Rehabilitation factors following transmetatarsal amputation

Despite the occurrence of approximately 10,000 transmetatarsal amputations (TMAs) a year in the United States, there are few reports describing rehabilitation for this patient group. The purposes of this clinical perspective are (1) to identify common problems encountered during rehabilitation of patients with TMA, (2) to identify factors that may contribute to these problems, and (3) to propose methods to manage these problems. A review of the literature and biomechanical models of the residuum, footwear, and orthotic devices are provided to help accomplish these purposes. Common problems encountered during rehabilitation of patients with TMA are skin breakdown and instability during functional activities. Decreased foot length and peripheral neuropathies appear to contribute to these problems. Solutions focus on attempting to provide a substitute for the plantar-flexor lever arm and protection of the insensitive residual foot. Suggestions for additional research are presented.