Transmetatarsal Amputation

WHAT YOU SHOULD KNOW:

Transmetatarsal Amputation (Inpatient Care) Care Guide

  • 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.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

There are always risks with having a transmetatarsal amputation. You may bleed more than usual, get an infection, have trouble breathing, or get blood clots. Your heart, lungs, blood vessels, or nerves may get injured while having the surgery. After surgery, you may have problems walking. You may have the stress of living with an amputated (cut) foot and may need time to recover from the feeling of loss. Some people continue to feel the part of their foot that has been amputated, which may or may not be painful. People who smoke or have problems with healing are at a higher risk for complications. Call your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

  • Anesthesia: This medicine is given to make you comfortable. You may not feel discomfort, pressure, or pain. An adult will need to drive you home and should stay with you for 24 hours. Ask your caregiver if you can drive or use machinery within 24 hours. Also ask if and when you can drink alcohol or use over-the-counter medicine. You may not want to make important decisions until 24 hours have passed.

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

During your surgery:

  • Caregivers clean your leg, ankle, and foot with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets are put over you to keep the surgery area clean. A tourniquet may be put around your thigh or ankle to decrease bleeding during surgery. Incisions (cuts) are made on the area of the forefoot to be removed. A skin flap may be used to close the stump. The bottom skin of the foot is left slightly longer than the top to form the flap.

  • The incisions reach directly down to the bone. The damaged or infected metatarsal bones are cut using a saw and removed along with the toes. Nerves, tendons, and blood vessels may need to be cut and the edges tied off. If an infection is present, caregivers clean the area by removing all infected or dead tissue. Additional incisions may be made to check how far the infection has spread. The wound is further cleaned by washing it with saline (salt solution).

  • If the infection is bad, the wound may be packed with special dressings and left open for wound care. If there is no infection or if the infection has been treated, the skin is brought together and closed using stitches (threads) or surgical staples. Skin used to cover the wound may also be taken from other parts of your leg or foot. Thin rubber tubes are put into your skin to drain blood from your incision. Bandages and pressure dressings are placed over the stump to prevent bleeding and hematomas (swelling with blood).

After your surgery:

You are taken to a room where you can rest. Caregivers will watch you closely for any problems. When caregivers see that you are OK, you may be taken to your hospital room.

  • Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Medicines: You may be given the following medicines:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

      • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

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

  • Physical therapy: A physical therapist (PT) will help you with special exercises. These exercises help make your bones and muscles stronger. They may teach you ways to care for yourself after an amputation. You may be fitted with orthoses, such as a special shoe or insole (shoe filler). Orthoses are devices used to protect, support, or improve function of the amputated foot. Physical therapists will also help you learn to walk with crutches or a walker to improve your balance.

  • Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.

  • Wound care:

    • Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.

    • Dressings: Dressings are placed to cover and protect the wound from further injury and infection. These may be in the form of bandages, films, or foams, and may contain certain substances to help promote faster healing. A caregiver may remove the bandage soon after your surgery to check the area. Do not remove the dressing yourself.

    • Splint or cast: A splint may be placed on your leg for a period of time. Your leg may also be placed in a cast. A splint or cast helps keep the skin of the wound or bones from moving and prevent further damage. Tell caregivers if your skin becomes cold, numb, or turn blue while wearing the splint or cast.

© 2013 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.

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