Partial foot amputation – what now?
If you have to come to terms with a partial foot amputation, this difficult situation can often make you feel helpless at first and in need of objective information. Affected individuals have many questions about the amputation and about life afterwards.
You’re not helpless when part of your foot has to be amputated. Please know that your life will be worth living even after a partial foot amputation. As the person affected, there is a lot you can do yourself to regain your mental and physical balance. A partial foot prosthesis is a long-term prosthetic treatment option.
We show you the functions of the partial foot prosthesis, who it’s suitable for and how you can get one, and provide you with tips for everyday life with the prosthesis.
Why do parts of my foot have to be amputated?
An amputation is only performed when this is the only way to protect your health over the long term. Often the reason for an amputation is that blood circulation in the affected part of the foot is no longer sufficient to adequately supply the cells of the tissue with oxygen, for example, in individuals with diabetic foot syndrome. Another cause for amputations are accidents in which the foot cannot be restored. As strange as it may sound, a partial foot amputation is often the only chance to walk again in such cases.
The most common causes
You aren’t the only one affected by this: 30,000 to 40,000 amputations are performed each year in Germany, most of them on the foot. The most common causes for amputations on the foot are diabetes – diabetic foot syndrome, to be precise – and serious accidents, for example, occupational or traffic accidents. However, occlusive arterial diseases, more commonly known as “smoker’s leg”, continue to play a significant role as well.
The numbers and causes of occlusive arterial diseases have remained consistently high for many years. This is because as more people reach an advanced age, the more are also developing diabetes mellitus. But since treatment continues to improve as well, amputation numbers are not rising. Well over 20,000 amputations in Germany each year are due to diabetic foot syndrome.
Amputation for diabetic foot syndrome
Diabetic foot syndrome is the most common cause of amputations on the foot. Diabetes mellitus causes several mutually reinforcing disorders:
Reduced perspiration causes the feet 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 get bigger and the tissue becomes inflamed and dies off
There is also a risk that the foot may become inflamed because diabetes impairs blood circulation and cells die off
Avoiding an amputation for diabetic foot syndrome
Diabetic foot syndrome does not inevitably have to lead to an amputation. The earlier it is detected, the more likely an amputation can be avoided or at least delayed. A key requirement is that you take the risk seriously and are disciplined in dealing with it.
Take good care of your feet.
Check the amount of sensation you have in the sole of your foot at least once a month, and use a mirror to examine the entire foot for injuries.
Have regular checkups and ask your doctor to examine your feet very closely. (Not all general practitioners are aware of the risk).
Buy proper shoes (not tight, room for the toes, no “health shoes”), and use special orthopaedic insoles for diabetics if indicated.
Visit a foot care specialist (even if this is not covered by health insurance) and get instructions on how to care for your feet yourself.
Care for dry skin with moisturising or urea creams.
When you notice even the smallest signs of cracks or wounds, see a specialist – ideally at a diabetic foot clinic. Don’t wait until a toe turns black or your foot develops an unpleasant odour. The first signs are dry skin, cracks, reduced sensation in the foot, calf cramps, fungal infections, calluses and warm feet.
If you have already been diagnosed with diabetic foot syndrome, examine your feet daily.
If you have diabetic foot syndrome, ask experts about special shoe customisation, protective shoes, custom-made shoes or orthoses to relieve strain on the foot.
Have any wounds treated exclusively by a specialist for diabetes or wound healing.
* (Working group for the development of diagnostic and therapeutic recommendations for diabetic foot syndrome in the practice of general practitioners: Diabetic foot manual; Emsdetten 2001, foreword: Prof. Dr. med. Maximilian Spraul, p. 3)
Amputation due to circulatory disorders
Smokers or people with other metabolic diseases may be similarly affected as those with diabetes mellitus. With a circulatory disorder, the supply of oxygen to the leg is no longer sufficient. In this case, you experience pain and it hurts to walk.
In any case, an amputation in the area of the foot is only performed when specific areas cannot be salvaged and have to be amputated in order to preserve the remainder of the foot or leg. This offers a chance that the foot will be able to bear weight again. Sometimes an amputation can be avoided by taking measures at the appropriate time.
