Transmetatarsal Amputation

WHAT YOU SHOULD KNOW:

  • Transmetatarsal amputation, also called TMA, is surgery to remove all or part of your forefoot. The forefoot includes the metatarsal bones, which are the five long bones between your toes and ankle. TMA is usually done when the forefoot is badly injured or infected. This means that the bones, tissues, blood vessels, and other parts are damaged beyond repair. Caregivers may also do TMA when there is poor blood flow to the foot, which may be caused by cancer, diabetes, or blood vessel disease. A failed attempt to treat the damaged forefoot with medicines and other treatment options may also need a TMA.

  • During surgery, caregivers will remove the damaged forefoot by cutting it off. Caregivers will only remove as much of the foot as needed. The wound is cleaned of dead or infected bones and tissues. You may need to wear a splint on your leg or special shoes to support your stump after surgery. The goal of TMA is to save enough of your foot to allow you to walk without a limp. You may need other procedures or treatments before, during, or after TMA to treat your damaged foot. You and your caregiver will work together to decide if other treatments should be included in your treatment plan.

INSTRUCTIONS:

Medicines:

  • Keep a current list of your medicines: Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Use vitamins, herbs, or food supplements only as directed.

  • Take your medicine as directed: Call your healthcare provider if you think your medicine is not working as expected. Tell him about any medicine allergies, and if you want to quit taking or change your medicine.

  • Antibiotics: This medicine is given to fight or prevent an infection caused by bacteria. Always take your antibiotics exactly as ordered by your healthcare provider. Do not stop taking your medicine unless directed by your healthcare provider. Never save antibiotics or take leftover antibiotics that were given to you for another illness.

  • Pain medicine: You may need medicine to take away or decrease pain.

    • Learn how to take your medicine. Ask what medicine and how much you should take. Be sure you know how, when, and how often to take it.

    • Do not wait until the pain is severe before you take your medicine. Tell caregivers if your pain does not decrease.

    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling someone when you get out of bed or if you need help.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

Ask your caregiver when you should return to have your wounds checked, dressings changed, and stitches removed.

Activity:

  • Rest when you need to while you heal after surgery. Slowly start to do more each day. Return to your daily activities as directed.

  • Elevate: Lie down and elevate (raise) your leg to a level above your heart to help decrease the swelling.

Diabetic foot care:

High blood sugar can damage nerves and blood vessels. This will prevent blood and oxygen from reaching your body tissues. You may lose feeling in your feet because of nerve damage.

  • Check and carefully wash your feet every day.

  • Do not wear shoes that are too small or socks that do not fit right inside your shoes.

  • Regularly check for cracks, calluses (hard areas of skin), corns, or ulcers (sores). Tell caregivers if you have any of these problems.

  • Soak your feet in warm soapy water for 10 minutes before cutting your nails. Trim your toenails straight across to prevent ingrown toenails. You may also file down your toenails. Do not cut your nails into the corners or close to the skin. You should not dig under or around the nail.

  • Ask caregivers for more information about diabetic foot care.

Diet:

Eat a variety of healthy foods including fruits, vegetables, breads, dairy products, meat and fish. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster. You may also need to take vitamins and minerals if you are not getting enough nutrients in your food. If you have other medical conditions, you may need to follow a certain diet. Ask your caregiver if you need to be on a special diet.

Rehabilitation:

A physical therapist (PT) and an occupational therapist (OT) may exercise your arms, legs, and hands. These exercises help make your bones and muscles stronger. They may teach you ways to care for yourself after an amputation. New ways to do work, self-care, and play activities to help you in your daily life may also be taught. Your therapists may also teach you how to use special devices or equipment to get things done at home or work. They may suggest ways to keep your home or workplace safe. You and your therapists will plan a therapy program that is right for you.

  • Orthosis: This is any device used to protect, support, or improve the function of your stump and good foot. Your lower leg may be placed in a cast or supported by a splint. You may need to use crutches or a walker until you can put weight on your stump without pain. Wearing an insole (shoe filler) made of sponge rubber or foam, or a specially made shoe may also help. Using these devices help decrease stress and strain on your stump and good foot, and prevents further problems. Ask your caregivers for more information about these devices.

  • Prosthesis: When your wound has healed completely, you may have a prosthesis (artificial foot) made for you. Prostheses are fit according to your height, weight, and type or level of activity. Your prosthesis may need to be adjusted several times before it fits well. Never try to fix or adjust it on your own. Once your prosthesis is made, it is important to wear it all day. Ask your caregiver for more information on prostheses.

Self care:

  • Maintain a healthy weight: Talk to your caregiver about your ideal body weight. Weighing too much can make your heart work harder and can increase pressure in your leg and foot blood vessels. Ask your caregiver about a weight loss and exercise plan if you are overweight.

  • Exercise: Exercise makes the heart stronger, lowers blood pressure, and keeps you healthy. It also helps keep your blood sugar level under control if you have diabetes. It is important that you wear good socks and well-fit footwear to prevent sores and blisters. Work with your caregiver to help plan the best exercise program for you.

  • Do not smoke: If you smoke, it is never too late to quit. Ask for information about how to stop smoking if you need help.

Wound and drain care:

When your caregiver says it is OK, carefully wash the wound with soap and water. Afterwards, put on clean, new bandages. Change your bandages every time they get wet or dirty. Always check your drain when changing your bandages. Do not pull it out. Ask your caregivers for more information about wound and drain care.

CONTACT A CAREGIVER IF:

  • You have a fever.

  • You have discharge or pain in the area where the drain was inserted.

  • You have nausea (upset stomach) or vomiting (throwing up).

  • Your skin is itchy, swollen, or has a rash.

  • You have any questions or concerns about your surgery, condition, medicine, or care.

SEEK CARE IMMEDIATELY IF:

  • You have increased pain or swelling in your foot that does not go away even after taking pain medicines.

  • You have trouble breathing all of a sudden.

  • Your cast or splint gets damaged or breaks, or becomes soaked with blood.

  • Your incision has blood, pus, or a foul-smelling odor.

  • Your skin on the stump turns blue or white or it feels cold, numb, or tingly.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Hide
(web2)