Physical Therapy Emphasizing Progressive Weight Bearing And Gait Training Following Chopart Amputation In A Patient With Diabetes: A Case Report

Background and Purpose: A Chopart amputation occurs at the Chopart joint that separates the midfoot from the hindfoot and often results from infection secondary to diabetic neuropathy and peripheral vascular disease. Previous studies have examined the associated complications, including the development of equinovarus foot contracture and the corresponding mortality risk. However, little research has been done to establish optimal rehabilitation protocols following surgery. The purpose of this case report was to describe a successful initial outpatient physical therapy intervention program that focuses on progressive weight bearing and gait training for a patient with diabetes who underwent Chopart amputation. Case Description: The patient was a 63-year-old male with Type II Diabetes Mellitus who underwent right Chopart amputation following a workplace accident. He desired to return to work as a commercial plumber, but he was non-ambulatory and weight-bearing through the residual limb was minimal at the time of the initial examination. The patient was seen twice per week for an initial eight-week outpatient physical therapy rehabilitation program. Interventions focused on progressive weight bearing, as well as manual therapy, resistive exercises, balance activities, and gait training. Outcomes: At the conclusion of the eight-week program, the patient’s residual limb weight-bearing had improved from 30 percent to 100 percent, and he was ambulating independently with a rolling walker. Progress was slowed by incomplete closure of the surgical wound that prevented prosthetic fitting, leaving the patient lacking a functional forefoot lever. Discussion: Progressive weight-bearing and manual therapy appeared effective at normalizing functional mobility and ankle range of motion. Delayed prosthetic fitting presented a significant barrier to rehabilitation, so further study is needed to examine potential temporary orthosis options