How is the partial foot amputation carried out?
Cooperation between surgeons, specialists for internal medicine, chiropractors, physiotherapists and O&P professionals creates the foundation for a successful partial foot amputation. The most important factor for your life afterwards is being able to stand and walk with the foot as normally as possible again.
Today, amputations are performed according to the motto “As much as necessary, but as little as possible”. Under a general anaesthetic, the surgeon only removes as much as is absolutely necessary, ensuring you can still be as mobile as possible going forward. The doctor incises the skin, removes the diseased tissue and bones, shapes the residual limb and closes the wound. The more healthy tissue is retained the better.
As a rule, the surgeon only sees you in the consultation before the operation in order to explain the partial foot amputation procedure to you. This means the surgeon only knows an abbreviated version of your story and is not always able to influence what lies ahead of you afterwards. Your family doctor or specialist cares for you during the period after the partial foot amputation. After some time, an O&P professional gets involved and will later fabricate your device. Therefore, it’s best to work together to decide what amputation level is right in your case. The type of amputation has a major influence on what and how much you can do with your foot after the operation. The surgeon’s main task is to perform the amputation so that you can do as much as possible again afterwards.
Today, the art no longer lies in how but exactly where the surgeon amputates – and how they shape the residual limb. This aspect is very important because the residual limb must be capable of bearing weight afterwards without developing sores. To accomplish this, the surgeon “pads” the bone with muscles and leaves sufficient skin to suture the wound without tension. The scar is placed on top of the foot as far as possible so it will not have to bear weight or be subjected to chafing.
What amputation levels are there?
In an ideal scenario, amputating a toe is sufficient. The surgeon attempts to fully retain the metatarsal bone in any case. When the head of the toe joint cannot be saved, however, the metatarsal bone belonging to the toe also has to be removed – at least in part. Doctors describe this as a “ray”. The loss of a ray already has major impacts on the ability to stand and walk. Without a prosthesis, this leads to malpositions.
If the entire midfoot region has already been affected, the surgeon has to remove all the metatarsal bones. A rounded residual limb cap is created to avoid different bone lengths. This makes the subsequent attachment of a tailor-made partial foot prosthesis easier.
Even if the anterior tarsal bones are affected, or in fact the entire tarsus, the surgeon should create a rounded cap to facilitate the fitting of a prosthesis.
The ankle joint is retained in all these cases. As a rule, the foot is capable of bearing weight again with a tailor-made partial foot prosthesis. You can stand and walk safely. If the ankle is also amputated but not the knee, this is a transtibial amputation. A transfemoral amputation is when the knee is affected as well.
As a rule, the amputation level is decided by the orthopaedist and the surgeon carrying out the operation. In view of your long-term treatment, however, it makes sense to involve the O&P professional even before the amputation.
What consequences will the partial foot amputation have for me?
We want to be honest: you will not feel well after the amputation. You have experienced a loss, and your self-confidence might be affected. You have to learn how to deal with the new way your body feels.
After the partial foot amputation, the surface you stand on has changed. Part of the leverage you need for walking is missing. Walking and standing will be more difficult for you at first. You will be cautious and won’t step down as firmly on the amputated residual limb. It’s to be expected that you will use malpositions to compensation for this. Getting information about devices early on is all the more important. These devices support you so you can perform your accustomed movement sequences again.
You may even feel self-conscious and perhaps find it difficult to go out in public with the amputated foot. A prosthesis can help you come to terms with your new situation more quickly. With a partial foot prosthesis, your ankle joint can move freely. Thanks to this freedom, your movements will appear virtually natural.
Your greatest challenge may be going out in public and developing a new sense of your body. That being said, you have every reason to be confident in yourself. After all, who can claim to have gone through what you have survived?
What happens in the first few weeks after the amputation?
The process of getting your life back begins immediately after the partial foot amputation. In order for you to be able to walk, ride a bicycle or drive a car again soon, the wound has to heal and the muscles need to be built up again. That takes strength and patience. The first few weeks are crucial in determining how you can live with the amputation later on.
