After the leg amputation

Summary

What lies ahead for you after the amputation?

After an amputation, you are undoubtedly wondering: What happens next? Directly after the operation, your recovery and the healing of the residual limb are initially the main concerns. Both are important so that you can begin with rehabilitation soon and a prosthesis can be fitted.

To start rehabilitation:

You should have little to no pain in the residual limb
Your residual limb should be capable of bearing weight
Swelling and water retention should have gone down and stabilised
You should be able to move your residual limb as much as possible in all directions

Your personal situation will determine how long it takes you to reach this point. However, you can promote healing by actively working towards it. While this often demands patience and a lot of endurance, it pays off: The more mobile you are when you start rehabilitation, the sooner you can be fitted with a prosthesis.

You should also use the time after the amputation in the hospital to choose a suitable clinic for your rehabilitation phase in cooperation with your O&P professional. Our list of experts helps you find facilities that specialise in working with amputees.

Residual limb healing

Prepare your residual limb for wearing a prosthesis

The healing of your residual limb after the leg amputation forms the basis for the subsequent prosthetic fitting and is therefore especially important. In the hospital, the doctors treating you will continuously monitor and check the healing process, while the inpatient nursing staff looks after the daily treatment of your residual limb. In addition to wound treatment, this includes oedema and compression therapy, desensitising the skin and scar care, among other approaches.

Residual limb healing

Residual limb pain

Various types of pain may occur in your residual limb after an amputation. These may include bone pain, wound pain, nerve pain or phantom pain. Each type of pain is treated according to its cause. Various treatment options are available, such as medication, warming/cooling or wrapping the residual limb. You can talk to your specialist and/or pain therapist about this.

Wound healing

When you wake up from the anaesthetic, your leg will usually already have a dressing consisting of simple bandages or a cast with a small tube coming out of it. This tube was inserted into the wound during the operation in order to drain fluid and blood from the wound. Known as drainage, it is removed in the course of healing. The initial wound healing phase is usually completed within the first fourteen days, when the wound has closed. After this, the connective tissue cells grow stronger and are converted into specific connective tissue. But even if the scar appears to have healed well from the outside and only the colour of the scar tissue changes slightly from this point on, the overall scar healing process takes much longer. It can take up to one and a half years before it is fully healed beneath the skin. The duration of the wound healing process depends on your individual constitution.

Oedema therapy

After the operation, the tissue around the residual limb will usually swell up at first. This swelling (oedema) is a normal reaction to the operation. It usually subsides after about one week. Only a loose wound dressing is applied until the sutures are removed. No pressure can be applied to the residual limb at first.

The circumference of the residual limb should be measured regularly to evaluate how the swelling is going down. The same measuring points always have to be used for this, and the results must be documented on measurement forms. If this isn’t done, the results are not comparable with each other and there is no way to tell whether the swelling is decreasing.

Phantom pain

Causes of phantom pain, types and therapy options

Many people are affected by phantom pain, which means pain in the limb that was amputated. Experts believe that up to 70 per cent of all amputees experience this, temporarily in most cases. The psychological strain is sometimes very high for affected individuals. There are various theories regarding the causes of phantom pain. Nevertheless, various and also promising therapy options are now available. Unfortunately, there is no treatment that helps everyone equally. We want to inform you about possible causes and the various therapy options here. In any case, talk to your O&P professional, therapist or doctor. They will work with you to find solutions that give you relief.

Initial mobilisation

Stay mobile

Even while your residual limb is healing, you can prepare for the stay in a rehabilitation centre by doing specific exercises. Talk to your doctor or physiotherapist and ask them to show you some important things: the proper position in bed so that the muscles and the joint closest to the residual limb do not shorten or stiffen, regular breathing exercises and light movement and mobilisation exercises, which also help stabilise the circulatory system. These measures help ensure that your treatment with a prosthesis is fast and straightforward so you can stay mobile and active.

Patient takes first steps after amputation

Correct positioning of the residual limb

Lying still for a long time directly after the operation will certainly be difficult for you. You probably won’t be able to roll over on your own in bed yet either. For this reason, you should have nursing staff help you change your position several times a day. This repositioning is important, since it ensures that you are as pain-free as possible and also prevents pressures sores from developing.

The correct positioning of your residual limb is important as well. If you are lying on your back, your residual limb should not be propped up on pillows. Also do not let the residual limb hang down while sitting in a wheelchair or on the bed. This could reduce the mobility of your residual limb – and limited mobility of the residual limb means you will not be able to properly control your prosthesis later on. Correct positioning with the joint extended – insofar as this is possible for you – prevents what are called contractions or shortening of the muscles.

