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.

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.

Getting Ready

The week before your surgery:

  • Ask a family member or friend to drive you home after surgery. Do not drive yourself home.

  • Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.

  • Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.

  • Caregivers will test your good leg to help you prepare for moving after surgery. You may also be given exercises to make your arms stronger. Caregivers will also teach you how to use crutches, a cane, or walker. This will help you get moving as soon as possible after surgery.

  • If you are female, tell your caregiver if you know or think you are pregnant.

  • You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.

  • You may need to have blood tests, an electrocardiogram (ECG) and chest x-ray. You may also need different imaging tests to show the bones, tissues, blood vessels, and other parts of the foot. Blood flow to the leg and foot will also be checked. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

  • You may be given medicine to help you sleep.

  • Ask caregivers about directions for eating and drinking.

The day of your surgery:

  • Write down the correct date, time, and location of your surgery.

  • What to bring: You may want to bring items such as a toothbrush and bathrobe.

  • Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.

  • You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

  • You will be asked to change into a hospital gown. You may be given medicine in your IV to help you relax or make you drowsy. You will be taken on a stretcher to the operating room. General or regional anesthesia may be given to control pain during the surgery. Your leg, ankle, and foot will be cleaned with soap and water and then covered with sheets.

  • An incision (cut) will be made on the front part of your foot. The damaged or infected metatarsal bones will be sawed off and removed. If your foot is infected, the incision may be left open for several days after surgery. If there is no infection or if the infection has been treated, the incision is closed with 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 may be put into your skin to drain blood from your incision. Bandages and pressure dressings will be placed to cover the stump.

After surgery:

You are taken to a room where your heart and breathing will be monitored. Do not get out of bed until your caregiver says it is okay. A bandage may cover wounds to help prevent infection. You may be able to go home after some time passes. An adult will need to drive you home and should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

  • You cannot make it to your appointment on time.

  • You have a fever.

  • You have a bad skin infection or a wound above or near the injured metatarsal area, such as the ankle or leg.

  • You have questions or concerns about your surgery or condition.

Seek Care Immediately if

  • You have pain, bleeding or foul smelling discharge on your wound.

  • The problems for which you are having surgery get worse.

© 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.

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