2 of 3: Responses: Symes vs. Chopart
Monica Motloch
Description
Collection
Title:
2 of 3: Responses: Symes vs. Chopart
Creator:
Monica Motloch
Date:
7/24/2002
Text:
--------------------------------------------------------------------------
3). I have been a Chopart's level amputee as a result of a farm accident since age 2 and my mother was given the same option 51 years ago.... I am glad she didn't.... She wanted to leave that decision to me when I was old enough!!! Despite the aesthetics, it is a much more functional level of amputation and the profession didn't know what thermoplastics and AFO type Chopart's Prostheses were back then!! I would make the same decision and recommendation today!
At her young age, a Chopart's would be much more functional and if she decides to have a revision at a later date in her life for aesthetic reasons there would be no regrets on the part of the parents. I hope her surgeons know to tie down the anterior tibs to prevent the heel from going in to equinus!!
-John N. Billock, CPO/L, FAAOP
---------------------------------------------------------------------------------------------------------------
4). Having fit numerous syme & chopart prostheses I would recommend the syme . Many more problems will occur with skin breakdown ,some due to higher incidence of equinovarus deformities. Syme is more pleasing cosmetically as child grows . More choice of foot componetry which I believe will result in increased function.
-Laura Ryder,CP
---------------------------------------------------------------------------
5). If the only choice is between Chopart and Symes, it's going to be tough. Either way, the surgeon has to do a lot of surgery and do it really right. The standard Chopart, without modification, will lead to an equino-varus deformity, not just equinus. The calcanus will also, more than likely, project posteriorly. Altogether, this will be a very unsightly residuum for a young lady.Again, if a standard Symes amputation is not modified, the bulbous end is a totally unacceptable result for a young lady. On the other hand, if a well planned Symes is modified by shaving the bulbous end, a very acceptable result can be achieved. Obviously, with a long transtibial length, most all cosmetic issues are resolved by the second fitting.My experience says DON'T subject the child to the Chopart.
-Jim Fenton, CPO, LPO
-----------------------------------------------------------------------------------------
6). I find when discussing issues with parents, sometimes you are fitting a prosthesis to the parents instead of the child. From my experience, I attempt to give the parents both sides of the fence. With that information, 9 out of 10 times, they will make the final decision, even though we as prosthetists may feel the decision is on us. I currently have three patients with symes: 9 yo, 12 yo and 16 yo. All are end weight bearing, self suspending and have required no revisions. The advantage to a symes is the variety of low profile componentry. Disadvantage would be higher trim lines and bulkier. A chopart can be accommodated with a slipper style silicone prosthesis, trim lines to ankle. Cosmesis is a benefit. A carbon foot plate can provide the energy storing capabilities that are lost when the toes/Tran metatarsals are removed.
-Mary Reedy, CP
------------------------------------------------------------------------------------------7). As you know, the decision to possibly revise from a Chopart to a Symes level should be made by discussion with the surgeon, the parents, and the child. You may want to seek advice from an orthopedic surgeon in children's hospital like Cardinal Glennon Hospital, Children's Hospital, or the Shriner's Hospital which are all in St. Louis, MO.
From the standpoint of fitting a prosthesis, the classical Symes amputation has some advantages. Namely being able to maintain a level pelvis, having a good distal weight-bearing surface with the heel pad, and ease of donning a prosthesis with the malleoli prominences reduced. However, the malleoli are often left untouched and you have a bulbous end needing a prosthesis with a window or an expandable bladder or a liner with a filler above the ankle, all of which compromise a good cosmesis. The bulbous end eventually shrinks but this may take two years.
The Chopart maintains the level pelvis at first. The problem anatomically is that the calf muscle plantar flexors are too strong for the anterior dorsiflexors which have lost their insertions and you end up eventually with a plantar flexed heel which protrudes posteriorly making it difficult to get a good shoe fitting. The skin is stretched over the remaining bone anteriorly which is prone to breakdown in a prosthesis. The same cosmesis problems occur when fitting a prosthesis as with a Symes with a bulbous end. The closest I have been able to get with a footplate, lamination, and distal pad is 5/8 to 3/4 which means that a compensatory lift is needed on the other shoe. You may want to ask the surgeon if there is a way to stabilize the calcaneous so that it remains neutral with no varus, valgus, or dorsiflexion.
I have also fitted patients who were not prosthetic candidates with a custom molded shoe both with and without a toe filler.
Whatever is finally chosen needs to be well-padded anteriorly as there will be a dorsiflexion torque during ambulation.
-Ron LeFors, C.P.O.
---------------------------------------------------------------------------------------------------------------
8). As to your question about Symes vs Chopart, in my opinion the symes is more functional for one using a prosthesis and walking great distances where a Chopart would be better for one who is only transferring (K-1 level).......
I am not going to go into the considerations of the ephiseal plates (growth), bone strenght. However, it should be noted that bones are stronger when they transfer weight internally and those who do not go through osteoporosis.
-Donnie Priest, Prosthetic Resident
-----------------------------------------------------------------------------------------
9). I would advise going with the Symes level. While it is still less cosmetic than TT level, it offers more prosthetic foot options and is a good end bearing level.
The Chopart level is undesirable functionally partly because the midfoot tends to develop a planterflexion contracture.
