Living with a leg amputation

Before the leg amputation

Learn about what happens leading up to a planned amputation and how you can prepare yourself.

Get in touch with experts

Get in touch with experts

Even though it’s so important, many people don’t realise that you can have influence on who will be treating you. Your care team includes everyone who looks after you during and after the amputation. The team centres around your O&P professional, who also coordinates the process. It’s important that you are treated by specialists with plenty of experience with leg amputees. We provide you with information here so you can learn all about the general treatment process and the various tasks of everyone involved. Our list of experts helps you get in contact with the right specialists, and you can use our checklist to make sure you have considered all the steps.

Reasons for amputating

The most common causes for a leg amputation

An amputation is the severing of a bone in healthy tissue. When a body part is severed in a joint, this is known as a disarticulation. An amputation is required when a diseased body part is not expected to heal and the patient’s life is at risk as a result. Causes may include circulatory disorders, infections, accidents, cancer or a congenital limb difference (dysmelia). In some of the above cases, the need for an amputation is known some time in advance. On the other hand, amputations are sometimes necessary entirely unexpectedly, for example, due to severe injuries after an accident.

Amputation due to circulatory disorders

Amputation due to circulatory disorders

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.

Amputation due to diabetic foot syndrome

Amputation due to diabetic foot syndrome

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.

Amputation after an accident

Amputation after an accident

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.

Amputation due to tumours

Amputation due to tumours

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.

Amputation after an infection

Amputation after an infection

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.

Amputation levels

The appropriate amputation level is established

The term amputation level describes the place where a body part is amputated. It is established by the doctor before the operation and is based on the reason for amputating.

If the surgery is planned, your O&P professional can be included in the consultations beforehand. The O&P professional can provide advice regarding the most suitable amputation level for the subsequent fitting with a prosthesis.

This is because the amputation level is one of the factors in determining the right prosthesis. It establishes what parts and joints of your leg have to be replaced by a prosthesis.

Foot amputation

Foot amputation

There are more than twelve different amputation levels in the area of the foot. They range from a toe amputation to a midfoot amputation to amputations in the area of the tarsus.

Silicone prostheses can be used for a prosthetic fitting.

Transtibial amputation (lower leg amputation)

Transtibial amputation (lower leg amputation)

With a transtibial amputation, the tibia and fibula are severed.

A prosthetic foot, adapters and connecting elements to the prosthetic socket are needed for the prosthetic fitting.

Knee disarticulation

Knee disarticulation

A knee disarticulation is when the knee joint is cut, severing the lower leg. The entire thigh is retained.

A prosthetic foot, knee joint, adapters and connecting elements to the prosthetic socket are needed for the prosthetic fitting.

Transfemoral amputation (above-knee amputation)

Transfemoral amputation (above-knee amputation)

With a transfemoral amputation, the femur is severed.

A prosthetic foot, knee joint, adapters and connecting elements to the prosthetic socket are needed for the prosthetic fitting.

Hip disarticulation

Hip disarticulation

During a hip disarticulation, the amputation is performed in the area of the hip joint. With this amputation, the pelvis will later control the prosthesis.

A prosthetic foot, knee joint, hip joint, adapters and connecting elements to the prosthetic socket are needed for the prosthetic fitting.

Hemipelvectomy

Hemipelvectomy

In a hemipelvectomy, the entire leg and parts of the pelvis up to the sacrum are amputated. With this amputation, the pelvis will later control the prosthesis.

A prosthetic foot, knee joint, hip joint, adapters and connecting elements to the prosthetic socket are needed for the prosthetic fitting.

Treatment team

These experts are there for you and look after your treatment

A team of experts from various disciplines handles your treatment before and after an amputation. We have listed the members of this team here and described the role each of them plays in your treatment.

The O&P professional plays a pivotal role within this team. We advise you to seek contact with them even before the amputation if possible. Our list of experts can help you find someone who already has a great deal of experience in working with leg amputees and is therefore able to provide you with good advice.

Physiotherapists and occupational therapists

Physiotherapists and occupational therapists

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.

O&P professional

O&P professional

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.