This study retrospectively reviews an 8-year consecutive series of transmetatarsal amputation (TMA) for forefoot ischaemia in diabetic and non-diabetic patients. Forty-one patients had TMA. Peri-operative mortality was 17% (7/41). A healed stump was achieved in 19 patients (46%) and 18 of these patients were independently mobile, or mobile with sticks. Non-diabetic patients (8/12) healed significantly better than diabetics (11/29). Median time to healing was 7 months (range 3-20 months). All non-healed survivors had a higher amputation (14 below-knee, 1 Syme's). A healed TMA gives good mobility, but prediction of who will heal after operation is unreliable. Time to healing is often lengthy, and failed healing results in higher amputation. These issues need to be fully discussed with the patient who is considered for TMA.