Mobility training

After a bit of time, you can practise your mobility. Sitting up in bed on your own and transferring to a wheelchair will probably be difficult for you at first. However, you will soon master this with some practice. Once again, your physiotherapist should give you detailed instructions. Often there are straps or handles on the bed which you can use for assistance. Soon you will also stand up for the first time. Since the familiar balancing weight of the amputated limb will be missing, you should expect balance problems at first. A walker or other walking aid can initially help you keep your balance after a leg amputation.

Correct positioning of the residual limb

Lying still for a long time directly after the operation will certainly be difficult for you. You probably won’t be able to roll over on your own in bed yet either. For this reason, you should have nursing staff help you change your position several times a day. This repositioning is important, since it ensures that you are as pain-free as possible and also prevents pressures sores from developing.

The correct positioning of your residual limb is important as well. If you are lying on your back, your residual limb should not be propped up on pillows. Also do not let the residual limb hang down while sitting in a wheelchair or on the bed. This could reduce the mobility of your residual limb – and limited mobility of the residual limb means you will not be able to properly control your prosthesis later on. Correct positioning with the joint extended – insofar as this is possible for you – prevents what are called contractions or shortening of the muscles.

Mobilisation to counteract muscle contractures after the amputation

Stretching exercises to counteract muscle contractures after the amputation

Movement exercises

Exercises to strengthen the torso, arm and leg muscles are highly recommended to ensure your body is as well-prepared as possible for the subsequent treatment steps, and to keep you moving. You should talk to your doctor or therapist to determine which exercises are suitable. The exercises can be performed with light weights and therapy bands, from a lying, sitting or standing position. The residual limb should also be included in the exercises. These movement exercises prevent the muscles and joints from becoming stiff. Also familiarise yourself with movement patterns that are unfamiliar with the amputated leg at first. Your physiotherapist should show you all the exercises and check that you are doing them correctly. They can tell you which exercises are right at the respective time.

Mobility training

After a bit of time, you can practise your mobility. Sitting up in bed on your own and transferring to a wheelchair will probably be difficult for you at first. However, you will soon master this with some practice. Once again, your physiotherapist should give you detailed instructions. Often there are straps or handles on the bed which you can use for assistance. Soon you will also stand up for the first time. Since the familiar balancing weight of the amputated limb will be missing, you should expect balance problems at first. A walker or other walking aid can initially help you keep your balance after a leg amputation.

Correct positioning of the residual limb

Lying still for a long time directly after the operation will certainly be difficult for you. You probably won’t be able to roll over on your own in bed yet either. For this reason, you should have nursing staff help you change your position several times a day. This repositioning is important, since it ensures that you are as pain-free as possible and also prevents pressures sores from developing.

The correct positioning of your residual limb is important as well. If you are lying on your back, your residual limb should not be propped up on pillows. Also do not let the residual limb hang down while sitting in a wheelchair or on the bed. This could reduce the mobility of your residual limb – and limited mobility of the residual limb means you will not be able to properly control your prosthesis later on. Correct positioning with the joint extended – insofar as this is possible for you – prevents what are called contractions or shortening of the muscles.

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Rehabilitation facilities

How do I find the right rehabilitation facility?

After being released from hospital, your care will usually continue in a rehabilitation centre. The goal here is to prepare you for everyday life with a leg prosthesis. In order to use this time to best advantage, you should definitely choose a rehabilitation centre with experience in the rehabilitation of amputees.

The more experience a rehabilitation facility has, the better it will be able to meet your needs. As a general guideline, a centre should have at least 50 patients per year. Ask the rehabilitation centre you are considering about the number of patients they treat.
Talk to your O&P professional – they can also help you make the right choice.
Your doctor will tell when it would be useful to visit a rehabilitation centre and whether inpatient or outpatient rehabilitation is appropriate in your case. All of this depends on numerous factors, such as your healing progress and how adequately you can prepare yourself at home.

Treatment with a prosthesis

The process of getting a prosthesis

After your amputation, you will have many urgent questions: When will I get a prosthesis, how do I get a prosthesis and which prosthesis will I get? We want to provide you with all the details about the next steps here.

