Lisfranc Amputation Foot: Meaning, History, Technique, Rehabilitation, Physical Therapy & vs TMA Comparison (Left Foot)

Content:

• What is Lisfranc Amputation Foot?
• Meaning
• History
• Technique
• Rehabilitation
• Physical Therapy
• Lisfranc vs TMA Comparison (Left Foot)

What is Lisfranc Amputation Foot?

Lisfranc amputation is a surgical procedure in which the forefoot is removed at the level of the tarsometatarsal (TMT) joints. This means the metatarsal bones are separated from the midfoot bones (cuneiforms and cuboid), preserving the hindfoot and much of the midfoot structure. The procedure is usually performed in cases of severe infection, trauma, diabetic foot complications, gangrene, or non-healing ulcers affecting the forefoot.

The goal of a Lisfranc amputation is to remove diseased or non-viable tissue while maintaining as much foot function as possible. Because part of the foot arch and ankle mechanics are preserved, patients often retain better stability compared to more proximal amputations. However, muscle imbalance and equinus deformity can develop if not properly managed during recovery and rehabilitation.

Meaning

The term “Lisfranc” refers to the Lisfranc joint complex, which connects the forefoot (metatarsals) to the midfoot bones. In a Lisfranc amputation, the surgical cut is made through this joint line. The procedure removes the front portion of the foot but preserves the talus and calcaneus, which are essential for weight-bearing and walking.

Clinically, this amputation is categorized as a partial foot amputation. It is more distal (further toward the toes) than a Chopart amputation and more proximal (closer to the ankle) than a transmetatarsal amputation in certain contexts. The meaning of Lisfranc amputation emphasizes its anatomical location and its function-preserving approach.

History

The Lisfranc joint is named after Jacques Lisfranc de St. Martin, a French surgeon who described injuries to this area in the early 19th century. Historically, amputations at this level were performed in soldiers who sustained severe forefoot injuries during war. At that time, rapid surgical intervention was often necessary to prevent infection and death.

Over time, surgical techniques improved, and Lisfranc amputation became a limb-salvage procedure commonly used in diabetic patients and trauma cases. Modern surgical methods focus on flap design, muscle balancing, and wound care to improve long-term function and reduce complications such as ulcer recurrence.

Technique

The surgical technique for Lisfranc amputation involves disarticulation at the tarsometatarsal joints. Surgeons carefully design plantar and dorsal skin flaps to ensure adequate soft tissue coverage. Preservation of as much viable tissue as possible is essential for proper healing and weight-bearing.

During the procedure, tendons may be balanced or lengthened to prevent postoperative deformities such as equinus (downward pointing of the foot). The wound is then closed with attention to tension-free suturing. Proper technique minimizes complications like wound breakdown, infection, and long-term instability.

Rehabilitation

Rehabilitation after Lisfranc amputation focuses on wound healing, prevention of contractures, and gradual return to weight-bearing. Initially, patients are kept non-weight-bearing until healing is confirmed. Custom orthotics or specialized footwear may be prescribed to redistribute pressure and protect the residual foot.

Long-term rehabilitation aims to restore mobility and prevent complications such as skin breakdown or ulcer formation. Many patients can walk independently with supportive shoes or inserts. Early and consistent rehabilitation greatly improves functional outcomes and quality of life.

Physical Therapy

Physical therapy plays a crucial role in recovery after Lisfranc amputation. Therapy focuses on strengthening the ankle, improving balance, and maintaining flexibility. Stretching exercises are particularly important to prevent equinus contracture, which can occur due to muscle imbalance.

Gait training is another key component. Patients learn how to walk safely with altered foot mechanics, often using custom orthotics or prosthetic fillers. Physical therapy not only improves mobility but also reduces the risk of falls and secondary musculoskeletal problems.

Lisfranc vs TMA Comparison (Left Foot)

When comparing Lisfranc amputation with Transmetatarsal Amputation (TMA), the main difference lies in the level of bone removal. In TMA, the metatarsal bones are cut across their shafts, preserving more forefoot length. In Lisfranc amputation, the disarticulation occurs at the tarsometatarsal joint, removing the entire metatarsals.

For the left foot or either side, functional outcomes depend on healing and rehabilitation. TMA may offer slightly better push-off during walking due to preserved metatarsal bases. However, Lisfranc amputation may be necessary when infection or damage extends proximally to the TMT joints. Both procedures aim to preserve limb function, but choice depends on the extent of disease, vascular supply, and tissue viability.