Boyd Amputation: Uses, History, and Process

If you’re dealing with pain or a congenital defect in your foot and your doctor has discussed amputation, you should understand there are different types of amputations available. One such lower-body amputation is the Boyd amputation. This procedure involves amputation at the ankle level while preserving the calcaneus and heel pad. That way you can use the stabilization of the heel pad and suspension for a prosthetic.

What Is Boyd’s Amputation?

two doctors in surgical gear doing surgery

Image via Pixabay by marionbrun

Any type of amputation involves removing a limb. This surgical procedure is used to control pain, combat a disease that’s taken hold on the affected limb, or as a solution to a congenital disorder. Boyd’s amputation treats osteomyelitis of the foot, which involves an infection in the bone. Infections can reach into the bone by traveling through the bloodstream or by spreading from nearby tissue. If the bone is exposed due to an injury, the infection can also begin directly in the bone.

People who are smokers or have chronic health conditions such as kidney failure or diabetes might develop osteomyelitis in their feet if they develop foot ulcers. For many years, osteomyelitis was thought to be incurable and people who had it just had to deal. It can now be successfully treated, most commonly via a Boyd amputation.

History Behind the Boyd Amputation

In 1939, Dr. Harold B. Boyd described using a technique for foot amputation that involved fusing the tibia, talus, and calcaneal bones. At the time, he stated the procedure was more advantageous compared to the other types of amputations, not only from an anatomical standpoint but also from a physiological one. The primary use of the Boyd amputation dealt with congenital or an acquired foot deformity or another type of discrepancy involving the limb’s length.

The Boyd amputation is a slight modification of Syme amputation, which James Syme first described in 1843. He performed the technique on a 16-year-old boy who had a chronic foot infection. With the Syme amputation, the foot is removed through the ankle joint, but the patient’s heel pad is saved so the patient can place weight on the leg without the need for a prosthetic. The goal of this procedure is to leave the patient with a functional and painless limb while removing diseased tissue or a non-useable foot.

It wasn’t until the 1950s when doctors began stressing the importance of preserving the heel during a Syme amputation. They believed the cushioning effect of the heel should remain, if possible. As a result, a two-stage amputation procedure was developed, although some doctors still operate on one stage. The Boyd amputation is much more complex than the Syme amputation but offers several advantages such as providing a more solid stump by preserving the plantar heel pad.

What Is a Boyd Amputation Used For?

Although the Syme amputation is a well-known and effective procedure, the Boyd amputation is often a better choice for patients dealing with osteomyelitis of the midfoot or forefoot. Doctors also might recommend a Boyd amputation as an alternative to a below-knee amputation since it gives the patient a more solid weight-bearing surface. The best indication for this type of amputation is a large leg length discrepancy of more than 30% when the skeleton is fully mature. Also, since the 1960s, the Boyd amputation has been used to treat children who were born without a fibula.

What Occurs During a Boyd Amputation?

As mentioned, the Boyd amputation can be performed in a one- or two-stage process. Before the Boyd amputation procedure begins, a doctor will make incision marks on your foot. Remember, the goal is to preserve as much of the plantar flap as possible. The surgeon uses a sagittal saw and cuts the anterior process, sustentacalcum tail, as well as posterior and middle facets.

One way to connect the bones involves making two incisions on the skin near the distal lateral and medial parts of the leg. The surgeon uses wires from the superior to inferior parts so they exit the tibia. Once the wires are crossed and secured, two 6.5-mm cannulated screws are passed over the wires. The wires are then removed, and the screws are tightened. The lateral portion of the malleolus is resected at a 45-degree angle to prevent the area from further breaking down. The surgeon uses sutures or staples to close the area, and a drain is inserted for 48 to 72 hours.

What You Should Expect Afterward

After the surgery, expect to spend a night in the hospital. Upon discharge, you want to avoid placing weight on that limb for approximately four weeks. Once you’ve been approved by your team of doctors, you will be outfitted with a removable cast, which you should wear for another four weeks. This cast has an additional heel cushion that is constructed out of shock-absorbent material. The next phase has you fitted with a prosthetic leg, which should allow you to walk unassisted three months after surgery.

What Prosthetics Are Available After a Boyd Amputation?

Prosthetic legs can give you the mobility to resume the lifestyle you’re accustomed to. Your prosthetist can help you decide which one will work best and recommend any extra products that can make wearing the prosthetic more comfortable. After you’ve selected a prosthetic foot, your prosthetist will create a schedule that will gradually increase the time you spend wearing your prosthetic. You’ll start by wearing it just a few hours a day and increase the time to all-day wear. Avoid rushing the process since that can cause soreness and skin damage.

As a viable treatment option for serious foot ailments, the Boyd amputation is a solid option if you’re considering amputation. If you need a prosthetic once you undergo the amputation, reach out to Scheck & Siress. We have more than 50 American Board Certified practitioners at our 18-plus locations scattered throughout Illinois, Indiana, and Wisconsin. We even offer in-house fabrication for timely service, so you won’t need to wait long for your prosthetic. Let us help you navigate the process and help you make an informed decision.