After the leg amputation
Read about residual limb healing, phantom pain, initial exercises after the amputation and the fitting with an interim and definitive prosthesis.
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.
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.
When you wake up from the anesthetic, 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.
After the operation, the tissue around the residual limb will usually swell up at first. This swelling, referred to as edema, is a normal reaction to the operation. It usually subsides after a 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 the swelling. The same measuring points must be used consistently, and the results must be documented on measurement forms. If neglected, the results are not comparable with each other and there is no way to tell if the swelling is decreasing.
Early compression therapy
After the operation, a wound dressing is applied and changed at regular intervals. Compression therapy begins after that, for example, with a compression bandage. Your doctor will determine the exact timing. The purpose of compression therapy is to reduce the residual limb edema and prepare your residual limb for your subsequent prosthesis. Residual limb compression helps optimize the fitting of your prosthesis. Compression also promotes blood circulation in the residual limb. This reduces pain and promotes scar healing.
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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.
Causes of phantom pain
Experts have various theories regarding the origin of phantom pain. One of the most common ones is that different areas in the brain are responsible for different body regions. When a body part is missing and doesn’t produce any feedback anymore, the brain interprets this lack of a signal as pain. In this context, it’s interesting to note that people with a congenital limb difference, known as dysmelia, do not experience phantom pain as often. This suggests that there is a sort of “learning effect” in the brain. Pain memory appears to play an important role as well. If the patient was already experiencing pain before the amputation, this can affect the development of phantom pain and should also be taken into account in selecting the therapy.
Types of phantom pain
Phantom pain is very individual and depends on many factors. It affects individuals with leg or arm amputations equally. The pain may be triggered or intensified by certain types of weather, exposure to cold temperatures or emotional stress. It may occur only at certain times, gradually decrease or increase, or always be present. The type, intensity and characteristics of the pain can differ as well. Affected individuals describe pulling and piercing or burning and cramp-like pain.
Phantom pain is different from phantom sensations, feelings in the lost limb that are not painful.
Therapy options for phantom pain
Various kinds of pain may occur in the residual limb after an amputation. It is important to differentiate between residual limb pain and phantom pain, since these types of pain are treated differently.
There are many different therapy approaches for both types of pain. Combining several types of therapy is recommended for phantom pain. There is no standard therapy that helps all affected individuals. Furthermore, many therapies are of a long-term nature and require the active participation of the affected person. You may need a great deal of patience and endurance. But we can only encourage you to do the therapy, even if it is challenging. Be sure to talk to your doctor, O&P professional and therapist. They will work closely with you and support you to the best of their ability. The following methods are suitable means of therapy for phantom pain after an amputation and complement each other
Mirror therapy: sitting in front of a mirror, the patient’s sound limb is reflected with the help of mirrors. This makes it appear as though the amputated limb is there again. Known as the phantom limb, it can now be moved purposely via the sound side and therefore influenced. This makes it possible to release the phantom limb from cramped and painful positions with the help of movements by the sound side, moving it into a more comfortable, pain-free position. Comparable results can be obtained by looking at photographs (known as lateralisation training). This is intended to practise right/left memory.
Sensorimotor therapy: massaging the residual limb with various materials stimulates nerves via the skin. Ultrasound, thermal or electrotherapy can be used here as well.
Wearing a prosthesis or liner: for many affected individuals, pain is alleviated by wearing a prosthesis or liner. This may be due to sensory stimulation of the residual limb as well as the idea that, with a prosthesis, the body part is still there so the brain is receiving corresponding feedback.
Pain therapy: a pain therapist is a doctor specialising in the treatment of pain. Your doctor will put you in contact with such a specialist. It’s important that you do not try to treat yourself with pain medication in any case.
Residual limb pain
Residual limb pain and phantom pain are different types of pain and are therefore treated differently. For this reason, it’s important that you are thoroughly examined in order to determine whether you are experiencing phantom pain or another form of residual limb pain. Residual limb pain can also be caused by a poorly fitting prosthesis. Medical examinations help clarify whether you may have bothersome scar tissue, painful residual limb neuromas, inadequate soft tissue coverage or excess soft tissue. These causes of pain can be eliminated on a long-term basis by adapting the components or via another surgical intervention.
Certain operating techniques can also help reduce residual limb pain and especially the pain originating from some nerves in the residual limb after the amputation. If possible, preventive pain therapy should commence during the operation with a local anaesthetic or begin directly after the operation to prevent the onset of pain or the development of chronic pain.
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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.
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.
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.
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.