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

Dr. Premkumar M

Orthopedics & Joint Replacement · Iswarya Hospital

A Lisfranc amputation removes the forefoot while preserving the heel and ankle, allowing patients to walk with a prosthesis. Here's what you need to know.

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.

Tags:

#Lisfranc amputation#forefoot amputation#diabetic foot#orthopedics#vascular surgery#prosthesis

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