Limb amputations in the U.S. occur for a variety of reasons. The most common is a vascular problem such as diabetes or peripheral vascular disease, accounting for 82 percent of all lower extremity amputations. Trauma is the second most common reason, and affects more men than women. The leading causes of trauma-related lower extremity amputations are machinery injuries (40%), powered tools and appliances (28%), firearms (9%) and car accidents (8%).
Whatever the reason for the amputation, that person will face a long recovery and treatments that can be challenging physically and emotionally. There are a variety of treatment options for a below the knee amputation, all aimed at helping the patient to recover as much as possible.
Right after surgery, postoperative treatment methods vary widely. The main goals are pain control, promotion of wound healing, range of motion exercises, phantom limb pain/sensation management, and infection control. As healing progresses, the prosthesis will be fitted and treatments will focus on improving comfort and acceptance of the device. After that, the patient will learn to walk with the prosthesis and will begin a long-term therapy program aimed at rehabilitating muscles and joints to regain strength and improve balance and flexibility.
Here are some common treatments after surgery for a below the knee amputation:
· Cold and compression therapy – to relieve pain and swelling and provide relief for phantom limb pain and sensation
· Mechanical stimulation - Rubbing/tapping, massage, soft-tissue and scar mobilization – these treatments help manage edema and prevent contractures. Massage also helps prepare limbs for prostheses by ‘toughening them up’ and making them less sensitive to touch and stimulation. Initially, the patient’s physical therapist will do these treatments but eventually the patient/family can be taught to perform them.
· Nerve stimulation or TENS – TENS has been shown to have about a 50 percent success rate in managing phantom pain.
· Strength exercises – For people undergoing a below the knee amputation, the therapist will likely focus on improving the strength of the residual limb hip extensors and abductors, as well as the knee flexors and extensors to prepare for eventual prosthetic use.
· Cardiovascular training – For patients who can tolerate it, this is very important in order to improve endurance and functional mobility tolerance.
· Balance training – Patients may be asked to do sitting and standing, static and dynamic activities to improve balance. Other balance exercises might include reaching for objects or using soft or unstable surfaces to stand on.
· Stump shrinkers – The residual limb needs shaping after surgery so that the prosthesis can be fitted. The shaping or shrinking is often done using an elastic bandage or shrinker. Physical therapists will keep a close eye on their patients to make sure these fit properly and don’t cause circulation problems, pressure sores, or misshapen limbs.
· Stretching – Contracture is a common post-operative condition caused by shortened muscles, tendons or skin. It stops normal movement of the tissues and joints. One cause is when patients don’t move their residual limb often enough. Therapists will reduce this risk by taking their patients through a series of stretching, positioning and range-of-motion exercises.
According to medical experts, a below the knee amputation is one with a wide range of outcomes – some people learn to run and jump with their prosthesis while others never adjust to the artificial limb and must use a wheelchair to get around. Fortunately, advancements in technology continue so that hopefully one day every below the knee amputee is able to live the life they had before their amputation. How can we help?