After the amputation, you have to spend the first few days lying down without putting any weight on the foot at all. A whole host of helpers will likely arrive at your bedside shortly and expect things of you. This is the start of your rehabilitation. Nobody can tell you ahead of time how long it will take for the wound to heal and when you can walk again, drive a car or go to work. But every doctor can tell you this based on experience: The more actively and positively you get involved, the faster you will see progress in your rehabilitation.
At first, all efforts focus on wound healing. A physiotherapist helps you with mobility training starting in the wound healing phase. This ensures your muscles don’t atrophy and the joints remain mobile, even during this prolonged period of inactivity. Later, they practise compensating movements with you and train the muscles in the residual limb so you can walk safely with a prosthesis.
Rehabilitation – practice makes perfect!
The physiotherapist has another important task: they have to help you develop your sense of feeling in your residual foot. Your residual limb is so new that your brain is initially unable to process the messages from the nerves. But being able to feel the foot very precisely is of crucial importance for your health.
As soon as the wound has fully healed and you are able to bear weight on the residual limb, you are fitted with a prosthesis that you will need to gradually get used to.
You will likely be given a special shoe that relieves the forefoot to ease the transition. This shoe allows you to walk without putting excessive strain on the wound. Your rehabilitation process includes occupational therapy as well: The occupational therapist helps you improve your dexterity and practises movements for everyday life and work with you. With their support, you’re better able to cope with your own life, day by day.
Taking part in gait training and getting advice from career coaches, psychologists and, where applicable, family counsellors are also part of the process. You may need to question your previous lifestyle as well: do you have a healthy diet? Do you smoke? If you can cope with an amputation, you have the capacity to stop smoking, too. Want to bet?
As important as all the experts may be, your active participation is even more vital.
What do I need to know about wound healing?
After the partial foot amputation, you first have to lie down and elevate your foot so the blood can easily flow back to your heart. Blood and tissue fluid accumulate in the wound because of the operation and have to be gradually reabsorbed.
An elastic bandage helps dissipate the fluids. It applies even pressure without tearing at the wound. The wound is checked daily for inflammation and swelling, and the dressing is changed every day. The wound healing process is thus continuously monitored by qualified personnel.
The bandages perform another important task by shaping the residual limb so it can later bear weight again. You should therefore have the bandages changed by specialists. Please be aware that a partial foot amputation is a major operation. You have a serious wound. It may take weeks or even months for it to heal completely. Wound healing may be disrupted, which is actually common in diabetes mellitus patients. With diabetes in particular, the diabetic foot syndrome that led to the amputation is also an obstacle to wound healing. Time is your most important resource during this phase.
What are the treatment options?
A custom shaped insole can be sufficient for more minor amputations. While an insole does not help you regain function, stabilising the footbed can be sufficient after very minor operations.
A silicone partial foot prosthesis gives you freedom of movement in your ankle joint and provides you with a custom fit. The O&P professional specially adapts the silicone partial foot prosthesis to your own residual limb. It fits “like a glove”. The ankle remains free. Your entire foot is fully mobile. People with a partial foot amputation have a more natural looking motion sequence overall. Current studies indicate that the muscles are also more active compared to other treatments. Thanks to the flexible material, you can also walk longer distances and wear conventional shoes with a partial foot prosthesis.
Some doctors and O&P professionals recommend a custom-made shoe from an orthopaedic shoemaker. Carefully consider whether this is really the best choice for you. Not only do such shoes have a conspicuous appearance, they may also cause problems because the ankle joint is rigidly fixed in one position. Walking in them doesn’t look as smooth as a result and may be less comfortable for you.
An orthopaedic inner shoe, also made by an orthopaedic shoemaker, is less conspicuous. The upper ankle joint is fixed in this case as well. You cannot wear it with conventional, ready-made shoes from a shoe shop.
The Bellmann prosthesis provided by your O&P professional offers considerably more mobility. You use a stocking to slip into a prosthesis made from several layers of foam. This treatment leaves the upper ankle joint free. Other benefits are the low weight and a shape that allows you to wear conventional shoes. However, the Bellmann prosthesis cannot be adapted to resemble your other foot. People will notice that it’s a prosthesis. The material also wears relatively quickly. You will need a new prosthesis after two years, and the stocking creates friction that may be uncomfortable for you.
