• need to conserve as much plantar skin with normal sensation
• need to preserve or transplant ankle dorsiflexors to assist with balance
• cover stump end with plantar skin to prevent breakdown
• level of amputation is determined by tissue viability
• indicated for advanced changes such as Charcot’s neuroarthropathy, multiple foot ulcers and vascular pathology – when surgical debridement would not result in a good functional outcome.
• generally need a higher level amputation
• TcPO2 – when >30mmHg, 90% healed