Before the leg amputation

The most common cause for amputations in the Western world are what are known as occlusive arterial diseases. Aside from other metabolic diseases such as diabetes, what is known as “smoker’s leg” is a very well known and widespread occlusive arterial disease. With a circulatory disorder, the supply of oxygen to the leg is no longer sufficient. If you are affected by this, you often experience pain and find walking uncomfortable. The leg or foot are colder than the rest of the body and sometimes also bluish in colour. An amputation of the lower limb is performed only if blood circulation cannot be restored by other vascular surgery procedures. With partial amputations, the goal is also to preserve the rest of the foot or leg.

Diabetic foot syndrome is one of the most common causes for leg or foot amputations. But even though more and more people are living to an advanced age and the number of persons with diabetes mellitus is thus rising, the number of amputations is changing very little. This is due to better treatment and new possibilities for affected individuals.

Diabetes mellitus generally causes several mutually reinforcing disorders.

• Reduced perspiration causes the feet and legs to dry out and crack.

• Sugar deposits in the nerves cause affected individuals to lose feeling, so they no longer notice cracks and wounds.

• Diabetes mellitus severely impairs wound healing.

• When sores are subjected to stress, the wounds grow larger. The tissue becomes inflamed and dies off.

There is also a risk of the foot and leg becoming inflamed more quickly because blood circulation is disrupted by diabetes and the cells die off.

The frequency of amputations after accidents – including work and traffic accidents, for example – has decreased considerably in the Western world. There are many reasons for this, including higher occupational health and safety standards. Progress in the fields of intensive care and surgery means that the nerves, vessels, bones and soft tissue of injured limbs can be restored in many cases, so an amputation is not required as the last resort.

Amputations due to cancer are relatively rare. In many cases, however, there are tumours close to the knee or in the area of the hip. Around half of all amputations in the area of the hip and pelvis are due to tumours. The goal of an amputation in such cases is to save the patient’s life by preventing the spread of cancer cells that would affect other parts of the body.

Amputations due to infections have become extremely rare since Louis Pasteur described the effect of antibiotics in 1877. The high antiseptic standards in medical treatment and tetanus shots are another reason for the decrease. Nevertheless, you need to be vigilant even with the tiniest injury. Signs of inflammation include reddening, swelling, fever and pain in a wound.

Also check whether your tetanus shot is still up to date. The Robert Koch Institute recommends a booster every ten years, or sometimes sooner if wounds occur. Please contact your doctor in any case.

The surgeon advises you before the amputation and performs the operation. Ideally, the surgeon will work with your O&P professional to coordinate the course of the operation in advance. For example, the surgeon and O&P professional can discuss the shape of your residual limb ahead of time, which makes the subsequent fitting of your prosthetic socket easier. After the amputation, the surgeon monitors your recovery and prescribes rehabilitation.

In most cases, your general practitioner and specialist have looked after you even before the amputation and are familiar with the course of your illness. They are available when you need prescriptions for new prosthetic components or additional rehabilitation measures.

A social education worker or other social services employee usually looks after you while you are still in hospital. Their task is to help you during your return to everyday life. This includes topics such as your home, education, work, family, income and social networks. They tell you what services are available and how you can access them. Examples of services include medical, special and social education measures or assistance for participation in social life.

After the amputation, nursing staff in the hospital and specialised wound managers look after wound healing and the correct positioning and compression of your residual limb. Ideally, this is coordinated with the doctors, O&P professional and therapist.

Physiotherapists and occupational therapists assist you in the hospital, during rehabilitation and in everyday life. Their task is to get you moving, to strengthen and stretch your musculature, and to help you learn and make further improvements in walking and coping with activities of daily living. Therapists also do compression therapy in the hospital.

Your O&P professional plays a central role since they fit you with a suitable prosthesis and can offer advice if you have questions. Leading up to an amputation, the O&P professional can discuss with the surgeon what your residual limb should look like if possible. They can recommend experienced therapists or orthopaedic shoemakers and put you in contact with other amputees. You can also ask them about things like a contact for home conversions or vehicle alterations.

When fitting you with a prosthesis, the O&P professional clarifies your needs and preferences and discusses the various treatment options with you. Based on this, they select the appropriate prosthetic components and fabricate your prosthesis with a customised prosthetic socket. They will already examine your residual limb shortly after the amputation and determine whether an interim prosthesis is an option for you.

Your O&P professional is available to you for all questions related to your prosthesis.

In addition to the prosthesis, you may need appropriate shoes for your sound foot. This may be the case if you have a circulatory disorder, for example. Orthopaedic shoes may also be an option for you with a partial foot amputation if you do not wear a partial foot prosthesis. Ask your O&P professional for contact information.

Depending on your family situation, outpatient nurses can assist you with using the prosthesis and also take charge of compression and mobilisation in everyday life.