Frequently asked questions about partial foot prostheses
What is a partial foot prosthesis?
The partial foot prosthesis replaces the functions and appearance of the missing parts of your foot. It supports you during everyday movements, increases your muscle activity, improves the flow of blood back through the leg and makes the foot appear almost as usual again.
A silicone partial foot prosthesis can recreate the look of the other foot down to the details. The socket of the foot prosthesis is precisely adapted to your residual limb. This optimises the fit compared to other treatments. It keeps the foot very stable while also evenly distributing the load over the entire surface while walking. You can also wear any conventional shoe with a partial foot prosthesis.
What is a partial foot prosthesis made of?
We use high-grade medical silicone (HTV silicone) as the material in our partial foot prostheses. The key advantage of this silicone is that we can vary the firmness and hardness in different zones of the foot while shaping it, so that each section of the partial foot prosthesis can fulfil its respective function – firm where your foot performs the rollover, softer where your residual limb bears weight.
A special advantage is that this material is skin-friendly: silicone is permeable to gases and vapours, which means perspiration can escape. Likewise, it doesn’t contain any softeners, does not become porous, and is odour and flavour-neutral. Wearers also generally feel that the material is comfortable on their skin.
Who is a partial foot prosthesis suitable for?
Fitting and wearing a partial foot prosthesis are only a good idea if the following criteria are met:
The amputation wound has fully healed.
The ankle joint is capable of bearing weight.
The residual limb is capable of bearing weight.
The residual limb volume is stable.
Modern silicone prostheses can be used in almost all partial foot amputation cases. A prosthesis should only be ruled out if the residual limb is subject to pronounced swelling. In this case, it can’t be optimally fitted to the residual limb and creates pressure. But these are rare exceptions.
How well can I walk with a partial foot prosthesis?
A partial foot prosthesis is a good replacement for the lost part of the foot because it restores the full surface for stepping down and for the rollover. This creates safety while walking. Since the prosthesis is flexible and deforms while walking, the entire body moves correctly. You do not adopt an unnatural posture and the load on your muscles is natural. The fact that you can even walk barefoot with the prosthesis demonstrates how well this works. Every second person surveyed can walk distances of five kilometres or more with a partial foot prosthesis.
How do I care for a partial foot prosthesis?
The best way to clean the partial foot prosthesis is simply with lukewarm water and soap. You will be able to use it for a long time if you wash it daily. Wash, dry, done!
If you have a more stubborn stain on your partial foot prosthesis, just boil it for a few minutes in tap water. This is all you need to know and do in order to care for your silicone partial foot prosthesis and use it for a long time to come.
You won’t need solvents or other chemicals. In fact, using solvents is prohibited. Solvents not only penetrate the silicone but are also transferred to the skin while wearing the prosthesis.
How do I get a partial foot prosthesis?
Start by talking to your doctor about the possibility of a partial foot prosthesis. They can assist you with health insurance and, if necessary, provide the O&P professional with important information about your special requirements. As a rule, health insurers cover the cost for a purely functional model. Co-payment is generally required for models with more complex cosmetic features.
Then look for a medical supply company that has experience with partial foot prostheses. You can use the expert search function to find a specialist near you. Ottobock’s partners have the necessary technical equipment and special training, and they are certified by Ottobock. (Please get in touch with us if you can’t find any partners near you.)
The O&P professional will take precise measurements of your foot as well as taking photos and preparing a plaster cast. Based on this cast, we fabricate a trial prosthesis that you wear for four to six weeks. Your O&P professional adapts the prosthesis during this period. This is necessary because you can walk again with the trial prosthesis and your muscles get stronger by exercising. Plus, you naturally need time to get used to a prosthesis.
Finally, the medical supply company determines the right skin colour for the prosthesis with you. The data and all corrections are sent to Ottobock. Based on all the information, we then fabricate the final partial foot prosthesis that gives you a virtually normal life.