Amputation; Artificial limbs; Orthopedics; Surgery, Military
1. _The amputations of Chopart and Lisfranc._--Chopart's amputation
has a grave defect: the anterior muscles have not sufficient leverage
to oppose this gastrocnemius and soleus, and the posterior tarsal
bones tilt forward so that the patient walks, not on the lower
surface of the os calcis and the plantar skin, but on the head of the
astragalus and of the os calcis and on a painful cicatrix. If certain
precautions are taken (careful preservation of the fibrous plantar
flap and suture to it of the anterior tendons) this defect is not
invariably present, and it is an exaggeration to say that Chopart's
amputation "has never given anything but disappointment." It should,
however, only be practised if the technique is well understood, and
even then it is rarely indicated, because it demands almost as much
plantar skin as Lisfranc's amputation.
Nevertheless I have seen some good Chopart stumps the result of
operations by myself or by other surgeons; they should be fitted like
the stumps resulting from Lisfranc's operation.
With regard to the latter, they can be easily and comfortably fitted,
provided that the scar is dorsal and is not stretched over prominent
bones.
If the first cuneiform is not well covered it can simply be removed,
no functional disability results. It is mainly upon the plantar
surface of the stump that pressure is borne, but pressure comes also
upon the anterior surface when the foot is tilted downwards.
[Illustration: FIG. 122.]
The fore part of the foot which constitutes the prosthetic apparatus
consists of a block of wood, which reaches forward as far as the
middle of the metatarsus and ends in a vertical plate in front of the
stump. This block of wood is carved to the shape of the stump and
lined with felt. It is attached to the leg by a leather gaiter which
laces in front.
Anteriorly it is prolonged into an artificial toe piece similar to
that already described for the artificial limb for amputation through
the thigh.
This appliance is not indispensable. It is sufficient to use a piece
of cork shaped to the anterior surface of the stump and filling up the
anterior part of the boot, its advantage, however, is that once the
patient is fitted with this appliance he can wear an ordinary boot.
2. _Partial Amputation of the Fore Part of the Foot._--These are--
Transverse amputation through the metatarsal bones.
Disarticulation of one or more toes with their metatarsal bones.
Disarticulation of one or more toes.
For any of these amputations all that is required is an ordinary boot,
fitted with a cork, which is shaped to fit the stump and which fills
up the space left by the amputation.
In order that the patient may walk well the scar should be dorsal and
should not be tense.
We consider that the difficulty of maintaining equilibrium after
removal of the head of the first metatarsal, or even of the whole of
this metatarsal bone, has been much exaggerated.
Public-domain text, read in full here on John Shaqi.
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