Dr. G explains why leaving the fifth digit after other forefoot amputations creates biomechanical imbalance, increased lateral pressure, and recurrent ulcers. He reviews the muscle and tendon changes that drive varus/supination bias and lateral overload.

The episode covers when a full transmetatarsal amputation (TMA) is preferable, the importance of adjunct procedures like Achilles tendon lengthening, and post-op management including orthotics, AFOs, rocker soles, and rehabilitation to restore balanced gait and prevent reulceration.