Amputations proximal to the transmetatarsal level often result in considerable gait problems during walking.  This is secondary to the loss of support and push-off.   When performed (often for the diabetic patient and in certain traumas), recent improvements in preoperative testing (e.g. ultrasound) allow for a relative high accuracy in predicting which patients will heal.  The principle complication of the Lisfranc amputation is a tendency towards an equinus deformity from the loss of dorsiflexor attachments.  If severe, such a deformity may require repeat amputation at a higher level.