INDICATIONS: Lesions limited to the forefoot when reconstruction of the forefoot is impossible. In situations where due to the unavailability of protheses a forefoot amputation has to be done.
CONTRAINDICATIONS: Absolute: Badly scarred or destroyed calcaneum and/or heel pad. Osteomyelitis of lower tibia or calcaneum. Malignancy of the heel area. Relative: Inadequate circulation of the heel area. Uncontrolled diabetes mellitus.
SURGICAL TECHNIQUE: Forefoot amputation with arthrodesis between tibia and os calcis. Specially applicable in patients with neuropathy because this simple procedure leaves a stable stump. Prosthetic fitting not mandatory. Negligible shortening of limb.
POSTOPERATIVE MANAGEMENT: Bed rest, elevation of limb, and protective splinting for 3 postoperative days. Non weight bearing on crutches for the next 2 weeks, then well fitted contact cast with Böhler iron for walking. Application of prosthesis not before bony consolidation.
POSSIBLE COMPLICATIONS: Infections. Treat very intensively.
RESULTS: Fifty modified Pirogoff procedures were done over 30 years, mostly for leprosy or malignancy. Long-term follow-up available of 16 patients who suffered from leprosy (see Figure 11).
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