LE Amputation

Question 1

LE Amputation : Background

Answer 1

Geriatric client
PVD (Diabetes)
Cardiovascular disease
109,000 vascular amputations annually in US

Question 2

Classification : 1. Partial Foot

Answer 2

Chopart (toes area)
Symes (Ankle)
Phalangeal
Transmetatarsal

Question 3

Classification : II Below Knee (transtibial)

Answer 3

Most common site for LE amputation
Good functional outcome for sitting &walking
Knee disarticulation
Short BK
Long BK
(Avoid contractors-Encourage knee flexion)

Question 4

Classification : III Above Knee (Transfemoral)

Answer 4

Poorer prognosis for prosthetic use 
Hemipelvectomy 
Hip disarticulation 
Short AK 
Standard AK

Question 5

Issues Related to Amputation

Answer 5

Generalized weakness (decreased endurance/tolerance for program)
Balance
Sensation (skin checks)
COG (Center of Gravity - will shift)
Mobility (transfers with and w/o prosthetic)
ADL’s
IADL’s (housework driving)

Question 6

Rehabilitation

Answer 6

Foot inspection (both affected and unnafected- pt. ed on what to look for) 
Hygiene (wash dry toes & residual limb daily to prevent breakdown) 
Suitable footwear (closed toe shoes- wound prevention)

Question 7

Prosthetic Training

Answer 7

Reduce pain (increased tolerance w/ deep pressure/light touch)
Foster healing (maintain diabetic diet)
Prevent contractures/optimize positioning
Prevent skin ulcers (address redness ASAP)
Endurance building (biomechanical approach)
ADL’s seated (Progress to standing)
Stump shaping/wrapping (shrinker socks)
Ambulation (crutches or walker)

Question 8

Post- Prosthetic Training

Answer 8

Balance (increased fall risk) 
Mobility 
Endurance 
Strength 
Standing tolerance 
ADLS in standing 
Community level functioning (mobility, outings)