Midtarsal Disarticulation

Disarticulation of the forefoot from the midfoot, through the talonavicular and calcaneocuboid joints, was performed by Chopart before 1792, preserving the talus in the ankle mortise and the calcaneum24 (Fig. 11.1). Originally performed with a long plantar flap, other approaches attempted equal dorsal and plantar flaps championed by Chelius, the medioplantar flap by Sedillot and the dorsal flap by Baudens.25 These operations are modified by preserving the navicular and/or cuboid, often by mistake, the foot assuming an equinus position unless measures are taken to oppose the intact tendo Achilles by attaching the dorsiflexor tendons. In recommending his own amputation, Syme remained partisan to Chopart's

Lisfranc Chopart Amputation

Fig. 11.1. E,F,G. Operative diagram of Chopart's midtarsal disarticulation with plantar flap. H. Sedillott's slightly modified approach. (From Bernard C, Huette C, Précis Iconographique de Médecine Opératoire, Paris, Mequignon-Maris, 1854, plate 25.9)

after the manner of Pirigov. Suitable indications for subtalar disarticulation were uncommon and results often unsatisfactory. Nevertheless, in 1921, Farabeuf devoted a complete chapter to this procedure, noting every conceivable form of skin flap which made little difference to an unsatisfactory outcome.29 On the basis of extensive surgical experience in World War I, Elmslie wrote in 1924:

"Subastragaloid [subtalar] amputation consists in a disarticulation of the foot... being covered by an internal plantar flap. This amputation is rarely possible, and leaves a stump which is less satisfactory than that of Syme's amputation."30

These procedures are now of historic interest only.

Fig. 11.1. E,F,G. Operative diagram of Chopart's midtarsal disarticulation with plantar flap. H. Sedillott's slightly modified approach. (From Bernard C, Huette C, Précis Iconographique de Médecine Opératoire, Paris, Mequignon-Maris, 1854, plate 25.9)

classical disarticulation when possible, claiming none of his patients developed an equinus defor-mity.26 Others disagreed and abandoned this and also Lisfranc's amputation, although reappraisal by Millstein et al. in 1988 suggested Lisfranc and Chopart amputations for trauma were better long term than more-distal amputations, that is, with a longer foot often with a troublesome scar. Nevertheless, more than 50% of their Chopart operations were revised to a Syme's or below-knee amputation.27

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  • kibra
    What is chopart disarticulation?
    3 years ago

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