranc Amputation: This procedure is used to remove the entire midfoot region including the metatarsals and tarsal bones.
• Syme Amputation: This procedure is used to remove the entire lower leg from below the knee, including all of the bones, muscles, and nerves in that area.
• Boyd Amputation: This procedure is used to remove the entire lower leg from below the knee, but does not include removal of any bones or nerves in that area.

• Low morbidity: Chopart amputation results in a low postoperative morbidity as there is minimal tissue damage and patients require fewer postoperative interventions, such as dressing changes and physical therapy.
• Faster healing time: Chopart amputations heal fast, particularly on each side of the foot where the surgical cut is made. Chopart amputations also shorten the recovery period and patients can be mobilised quickly compared to longer surgical procedures.
• Improved cosmesis: As the procedure does not require any skin removal from the heel, it does not leave behind unsightly scarring or deformity. Furthermore, since no muscles are removed during this type of surgery, gait performance and balance is improved significantly compared to longer surgical procedures–making it optimal for active lifestyles.
• Improved long-term prognosis: Even though it requires additional maintenance due to its short length, Chopart amputations remain viable for a longer duration than other types of amputations due to increased blood flow from arterial circulation in residual limb following surgery (compared to below knee amputations) which can have an impact on pressure ulcers over time because of improved limbal circulation

• Chopart amputation is done in cases of severe trauma or infection to a foot or ankle joint, where the foot or ankle joint is unable to heal and function properly.
• It is performed to prevent further damage to the surrounding tissue, reduce pain and improve mobility.
• It is also used in cases of severe deformities such as clubfoot, when other treatments have failed.
• In some cases, it may be done to reduce the risk of infection or to improve the appearance of a limb.

Possible risks of this procedure include:-

• Infection: As with any kind of surgery, there is a risk of infection at the surgical site or elsewhere in the body.
• Excessive Bleeding: If too much blood is lost during the operation, it can cause complications such as anaemia or organ damage.
• Injury to Nerve and Vessels: The delicate nerves and vessels in the midfoot can be easily damaged during surgery, leading to nerve pain, numbness, tingling and even impaired circulation.
• Poor Circulation in Foot: Without proper circulation, it can be difficult for the foot to heal properly and quickly after surgery, which increases the risk of further complications such as skin necrosis (tissue death) or bone infection.
• Joint Instability: Because bones are being removed from the foot during surgery, there is a risk that remaining joints in the foot may become unstable afterward due to lack of support from adjoining bones. This instability can lead to further pain and disability down the line if not properly managed by supportive footwear or custom orthotics.

• Make sure to discuss the procedure and any risks or complications with your doctor prior to the procedure.
• Ask questions about what to expect during the surgery and the recovery period.
• Arrange for transportation to and from the hospital for the procedure and recovery period, if needed.
• Follow any instructions given by your doctor regarding medications, diet, activity level, etc., before and after the procedure.
• Attend any pre-operative appointments scheduled by your doctor prior to the surgery.
• Be sure that you understand everything that will happen during your surgery as well as what will be required of you during your recovery period.
• Get emotional support from friends and family if necessary prior to and after the procedure, as it can be a difficult time both physically and emotionally.

• The entire procedure is done in an operating room with general anaesthesia and usually takes two to three hours to complete.
• The surgeon begins by making an incision into the skin, separating the soft tissues from the bones of the midfoot.
• The metatarsals (midfoot bones) are then cut off, leaving a portion of each metatarsal and phalanges (toe bones) in place to allow for prosthesis attachment later on.
• After that, the tendons are reattached, along with any other structures necessary for function and stability of the residual limb before closing up the wound with stitches or staples.
• The residual limb is then placed in a cast or splint to protect it during healing and fitted with a temporary prosthetic device for mobility while healing occurs.

