Amputation of the Ankle Region and its Indication for Intractable Plantar Ulcer in Leprosy Patients

Abstract

A series of twelve leprosy patients with forefoot amputation, talipes equinovarus-type contracture or a marked degree of destruction of the tissues adjacent to the ankle-joint ar of the tarsal region, with an extensive incurable ulcer, were treated surgically by Chopart's amputation combined with resection of the talus and with coaptation of the calcaneus to the tibia. Six months to a little over years after the operation, the patients show an average foot contraction of 4cm and are capable of walking along bare-foot within the walls. There is no evidence of ulcer in 10 of the cases and they are now quite able to walk to distant places with the aid of an artificial limb. With the combfined surgical treatment, not only does the patient become able to stand and with bare feet but also may the stump or the base of the calcaneus be maintained more physiologically with remarkable firmness than With the case of Syme's amputation which usually provides only an uncertain degree of correction for a paralyzed leg. The method described is considered preferable particularly for the treatment of affected legs in leprosy patients who tend to develop ulceration.