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

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.