Boyd Amputation

Boyd Amputation technique at the level of hindfoot retains the calcaneus and fuses it with the distal tibia at the ankle mortise. It provides an excellent weight-bearing stump and in most cases does not require an artificial limb but its use has been restricted because of the difficulty in obtaining high union rates in the tibiocalcaneal fusion.

Boyd Amputation is more difficult to perform than the Syme amputation, but it offers certain advantages. The Boyd amputation provides a more solid stump because it preserves the function of the plantar heel pad. Also, because a portion of the calcaneus is left and fused to the tibia, the weightbearing surface is more solid than in the case of a Syme amputation. 

See Also: Syme amputation

Boyd Amputation Technique Steps

• Create a lengthy plantar flap and a shorter dorsal flap. Initiate the incision from the tip of the lateral malleolus, extending it over the top of the foot at the level of the talonavicular joint, and concluding one fingerbreadth below the medial malleolus. Curve the incision downward and distally along the sole of the foot, aligning with the metatarsal bases. Finally, continue the incision upward and proximally to the tip of the lateral malleolus.
• Lift the skin flaps and amputate the forefoot by severing the midtarsal joints.
• Using precise dissection near the bone, divide the ligaments connecting the calcaneus and tibia, followed by the removal of the talus.
• Perform a transverse osteotomy just below the peroneal tubercle to excise the front portion of the calcaneus.
• Eliminate the cartilage from the appropriate surfaces of the tibia, fibula, and calcaneus to prepare them for arthrodesis.
• Pull any tendons present in the wound towards the distal end, then cut them proximally and allow them to retract.
• To prevent pressure, sever the medial and lateral plantar nerves.
• Reposition the calcaneus anteriorly in relation to the ankle joint, and properly align it for arthrodesis, ensuring that its underside remains parallel to the ground.
• If necessary, insert a Steinmann pin or cannulated screw through the heel, from bottom to top, to securely fix the calcaneus to the tibia.
• Close the skin flaps using interrupted sutures and insert a drain, which should be removed within 48 to 72 hours.

See Also: Ankle Anatomy

Aftercare

• The sutures are removed after 2 weeks, and any Steinmann pin is removed after 4 weeks.
• Weight bearing on the stump is prohibited until 8 weeks.
• A walking cast is then applied and left in place until arthrodesis is complete.

References & More

1. Mongon ML, Sposito AL, Nunes GM, Livani B, Belangero W. Boyd Amputation Using the Tension Band Technique. Strategies Trauma Limb Reconstr. 2019 May-Aug;14(2):102-105. doi: 10.5005/jp-journals-10080-1433. PMID: 32742422; PMCID: PMC7376589. Pubmed
2. Grady JF, Winters CL. The Boyd amputation as a treatment for osteomyelitis of the foot. J Am Podiatr Med Assoc. 2000 May;90(5):234-9. doi: 10.7547/87507315-90-5-234. PMID: 10833871. Pubmed
3. Campbel’s Operative Orthopaedics 12th edition Book.