Mortality and morbidity after transmetatarsal amputation: retrospective review of 101 cases

J Foot Ankle Surg. 2006 Mar-Apr;45(2):91-7. doi: 10.1053/j.jfas.2005.12.011.


Medical records were reviewed for 90 patients (101 amputations) (mean age 64.3 years, range 39 to 86 years) who underwent transmetatarsal amputation (TMA). The mean follow-up period, excluding those patients who either died or went on to a more proximal amputation less than 6 months after TMA, was 2.1 years. Patients were examined for any postoperative complications associated with TMA. Complications were defined as hospital mortality occurring less than 30 days postoperatively; stump infarction with or without more proximal amputation; postoperative infection; chronic stump ulceration; stump deformity in any of 3 cardinal planes; wound dehiscence; equinus and calcaneus gait. An uncomplicated outcome was defined as the absence of all these complications and an ability to walk on the residuum with a diabetic shoe and filler after a minimum follow-up of 6 months. The chi(2) tests of association were used to determine whether diabetes, a palpable pedal pulse, coronary artery disease, end-stage renal disease, cerebral vascular accident, or hypertension were predictive of or associated with healing. A documented palpable pedal pulse was a predictor of healing (P = .0567) and of not requiring more proximal amputation (P = .03). End-stage renal disease predicted nonhealing (P = .04). A healed stump was achieved in 58 cases (57.4%). Postsurgical complications developed in 88 cases (87.1%). Two patients died within 30 days postoperatively. These data suggest that TMA is associated with high complication rates in a diabetic and vasculopathic population.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amputation, Surgical / adverse effects*
  • Amputation, Surgical / methods
  • Amputation, Surgical / mortality*
  • Bacterial Infections / surgery
  • Coronary Artery Disease / complications
  • Diabetic Foot / surgery
  • Female
  • Foot Ulcer / surgery
  • Gangrene / surgery
  • Hospital Mortality
  • Humans
  • Hypertension / complications
  • Infarction / surgery
  • Kidney Failure, Chronic / complications
  • Male
  • Metatarsal Bones / surgery*
  • Middle Aged
  • Pulse
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Stroke / complications
  • Surgical Wound Dehiscence / surgery
  • Wound Healing*