-Randy McFarland, CPO
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affilliations should be used in all communications.
3). I have been a Chopart's level amputee as a result of a farm accident since age 2 and my mother was given the same option 51 years ago.... I am glad she didn't.... She wanted to leave that decision to me when I was old enough!!! Despite the aesthetics, it is a much more functional level of amputation and the profession didn't know what thermoplastics and AFO type Chopart's Prostheses were back then!! I would make the same decision and recommendation today!
At her young age, a Chopart's would be much more functional and if she decides to have a revision at a later date in her life for aesthetic reasons there would be no regrets on the part of the parents. I hope her surgeons know to tie down the anterior tibs to prevent the heel from going in to equinus!!
-John N. Billock, CPO/L, FAAOP
---------------------------------------------------------------------------------------------------------------
4). Having fit numerous syme & chopart prostheses I would recommend the syme . Many more problems will occur with skin breakdown ,some due to higher incidence of equinovarus deformities. Syme is more pleasing cosmetically as child grows . More choice of foot componetry which I believe will result in increased function.
-Laura Ryder,CP
---------------------------------------------------------------------------
5). If the only choice is between Chopart and Symes, it's going to be tough. Either way, the surgeon has to do a lot of surgery and do it really right. The standard Chopart, without modification, will lead to an equino-varus deformity, not just equinus. The calcanus will also, more than likely, project posteriorly. Altogether, this will be a very unsightly residuum for a young lady.Again, if a standard Symes amputation is not modified, the bulbous end is a totally unacceptable result for a young lady. On the other hand, if a well planned Symes is modified by shaving the bulbous end, a very acceptable result can be achieved. Obviously, with a long transtibial length, most all cosmetic issues are resolved by the second fitting.My experience says DON'T subject the child to the Chopart.
-Jim Fenton, CPO, LPO
-----------------------------------------------------------------------------------------
6). I find when discussing issues with parents, sometimes you are fitting a prosthesis to the parents instead of the child. From my experience, I attempt to give the parents both sides of the fence. With that information, 9 out of 10 times, they will make the final decision, even though we as prosthetists may feel the decision is on us. I currently have three patients with symes: 9 yo, 12 yo and 16 yo. All are end weight bearing, self suspending and have required no revisions. The advantage to a symes is the variety of low profile componentry. Disadvantage would be higher trim lines and bulkier. A chopart can be accommodated with a slipper style silicone prosthesis, trim lines to ankle. Cosmesis is a benefit. A carbon foot plate can provide the energy storing capabilities that are lost when the toes/Tran metatarsals are removed.
-Mary Reedy, CP
------------------------------------------------------------------------------------------7). As you know, the decision to possibly revise from a Chopart to a Symes level should be made by discussion with the surgeon, the parents, and the child. You may want to seek advice from an orthopedic surgeon in children's hospital like Cardinal Glennon Hospital, Children's Hospital, or the Shriner's Hospital which are all in St. Louis, MO.
From the standpoint of fitting a prosthesis, the classical Symes amputation has some advantages. Namely being able to maintain a level pelvis, having a good distal weight-bearing surface with the heel pad, and ease of donning a prosthesis with the malleoli prominences reduced. However, the malleoli are often left untouched and you have a bulbous end needing a prosthesis with a window or an expandable bladder or a liner with a filler above the ankle, all of which compromise a good cosmesis. The bulbous end eventually shrinks but this may take two years.
The Chopart maintains the level pelvis at first. The problem anatomically is that the calf muscle plantar flexors are too strong for the anterior dorsiflexors which have lost their insertions and you end up eventually with a plantar flexed heel which protrudes posteriorly making it difficult to get a good shoe fitting. The skin is stretched over the remaining bone anteriorly which is prone to breakdown in a prosthesis. The same cosmesis problems occur when fitting a prosthesis as with a Symes with a bulbous end. The closest I have been able to get with a footplate, lamination, and distal pad is 5/8 to 3/4 which means that a compensatory lift is needed on the other shoe. You may want to ask the surgeon if there is a way to stabilize the calcaneous so that it remains neutral with no varus, valgus, or dorsiflexion.
I have also fitted patients who were not prosthetic candidates with a custom molded shoe both with and without a toe filler.
Whatever is finally chosen needs to be well-padded anteriorly as there will be a dorsiflexion torque during ambulation.
-Ron LeFors, C.P.O.
---------------------------------------------------------------------------------------------------------------
8). As to your question about Symes vs Chopart, in my opinion the symes is more functional for one using a prosthesis and walking great distances where a Chopart would be better for one who is only transferring (K-1 level).......
I am not going to go into the considerations of the ephiseal plates (growth), bone strenght. However, it should be noted that bones are stronger when they transfer weight internally and those who do not go through osteoporosis.
-Donnie Priest, Prosthetic Resident
-----------------------------------------------------------------------------------------
9). I would advise going with the Symes level. While it is still less cosmetic than TT level, it offers more prosthetic foot options and is a good end bearing level.
The Chopart level is undesirable functionally partly because the midfoot tends to develop a planterflexion contracture.
-Randy McFarland, CPO
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affilliations should be used in all communications.
Citation
Monica Motloch, “2 of 3: Responses: Symes vs. Chopart,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/219208.
