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Forefoot Surgery SURGERY

Transmetatarsal Amputation: What Is an Amputation of the Transmetatarsal Bones?

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In this article, you’ll learn about what you can expect when undergoing a transmetatarsal amputation, the recovery process, and the risks and benefits of the procedure. 

What Is a Transmetatarsal Amputation?

A transmetatarsal amputation (TMA) is a partial foot amputation. The term “trans” means “across”. Thus transmetatarsal amputation means amputation performed “across the metatarsals”. 

The metatarsal bones are the long bones that connect the midfoot to the toes. In this procedure, the five long metatarsal bones and the toes that connect to them are removed. 

surgeon performing surgery

Who Needs a Transmetatarsal Resection?

Individuals Who Have Diabetes

Diabetes can lead to complications like non-healing foot ulcers. These ulcers result from poor circulation and nerve damage in the feet. This can lead to bone infections in the foot.  

In these cases, to control the spread of infection and to preserve as much healthy tissue as possible, a transmetatarsal amputation becomes a necessary course of action. It’s important to monitor your blood sugar levels to prevent ulcers from forming.

Individuals With Foot Gangrene

Another group of individuals who may require a transmetatarsal amputation are those suffering from gangrene of the front portion of the foot. Gangrene is a condition marked by the death of an area of the body due to lack of blood supply.  

This can be caused by various underlying conditions like peripheral artery disease and infections. To prevent the spread of gangrene and tissue death, a transmetatarsal amputation would need to be performed. 

Individuals Who Have Sustained Foot Crush Injuries

Severe crush injuries that involve extensive fractures to the front portion of the foot may require a transmetatarsal amputation. 

When the damage is too severe to restore the normal function of the foot, or if there’s a high risk of serious infection due to the injury, amputation is the most practical option. 

What Should You Expect During the Surgery?

Transmetatarsal amputations are performed under general anesthesia. 

It’s quite common for individuals going through this amputation to already be hospitalized due to treatment of the foot infection. 

However, if the infection is well-managed, it’s possible to undergo a transmetatarsal amputation on an outpatient basis. This means that the patient can return home on the very day of the surgery.

The procedure starts with the surgeon making an incision on the dorsal, or top middle area of the foot. This incision is extended to the plantar ( bottom part of the foot) ensuring the preservation of a thick plantar flap of healthy tissue to adequately close the site of amputation. 

During this process, the toes and part of the metatarsal bones, along with any adjoining tendons and ligaments, are removed.

The surgeon then proceeds to close the incision with sutures (thread). 

There may be instances where a drain is inserted into the foot to aid in the discharge of fluid from the amputation site. This reduces the risk of blood clot formation.

A posterior splint or cast is then fitted to the leg, providing the necessary support and protection to the surgical site.

What Is the Recovery Process After the Amputation?

Following the surgical procedure, it’s necessary to elevate the leg on two pillows. This helps alleviate pain and swelling.  

To manage pain effectively, the surgeon will prescribe appropriate pain medication. Periodic icing of the foot is also beneficial in reducing pain. 

If a drain is in place, the fluid accumulation in the drain bulb will be emptied on a daily basis. The drain might be retained for a period extending up to a month prior to removal by the physician. Drain removal is a pain-free procedure and can be performed in the clinic.

For a span of 4-6 weeks post-surgery, the patient is advised to refrain from bearing weight on the operated foot.

Crutches or a knee scooter can be used to help the individual stay off the foot. Knee scooters can easily be purchased from Amazon.

Keeping the foot dressing clean and dry until the next doctor’s visit is important. A cast protector can be used to ensure the dressing stays dry during showers. 

After 6-8 weeks, if the incision is healed, individuals can gradually bear weight on their feet. 

The transition to wearing shoes will require a custom shoe fitted with a filler. The physician will provide a prescription for this, following which the patient will need to be fitted for the shoe at a specialized medical equipment facility.

The transmetatarsal filler offers increased comfort, reduces shock in the foot while walking by evenly redistributing pressure across the foot. The filler material also contributes to balance and stability during ambulation.

Physical therapy plays a significant role in the recovery process. It assists in readapting to walking and enhances balance. 

It’s common for physicians to recommend physical therapy sessions three times a week for 1 month.

What Are Complications of the Procedure?

  • Infection: Infection at the incision site or deep in the tissues can occur after a transmetatarsal amputation surgery. If you notice redness, pain, swelling, and warmth at the incision site, there may be an infection present. Your doctor will prescribe antibiotics. In some cases, stronger IV antibiotics may be needed. 
  • Flap failure: Flap failure occurs when the flap of skin, muscle, and nerves that are created during the surgery fails to heal correctly. This can lead to further complications such as wound breakdown and infection. The most common cause of flap failure is an inadequate blood supply to the flap.
  • Phantom pain: After the surgery, some patients may experience phantom pain, which is a sensation of pain coming from the missing limb or body part. This pain can be managed with pain medications and physical therapy. 
  • Bleeding: There is significant blood loss that occurs with a transmetatarsal amputation. However, some people may bleed more than others due to their vascular status. To control bleeding, your surgeon will use clotting agents to help control the bleeding. A drain will be inserted into the foot to prevent blood clot formation. If there is too much blood loss during the procedure, a blood transfusion may be needed. 
  • Transfer lesions: When you undergo an amputation, the pressure points in the foot change. If there is too much pressure in one spot, you may develop an ulcer. Transfer lesions are preventable and can be treated with offloading pads, orthotics, and shoes. Custom orthotics can help redistribute pressure away from high-pressure areas in the foot. 

When Can You Start Driving After a Transmetatarsal Amputation?

In the case of a TMA operation on the right foot, the patient can consider resuming driving once the surgical wound has adequately healed and comfortable walking is possible. 

This healing process spans around eight weeks. It’s strongly advised to avoid driving while wearing a cast boot and also when under the influence of narcotic medications.

If the TMA surgery was performed on the left foot, the patient may be able to start driving as early as 2-3 weeks post-surgery, assuming their doctor grants approval.

When Should You See a Health Care Provider for More Information About the Surgery?

If you are dealing with severe foot complications such as chronic infection, non-healing ulcers, gangrene, or poor circulation that hasn’t improved with other treatments, you should consult with your health care provider about a transmetatarsal amputation surgery. 

This is important to prevent a proximal amputation. A vascular surgery consult may also be needed at the time of amputation to ensure the surgery site heals.

Conclusion

Transmetatarsal amputation surgery is a necessary and effective surgery in treating foot infections that require amputation. With a combination of physical therapy, lifestyle modifications, and a supportive team of doctors, individuals can look forward to improved mobility and quality of life after undergoing this surgery. 

Related articles:

Can You Walk Without Toes: What Happens When You Lose A Toe

Toe amputation Surgery- What To Expect

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The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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