Lower Limb Amputation

The amputation of a leg is a major happening for a person and represents an upheaval in their life, with psychological problems added to the difficulties of learning the rehabilitation, the management of the new prosthesis, and the relearning of ambulation. The surgeon’s plan will be to manage the process to allow the patient early access to rehabilitation, reduce their energy requirements in walking to the minimum and allow them to manage the prosthesis successfully. Many new skills have to be learnt such as mobilising without the new limb, checking the skin pressure areas and managing to get the limb on and off.

The team managing the amputee needs to be multidisciplinary and skilled in this field to get the best out of the patient in terms of independence and the team may consist of the physiotherapist, an occupational therapist, the surgeon, the personal medical practitioner, a prosthetist and advisors on social care and employment. As the industrialised countries’ populations continue to age the number of amputations will also rise as the main cause of amputation is vascular disease in the periphery. The number of above knee versus below knee amputations has changed as surgeons have learned to preserve the knee joint in more cases, with seventy percent now being below knee.

Weight transfer can be achieved indirectly by allowing pressure through a bony point higher up the leg and also by effecting force transfer through the sides of the leg tissues. There may often be a pain issue after this procedure despite modern prosthetic accomplishments and if the pain is significant it can lead to limited use of the prosthesis, functional reduction and eventually to further attempts at surgery.

Other reasons for amputation are less common and include tumours, infections and congenital abnormalities of the lower limbs. Overall amputation is considered an operation which involves reconstruction rather than just removal of a limb, as the patient’s future life and independence is the crucial matter. The higher that the surgeon has to amputate the limb the higher levels of energy are needed for walking, with the speed of walking decreasing and the required oxygen consumption increasing. Low below knee amputation may make little difference to the energy required for gait, however once the level moves up to mid thigh the load may be over 50% more.

The amount of energy needed for normal ambulation is vital as patients who have had an amputation typically have vascular disease and other medical problems which require them to use most of their limited available energy in walking. If so much energy is consumed by simply walking then functional independence may be unrealistic. Healing of the tissues and the skin after amputation may be difficult or slow due to the likely ischaemic nature of the limb’s tissues, making important limits to the eventual independence of the patient. The interface between the prosthesis and the leg is now performed by the soft tissues at the site.

Allowing a bony area higher up to take some of the weight transfer indirectly can be successfully integrated with weight transfer sideways through the soft tissues of the lower leg. There may still be pain issues for patients despite the many advances made in modern prosthetics. Significant pain can lead to a reduction in function, reduced use of the prosthesis and even to further surgery.

More indirect weight transfer can be accomplished by allowing a higher bony area to take some of the force with other forces being transferred across the sides of the soft tissues of the leg. Pain may still be an issue for many patients despite the great advances made in prosthetic technology. If the pain is severe enough it can lead to further surgery, reduced function and limited wearing of the artificial limb.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in Nottingham, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

Related Articles:

• Pre Natal Massage Therapy in San Diego Texas | Pregnancy Massage at Home
• low vitamin d symptoms
• Eén van de eerste Quantum-Touch en Touch of Matrix Instructeurs in Nederland
• Sleep Innovations Contour Memory Foam Pillow | Compare Prices and reviews for Memory Foam Pillow
• Sleep Better Iso-Cool Memory Foam Pillow, Gusseted Side Sleeper | Best cheap @ Review for Pillows Memory Foam