Challenging the Parabola Paradigm in Transmetatarsal Amputation

Summary: In an oral abstract presented at the 2025 APMA National conference, Craig J. Verdin, DPM, DABPM, AACFAS and colleagues examined whether the residual metatarsal parabola structure truly affects function and outcomes following transmetatarsal amputation (TMA).

Key Insights:

• A retrospective study of 57 unilateral TMA patients at Georgetown University grouped outcomes by residual parabola shape and residual length.
• Major complications did not significantly vary by parabola shape. However, a longer second metatarsal remnant (“Type 4”) showed a weak but significant association with minor complications, possibly due to uneven plantar pressure distribution.
• Neither parabola shape nor residual length correlated with functional outcomes or quality of life, based on the LEFS and SF-12 assessments.
• The study suggests that achieving a “balanced” parabola—rather than strictly adhering to traditional length or shape norms—may suffice for optimal functional and clinical results.

Conclusion: This study challenges the long-held belief that maintaining a normal parabola or length post-TMA is essential. Its findings indicate that function-based planning may be more important than structural uniformity.

🔗 Read the full abstract on HMP Global Learning Network

Keywords: Craig J Verdin, metatarsal parabola, transmetatarsal amputation, second metatarsal remnant, limb salvage, APMA National 2025