Chapter 1

Limb Amputation: Epidemiology, Surgical Principles, and Prosthetic Foundations

Levels of Amputation

The level of amputation has profound implications for prosthetic fitting, functional outcomes, and energy expenditure during ambulation. Understanding the anatomical landmarks and terminology is essential for communication among healthcare providers.

Lower Extremity Amputations

Lower extremity amputations are classified from distal to proximal as follows:

Syme amputation: ankle disarticulation that preserves the heel pad, allowing potential for end-bearing
Transtibial (below-knee) amputation: Amputation through the tibia and fibula, preserving the knee joint
Knee disarticulation: Amputation through the knee joint, preserving the femoral condyles
Transfemoral (above-knee) amputation: Amputation through the femur
Hip disarticulation: Amputation through the hip joint
Hemipelvectomy: Resection of the lower half of the pelvis along with the entire lower extremity

Figure 1. Levels of lower extremity amputation. © Clinical Prosthetics, 2026.

Partial Foot Amputations

Partial foot amputations represent a spectrum of procedures that preserve varying amounts of foot anatomy:

Partial toe (transphalangeal) amputation: resection through one or more phalanges
Ray resection: removal of a single metatarsal with its corresponding toe
Transmetatarsal amputation: resection through all metatarsals
Lisfranc amputation: disarticulation at the tarsometatarsal joints
Chopart amputation: disarticulation at the talonavicular and calcaneocuboid joints, leaving only the talus and calcaneus

Figure 2. Dorsal view of foot skeletal anatomy, showing the tarsal bones, metatarsals, and phalanges. © Clinical Prosthetics, 2026.

Upper Extremity Amputations

Upper extremity amputations are similarly classified from distal to proximal:

Partial finger (transphalangeal) amputation: Amputation through the phalanges
Transmetacarpal amputation: Amputation through the metacarpals
Wrist disarticulation: Amputation through the wrist joint
Transradial (below-elbow) amputation: Amputation through the radius and ulna
Elbow disarticulation: Amputation through the elbow joint
Transhumeral (above-elbow) amputation: Amputation through the humerus
Shoulder disarticulation: Amputation through the glenohumeral joint
Forequarter amputation: Removal of the entire upper extremity including the scapula and part or all of the clavicle