Amputations of the foot and ankle. Current status.

Doppler assessment of ankle and foot systolic pressure is a practical aid in the evaluation of neurocirculatory problems. If the ratio of ankle pressure to arm pressure is over 0.45, more than 90 per cent of operative procedures will heal. Intraoperative testing of blood supply aids in determining level of amputation. Healing results in 80 per cent of cases if bleeding occurs in the skin within three minutes after release of tourniquet. With vigorous debridement of infected soft tissue and bone, the remaining tissue will often heal in local foot operations. A high percentage of patients with neuro-circulation disorders become bilateral amputees. Partial foot and Syme level amputations allow these patients to remain prosthetic users. Function tests show the Syme amputee to be superior in stride length, velocity, cadence and oxygen uptake when compared with the below-knee and above-knee amputees. The criteria of McKittrick must be followed carefully to ensure healing of transmetartarsal amputations.