Lisfranc Mid-Foot Amputation: When Is It Needed and What to Expect

Lisfranc mid-foot amputation — quick answers

What is a Lisfranc amputation?

A Lisfranc (mid-foot or transmetatarsal) amputation is the surgical removal of the forefoot at the tarsometatarsal joints, preserving the heel and ankle. It is a limb-salvage procedure that allows better walking with a prosthesis than a higher amputation.

When is a Lisfranc amputation needed?

It is considered for severe diabetic foot infection or gangrene limited to the forefoot, peripheral vascular disease with inadequate forefoot blood supply, non-salvageable crush or blast injuries, aggressive bone tumours of the metatarsals, and severe Charcot arthropathy with forefoot collapse and ulceration.

Can you walk after a Lisfranc amputation?

Yes. Because the heel fat pad and ankle are preserved, most patients return to walking within 3–6 months using a toe-filler prosthesis, custom shoe with filler or carbon-fibre forefoot prosthesis fitted by a certified prosthetist.

How long is recovery after a mid-foot amputation?

Hospital stay is 3–7 days, followed by 1–2 weeks non-weight bearing, gradual weight bearing in a cast boot from weeks 3–6, prosthetic fitting at weeks 6–12 and prosthetic training with physiotherapy over 3–6 months.

What are the complications of a Lisfranc amputation?

The main risks are wound breakdown (especially in diabetics, so good blood sugar control is essential), equinus deformity (prevented by tendon balancing and splinting), skin breakdown from an ill-fitting prosthesis and usually mild phantom pain.

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A Lisfranc amputation (also called transmetatarsal amputation or mid-foot amputation) is the surgical removal of the forefoot at the tarsometatarsal (Lisfranc) joints — the bones at the base of the five metatarsals. It is a limb-salvage procedure that preserves the heel and ankle, enabling better function with a prosthesis compared to higher amputations.

When Is a Lisfranc Amputation Required?

This level of amputation is considered when:

• Diabetic foot complications — severe infection or gangrene affecting the forefoot but not the hindfoot
• Peripheral vascular disease — inadequate blood supply to the forefoot
• Severe trauma — crush injury or blast injury to the forefoot with non-salvageable tissue
• Tumour — malignant or aggressive bone tumour of the metatarsals
• Severe Charcot arthropathy — with forefoot collapse and ulceration

The Procedure

• Performed under general or spinal anaesthesia
• Surgeon disarticulates through the tarsometatarsal joints
• Viable skin flaps (usually from the plantar surface) are used to close the wound
• Tendon rebalancing is done to prevent equinus deformity
• Duration: 1–2 hours
• Hospital stay: 3–7 days

Advantages Over Higher Amputation

• Preserves the heel fat pad (essential for walking)
• Better prosthetic fitting compared to below-knee amputation
• Shorter rehabilitation period
• Better long-term ambulation outcomes

Recovery and Rehabilitation

• Week 1–2: Non-weight bearing; wound care and elevation
• Week 3–6: Gradual weight bearing with specialised footwear/cast boot
• Week 6–12: Transition to prosthetic foot device or custom orthopaedic footwear
• 3–6 months: Prosthetic training with physiotherapy; return to walking

Prosthetic Options

A toe-filler prosthesis, custom shoe with filler, or carbon-fibre forefoot prosthesis is fitted by a certified prosthetist to enable comfortable walking.

Possible Complications

• Wound breakdown (especially in diabetics — good blood sugar control is essential)
• Equinus deformity (prevented by proper tendon balancing and splinting)
• Skin breakdown from ill-fitting prosthesis
• Phantom pain (usually mild and manageable)

Iswarya Hospital's Orthopaedics and Vascular Surgery teams work together to provide multidisciplinary care for complex foot conditions including Lisfranc amputation and rehabilitation.