Thursday, May 25, 2023
Forefoot Surgery SURGERY

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transmetatarsal amputation 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. 

A transmetatarsal amputation surgery is performed on people who have non-healing foot ulcers that result in bone infections in the forefoot. 

A transmetatarsal amputation surgery can also be performed to treat gangrene of the forefoot. Occasionally, severe crush injuries with extensive fractures may require a transmetatarsal amputation. 

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

surgeon performing surgery

Transmetatarsal Amputation Surgical Procedure- What to Expect

A transmetatarsal amputation surgery will be performed under general anesthesia. You will be sleeping during the entire procedure. 

Many people who undergo transmetatarsal amputation are already admitted to the hospital for medical management of their infection. However, if your infection is under control, a transmetatarsal amputation can be done in the outpatient setting. This means that you can go home the same day after your surgery. 

Your doctor will make an incision on the top middle portion of your foot. The incision will be extended to the bottom of the foot to ensure that a thick flap of healthy tissue is maintained to close the amputation site. The toes and part of the metatarsal bones will be removed. Surrounding tendons and ligaments are also removed. 

The incision will then be closed using sutures (thread). Your doctor may insert a drain in the foot. This helps to drain out excess fluid in the amputation site and thus prevents blood clot formation. 

A posterior splint or cast will be applied to the leg. 

Transmetatarsal Amputation Surgery- Recovery

After the surgery, you will need to keep your leg elevated on two pillows to help reduce swelling and pain. Your doctor will prescribe pain medication to help keep your pain under control. You can ice the foot intermittently to help reduce pain. 

If you have a drain in place, the fluid in the drain bulb will be removed daily. The drain may remain in place for up to a month before your doctor removes it. Removing the drain is a painless process and can be done in the office. 

You will need to stay off of your foot for 4-6 weeks after the surgery. You can use crutches or a knee scooter to help you stay off of your foot. You can buy a knee scooter from Amazon. 

You will need to keep your foot dressing clean and dry until you see your doctor. You can use a cast protector to help you keep the dressing dry while in the shower. 

Assuming your incision has healed in 6-8 weeks, your doctor will allow you to slowly start bearing weight on your foot. 

Physical therapy will be needed after a transmetatarsal amputation. Physical therapy will help you get used to walking again and will also help improve balance. Your doctor will suggest you get physical therapy 3 times a week for 1-2 months after surgery. 

When you transition to wearing shoes, you will need to wear a custom shoe with a filler in it. Your doctor can provide a script for this and you will need to get fitted for the shoe at a medical equipment facility. 

The transmetatarsal filler allows for increased comfort and reduces shock in the foot when walking by redistributing pressure more evenly across the foot. The filler material also helps provide balance and stability when walking. 

Transmetatarsal Surgery Complications

  • 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?

If you had surgery on your right foot, you can start driving once your foot wound has healed and you can walk comfortably. This can take 8 weeks. You should avoid driving while wearing a cast boot. Avoid driving if you are still taking narcotics. If you had surgery done on your left foot, you can start driving 2-3 weeks after the surgery if your doctor approves it. 


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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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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