Rehabilitation and the leg prosthesis

The goal of rehabilitation is to optimally prepare you for life with your prosthesis. First, this includes regaining your strength, endurance and coordination through targeted physiotherapy. In addition, special gait training teaches you how to use your prosthesis.

The basic functioning of the knee joint also plays a major role in gait training for transfemoral amputees. For this reason, the training and education programme will ideally be tailored to the prosthetic components you are using. The programme should be aimed at relearning everyday motion sequences and explaining the functionality of your prosthesis to you.

Learn more about what gait training for leg amputees entails here.

Putting on and taking off the prosthesis correctly by yourself is the basis for walking with a prosthesis, which you will practise first. Your family may have to help you at first. So it’s important to also include them in rehabilitation. However, the goal is for you to learn how to do this independently with some practice. There are various ways to put on a prosthesis, depending on the type of prosthesis and the condition of your residual limb. Your therapist or O&P professional will show you the best method for you.

Once you know how to correctly put on the prosthesis and take it off, sitting down and standing up are the next everyday actions you will learn. Users with a transfemoral amputation who are treated with a knee joint that supports sitting down can put weight on both legs while sitting down. The Prosedo, Kenevo, C-Leg® 4, Genium and Genium X3 from Ottobock offer this function, for example. This results in significant relief for the sound side, which helps prevent premature problems from excessive strain. Users with a transtibial amputation should also put the same amount of weight on both legs when sitting down and standing up for the same reason.

Once you are confident in using the prosthesis in general, actual gait training can begin. The focus now is on improving balance and coordination, sufficient weight bearing on the prosthesis side and straightening the pelvis and upper body. Your therapist also continues to work on strengthening your muscles, because strong muscles are essential for a stable body posture while walking.

First you learn how to shift your body weight and stand on one leg between parallel bars. Don’t support all your weight with your arms and sound leg; use your prosthesis, too. As soon as you can walk between parallel bars, you start the first exercises without support. The first objective is to gradually reduce the use of any walking aids you may require initially. This is achieved through a combination of a proper walking technique and strengthening your torso muscles. All gait exercises are monitored by your therapist to ensure that no gait deviations creep in. At first, the therapist is always by your side, offering help. However, you will gradually learn to do without this over time.

Once you have mastered walking on level ground, you will also practise walking on various other surfaces.

You will always encounter obstacles in daily life, such as curbs, stairs in your home or a ramp leading up to the garage. Walking safely on stairs and ramps is a constant part of your daily life and is practised with you during gait training. The individual components of your prosthesis determine which walking technique is right for you.

In the hospital, the nursing staff and doctors took care of your residual limb by cleaning the wound and changing the bandages or dressings. In the rehabilitation phase, you are shown how to care for your residual limb, the scar and also your sound leg yourself. Note that regular and intensive care are essential so you can wear your prosthesis without problems. There are special care products for your residual limb that you can use. Over time, you will develop a daily care routine that will be a natural part of your everyday life.

If wrinkles or drawn-in scars have formed on the residual limb, these require especially intensive care in order to prevent infections. Your rehabilitation team can provide you with advice. While caring for your residual limb, also look for skin injuries, pressure points and blisters. These may require medical treatment. A mirror can help you examine the back of your residual limb. Regularly massaging and gently stretching the scar is another important element of residual limb care and desensitising the sensitive skin on the residual limb.

After the amputation, your residual limb won’t be able to support a lot of weight. This automatically puts greater strain on the sound leg. However, it’s very important that it is healthy and intact so you can regain your mobility.

If you have circulatory disorders, regularly examine your sound leg for minor injuries as well. They could become dangerous in the event of an infection and should therefore be treated immediately by a doctor. Many affected individuals visit a trained pedicurist for foot care, such as having their toenails trimmed. Comfortable shoes with a good fit reduce the strain on your sound leg. Insoles may also be recommended. In addition to footwear, your choice of socks is important: Socks should be made of wool or cotton so they absorb perspiration well. If the cuff is too tight, it can disrupt blood circulation. Socks have to fit without wrinkles and should be worn only for one day. Otherwise, perspiration causes salt deposits to form that chafe the skin and can lead to infections. If you have circulatory disorders, it’s also important not to transfer to a wheelchair while barefoot. You shouldn’t stand or walk barefoot either – the risk of injury is too high. And when you are in bed, you can put a padded support under the heel and ankle of your sound leg in order to prevent pressure points.