Generally speaking, your prosthesis fulfils numerous functions: On the one hand, it restores your mobility to a large extent. By wearing a prosthesis, you also reduce or avoid posture problems and balance disorders that could result because of the missing weight of the amputated leg. It also prevents your sound leg from being overloaded, which could result in problems over the long term. Talk to your O&P professional right after the amputation. They can explain the process leading up to your fitting with a prosthesis. Please note that many factors determine when you get a prosthesis and whether you are first fitted with an interim (temporary) prosthesis. Your O&P professional can give you detailed advice.

Patient receives initial prosthetic fitting

How do I get a prosthesis?

To get a prosthesis, contact an O&P professional who is familiar with prosthetic fittings. You are free to choose your O&P professional and also to change providers if you are not satisfied. Ideally, you have already got in touch with them before the amputation or while in hospital. Our list of experts can help you find an O&P professional with experience in prosthetic fittings near you.

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When do I get a prosthesis?

The question of when you get a prosthesis, whether you are first fitted with an interim (temporary) prosthesis and when that happens is always decided on a case-by-case basis. The healing and recovery process is different for everyone. It might take some patience, but it’s worth trusting the advice of your doctor and O&P professional here. But one thing is certain: The better your residual limb is prepared for wearing a prosthesis, the better you will subsequently be able to use your prosthesis.

As a guideline, your O&P professional will examine your residual limb shortly after the amputation and determine whether an interim (temporary) prosthesis is an option for you. After the wound has closed (which takes between two weeks and three months), measurements are generally taken on the residual limb and an interim prosthesis is fabricated at this point. You wear this interim prosthesis for three to six months. It allows you to get used to the prosthesis and helps the residual limb develop its final shape. The process of fitting you with your definitive prosthesis can begin when this has happened, the residual limb of your leg has healed sufficiently and you are once again in good physical condition.

Which prosthesis will I get?

Various factors determine which prosthesis is an option for you. Factors that influence the selection of a suitable leg prosthesis for you include your physical fitness and health, the amputation level, your requirements for the prosthesis and your personal and working environment. Your O&P professional will advise you on all these aspects and work with you to select the corresponding components for your prosthesis.

The alignment of a prosthesis

The components a prosthesis is made of depend on the amputation level. In principle, a prosthesis replaces your missing limb, for instance your foot, knee or hip joint, and is made of various corresponding prosthetic components. Your residual limb goes into a prosthetic socket that connects the prosthesis to your body. There are connecting elements between the individual prosthetic components. These are used, for example, to individually adapt the height of the prosthesis and in some cases also fulfil additional functions.

Your O&P professional will start by selecting the individual prosthesis components together with you, based on your needs. Once the proper fit of the socket has been achieved after several fittings, the socket and components are assembled. Your O&P professional bases the alignment of the prosthesis on the results of the exams and existing alignment guidelines. Additional fittings follow once the prosthesis is ready. The O&P professional checks the prosthetic alignment with the help of technical equipment such as the L.A.S.A.R. Posture and adapts the prosthesis even more precisely to your requirements. You can then take your first steps with your new prosthesis.

The interim prosthesis

In some cases, an initial prosthesis can be fitted soon after the amputation. You wear this interim prosthesis, which is fabricated for you by your O&P professional, until you can be fitted with a final prosthesis (definitive prosthesis). An interim prosthesis can have a favourable influence on the therapy process. It allows you to put some weight on your residual limb early on and to begin with initial walking and standing exercises. However, an interim prosthesis is not suitable for every amputation. Ideally, your doctor, physiotherapist and O&P professional will decide together whether this is an option for you.

An interim prosthesis also serves to gradually adapt a prosthetic socket to fit you and to identify the suitable prosthetic components. Your O&P professional continually improves the fit of the prosthesis during this test and trial phase so that there shouldn’t be any problems with the fit of your final prosthesis (definitive prosthesis).

Other devices

You may need additional walking devices aside from the prosthesis. Various walking aids such as canes, forearm crutches and anterior walkers are available, depending on your physical fitness. Many amputees are also provided with a wheelchair. All of these devices are obtained at the hospital or from a medical supply company. Your O&P professional or contact person at the hospital can help you with this. They can also advise you regarding additional devices in your home environment.

Further information

First steps with a prosthesis

Rehabilitation and leg prosthesis

Discover detailed information on caring for the residual limb, handling prostheses and gait training for a life with a leg prosthesis.

Rehabilitation and leg prosthesis

Discover prosthetic legs

Prosthetic legs

Learn how prosthetic legs help people regain their mobility, rebuild their confidence, and explore their world again.

Prosthetic legs

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Connect with others

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MOVAO — Move as One