Soft-tissue and osseous balancing of forefoot and midfoot amputations is imperative to provide the patient with a stable, durable, and functional residual foot. This article discusses reproducible methods for balancing transmetatarsal and Lisfranc amputations in high-risk patients, with detailed explanations of the recommended surgical techniques. In addition to performing the appropriate procedures for the individual patient, careful attention to the perioperative management of this patient population, with a multidisciplinary approach, is mandatory for long-term success.