Factors Associated With Successful Chopart Amputation in Patients With Diabetes

Abstract

Chopart amputations were first performed for treatment of a non-salvageable distal foot but became unfavorable because of the development of equinovarus contractures and ulcerations. The majority of below-knee amputations today occur in ambulatory patients with diabetes in which a Chopart amputation may be a viable option; however, the durability of the residual limb is questionable. The authors undertook a systematic review of electronic databases and other relevant sources to identify material relating to the factors associated with a successful Chopart amputation in ambulatory patients with diabetes. Studies were eligible for inclusion only if they consecutively enrolled ambulatory patients with diabetes who underwent a Chopart amputation, regardless of etiology, with or without any tendinous or osseous balancing performed and had a mean follow-up of ≥12 months duration. Four studies involving 74 patients/feet were identified that met the inclusion criteria with a weighted mean follow-up of 21.1 months. The efficacy of tendinous and/or osseous balancing could not be assessed because of the lack of comparable techniques. However, review of the included studies supports that a residual functional limb can be maintained for ≥12 months with the use of a properly fitting high-profile prosthetic device for lifelong ambulation.

Digital Fillet Flaps

“…Although this systematic review was performed by a single reviewer, the author has performed several systematic reviews with multiple reviewers and is well versed in the process of performing a systematic review. [12][13][14][15] All the included studies correlated with a low level of clinical evidence (level 4 and 5, therapeutic). No minimum postoperative follow-up time was set in the inclusion criteria in order to include as many studies as possible in the systematic review because of the paucity of the available literature.…”

Soft Tissue Balancing After Partial Foot Amputations

“…They also saw that most complications or breakdowns occurred with ill-fitting devices or with unprotected ambulation. 27 …”

“…Regardless of the procedure and tendon balancing, success of Chopart amputations often relies on postoperative accommodation and bracing. 27,28 A systematic review looked at the literature associated with success of Chopart amputations and concluded that despite the osseous or tendinous procedures performed, a functional limb can be achieved with appropriate high-profile prosthetics. They also saw that most complications or breakdowns occurred with ill-fitting devices or with unprotected ambulation.…”

“…27 It was originally not seen as a favorable amputation due to the frequent ulceration and breakdown distally. Over the past 100 years, many osseous and tendinous procedures have been attempted to prevent equinovarus and distal breakdown.…”

Distal amputations for the diabetic foot

“…Successful limb salvage, which was defined as a stump with functional ambulation, was seen in only 30 patients (67%) (14). A systematic review of the existing literature was conducted by Schade et al to identify any factors that may be associated with a successful Chopart amputation in diabetic foot problems (15). The efficacy of tendinous and/or osseous balancing could not be assessed due to lack of comparable techniques, highlighting the paucity of literature in this field (15).…”