SmartHealthForLife.com

Lower limb amputation is a major undertaking and greatly affects the life of the individual, adding psychological stresses to the physical efforts of rehabilitation, fitting for a new limb and learning the skills of walking again. The surgeon will plan the process so that the patient can manage the prosthesis easily, participate as soon as possible in rehabilitation and expend the lowest levels of energy in gait. The patient has to learn a large number of new skills – putting the prosthesis on and taking it off, monitoring the skin for areas of excessive pressure, walking on even and uneven surfaces and getting around when they are not wearing the artificial limb.

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.

Less often amputation is performed for other conditions such as congenital lower limb abnormalities, infections and tumours. Amputation should be planned as an operation which is aimed at reconstruction rather than just removing a part, as the most important matter is the future function and independence of the patient. As the amputation is performed higher and higher in the limb so the speed of gait reduces, the oxygen consumption requirements increase and the overall energy requirements rise for the work of walking. There may be little increase in energy needed for below knee amputation, but 50% or more for mid thigh amputation.

The energy requirements for gait are extremely important as amputated patients frequently suffer from ischaemic tissue problems or other medical conditions which lead to walking consuming much of their energy abilities. Independence in functional activities may be hard to achieve as much of their limited energy supplies is taken up with simply walking. After the amputation, due to the skin viability and ischaemic diagnosis, healing may be delayed and this can have an important bearing on the eventual outcome for the patient’s independence. The soft tissues at the site of amputation must act as the connecting point between the leg and the prosthesis.

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.

PVD or peripheral vascular disease is the most prevalent reason for amputation, with elderly patients being the largest group and often having a second amputation inside three years. Ischaemia of the tissues occurs, often the result of diabetes which can then progress to neuropathy of the peripheral nerves, ulcers and eventually gangrenous changes in the limb. An accident to the leg involving open fractures and arterial and nerve damage can now be medically managed to save the leg but this may not always be positive as an amputation could permit early progress via rehabilitation towards independence.

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

Possibly Related Posts:

• The Various Kinds of Back Stretching Appliance
• The Top 3 Reasons Dansko Clogs Are Perfect For Women During Pregnancy
• Information On Sciatica And A Few Different Treatments Available
• What You Can Expect On The First Chiropractic Session
• Essential Information About Hip Pain And Lower Back