• Establish informed consent with the patient and document appropriately.
• Make sure appropriate preoperative Antibiotic prophylaxis is given according to local protocol
• Obtain proper antibiotics, flushes and dressings needed for post-procedure use and store in patient's room or central area
• Complete a full blood workup to assess for preoperative risks including hepatitis B/C antigen testing
• Consider sedation or general anaesthesia if needed for pain control during the procedure
• Place an IV catheter with appropriate access for intraoperative medications
• Prepare the OR with necessary drapes, supplies, and instruments to perform procedure
• Apply pressure over the artery prior to starting procedure if there is concern of bleeding

• Begin by local anaesthesia and an intravenous sedative for the patient.
• Make an incision on the foot between the toes and ankle to expose the foot bones, tendons, and ligaments.
• Insert a saw to cut away the bones of the foot below the ankle joint and remove any damaged tissue, such as muscles or tendons, that are preventing proper healing.
• Clamp off blood vessels such as veins, arteries or capillaries that may be bleeding during the procedure
• Carefully tie off any exposed blood vessels and nerves to prevent postoperative bleeding or infection
• If necessary drain any additional fluids that may have built up around the amputation site
• Dress wound with sterile bandages and apply antibiotics or antiseptic ointments
• Monitor patient’s vitals (such as heart rate, breathing rate etc.) throughout procedure in order to ensure there are no complications

• Place a sterile gauze dressing over the amputated area.
• Secure the dressing with a bandage, tape, or other appropriate material and secure it firmly but not too tight.
• Monitor patient’s vital signs and pain medication regularly post-surgery.
• Monitor edema (swelling) in the amputation area to watch for any complications such as infection or clotting.
• Apply pressure to stop bleeding if necessary by applying compresses with sterile pads onto the wound as instructed by a medical professional.
• Offer emotional and psychological support to the patient before and after surgery, especially during physical therapy sessions when talking about rehabilitation goals and further treatments that might be required following surgery such as prosthetics fitting.
• Follow-up care should be provided with regular visits with a medical professional to adjust compression, dressings, discuss any issues, complete wound care and evaluate progress through physical activities planned out prior to surgery such as walking or climbing stairs with assistive devices (cane/crutches).

Generally, the cost for a Chopart Amputation in India ranges from around ₹40,000 (approximately $560 USD) to ₹90,000 (approximately $1,250 USD).

• A well-balanced diet is essential for healing and regaining strength after an amputation.
• Protein-rich foods such as lean meats, fish, eggs, poultry, beans, nuts and low-fat dairy products should be included in the diet to help the body repair damaged tissues and rebuild muscle tissue.
• Fruits, vegetables and whole grains are important sources of fibre, vitamins, minerals and antioxidants that help the body heal and recover.
• Soft foods such as yoghourt, oatmeal, mashed potatoes or cooked vegetables may be easier to eat during recovery.
• It is important to stay hydrated by drinking plenty of fluids such as water or nutrient-rich juices throughout the day to prevent dehydration and aid in healing.

Yes, the Chopart amputation procedure is considered to be a safe surgical procedure when performed by a skilled and experienced surgeon.

• Yes, Chopart amputations are generally considered to be painful.
• Because this type of amputation involves the removal of bones and joints, it can be very painful for the patient.
• Generally, anaesthetics are used to help control pain during the procedure, however pain can still remain after surgery and rehabilitation.
• Sometimes additional medications and treatments are necessary to help manage pain during recovery.

Recovery from a Chopart amputation typically takes anywhere from 6-12 weeks.

After the initial recovery period of 6-12 weeks, it is vital for amputation patients to continue exercising the residual limb in order to maintain strength and mobility.

It is also important for patients to practise skin care daily in order to prevent skin breakdown that would otherwise require additional medical attention.

• The side effects of a Chopart amputation can include pain, infection, stiffness, swelling in the wound area, nerve damage and contractures.
• In some cases, general health problems like heart failure and diabetes may complicate the recovery.
• Other potential problems may include irritation of the skin where the amputated part meets the body, a buildup of scar tissue that impedes healing and movement of the remaining limb or joint.

• Keep the wound clean and dry, and check it for signs of infection.
• Change bandages regularly to keep the wound clean.
• Take medications prescribed by your doctor to manage pain and other symptoms.
• Avoid strenuous activities until you have been cleared by your doctor.
• Wear a prosthetic limb or brace, as prescribed by your doctor, to help with mobility and balance.
• Participate in physical therapy to improve mobility and strength in the affected area.
• Practise good hygiene habits like washing hands regularly and avoiding contact with people who are sick or have open wounds to prevent infection.
• Eat a balanced diet that includes plenty of protein and vitamin C to aid healing in the area around the amputation site

Chopart amputation is an important surgical procedure that can be used in cases where a limb needs to be removed. While there are potential risks and complications associated with Chopart amputation, it is generally very successful and is an effective way to provide pain relief and improved function for patients who require an amputation.