This was a patient referred to me by a surgeon who had treated him for a gas gangrene that was so bad that it required disarticulation of all five metatarsals, also known as a Lisfranc amputation. Unfortunately, the amputation stump has completely necrosed. Revising this would make his foot very very short, to a point where it is not much better than a below-the-knee amputation with a prosthesis. This patient has diabetes, works in a very labor intensive job, and it was important for him to have a foot, no matter how short.
I admitted him to the hospital for infection and ischemia workup. His circulation was evaluated with an arterial duplex and found to be normal. This means that the necrosis is likely due to the trauma of walking and/or infection. After removing all of the dead skin and soft tissue, his wound was too large to be closed with sutures unless I removed more bone. We decided to proceed with a Chopart amputation in order to close his wound and ensure eradication of any possible remaining bone infection.
After the stump has healed, I ordered an AFO to be made by a prosthetist. Looking at the videos below, you can see how little the foot moves with this amputation. It is a short foot, so he can’t use it to push off. He could walk with this foot in regular shoes, but needed to use a walker. However, with the AFO, he is able to walk without any walking aide and is able to perform all of his duties at work.