It is often difficult to decide at what level to amputate the ischemic limb when reconstructive surgery has nothing further to offer. The trend has been towards amputation below the knee, but many surgeons are unwilling, in the presence of ischemia, to amputate at a lower level than this. In a series of sixty transmetatarsal amputations performed for ischemia, 70 percent healed. Absence of a popliteal pulse did not influence the outcome. The incidence of healing in diabetic and nondiabetic patients was similar. For a few carefully selected patients, transmetatarsal amputation may be a suitable and preferable alternative to below-knee amputation.