Review Question - QID 6375

The Lisfranc level amputation removes the attachment of the peroneus brevis (base of the fifth metatarsal) and the peroneus longus (base of the first metatarsal), creating a varus deformity due to unopposed overpull by the tibialis anterior and posterior muscles. An anterior tibialis tendon transfer may be necessary. Other possible tissue balancing choices include posterior tibialis transfer and lengthening of the gastrocsoleus complex. Another option is to leave the base of the fifth metatarsal attached to preserve the eversion pull of the peroneus brevis. All the other amputations do not require soft-tissue balancing procedures to prevent deformities. However, adherence to the prescribed surgical techniques for reattachment of major muscle groups is important for optimizing limb strength and function.