title: Ankle dorsiflexion arthrodesis to salvage Chopart's amputation with anterior skin insufficiency.
abstract: BACKGROUND
  In Chopart-level amputations the heel often deviates into equinus and varus when, due to the lack of healthy anterior soft tissue, rebalancing tendon transfers to the talar head are not possible. Consequently, anterior and lateral wound dehiscence and ulceration may occur requiring higher-level amputation to achieve wound closure, with considerable loss of function for the patients.
  
  
  METHODS
  Twenty-four consecutive patients (15 diabetes, 6 trauma, and 3 tumor) had Chopart's amputation and simultaneous or delayed additional ankle dorsiflexion arthrodesis to allow for tension-free wound closure or soft tissue reconstruction, or to treat secondary recurrent ulcerations. Percutaneous Achilles tendon lengthening and subtalar arthrodesis were added as needed. Wound healing problems, time to fusion and full weight-bearing in the prosthesis, complications in the prosthesis, and the ambulatory status were assessed. Satisfaction and function were evaluated by the AmpuPro score and the validated Prosthesis Evaluation Questionnaire scale.
  
  
  RESULTS
  Five patients had successful soft tissue healing and fusions but died of their underlying disease 2 to 46 months after the operation. Two diabetic patients required a transtibial amputation. The other 17 patients were followed for 27 months (range, 13-63). The average age of the 4 women and 13 men was 53.9 years (range, 16-87). Postoperative complications included minor wound healing problems in 8 patients, wound breakdown requiring revision in 4, phantom pain in 3, residual equinus in 1, and adjacent scar carcinoma in 1 patient. The time to full weight-bearing in the prosthesis ranged from 6 to 24 weeks (mean 10). The mean AmpuPro score was 107 points (of 120), and the mean Prosthesis Evaluation Questionnaire scale was 147 points (of 200). No complications occurred with the prosthesis. Twelve patients lost 1 to 2 mobility classes (mean 0.9). The arthrodeses all healed within 2.5 months (range, 1.5 to 5 months).
  
  
  CONCLUSIONS
  Adding an ankle arthrodesis to a Chopart's amputation either immediately or in a delayed fashion to treat anterior soft tissue complications was a successful salvage in most patients at this amputation level. It enabled the patients to preserve the advantages of a full-length limb with terminal weight-bearing.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Inselspital, Berne, Switzerland.
authors.forename: Fabian G
authors.initials: FG
authors.lastname: Krause
authors.forename: Gilles
authors.initials: G
authors.lastname: Pfander
authors.forename: Julia
authors.initials: J
authors.lastname: Henning
authors.forename: Maziar
authors.initials: M
authors.lastname: Shafighi
authors.forename: Martin
authors.initials: M
authors.lastname: Weber
mesh_terms: D000125:Achilles Tendon / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000672:Amputation Stumps / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D001859:Bone Neoplasms / Q000601:surgery; D017719:Diabetic Foot / Q000601:surgery; D005260:Female; D018409:Foot Injuries / Q000601:surgery; D005545:Forefoot, Human / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016879:Salvage Therapy; D012883:Skin Ulcer / Q000209:etiology / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery; D014945:Wound Healing; D055815:Young Adult
keywords: Chopart’s amputation; ankle arthrodesis; diabetes; trauma; tumor