Lower limb amputation, or lower-extremity amputation, has to do with removing infected or damaged tissues or necrotic tumors above and below ankle level. Performing this procedure has significant psychological outcomes for patients as they endure rehabilitation, get limb fitments, and learn how to walk effectively again.
Surgical planning for lower limb amputation has to be performed with the purpose that the patient can easily and comfortably fit out the prosthesis, engage completely in rehabilitation, and lower energy levels that they could muster when they are walking. Patients usually struggle with their amputation – a learning process that involves getting the prosthesis on and off, checking pressure areas, trying to walk on the ground of varying surfaces, and managing the times when the prosthesis is not worn.
To help patients how to cope with their situation, there is a need for a skilled team of doctors, surgeons, prosthetists, and physiotherapists. Optimal access to healthcare and quality treatment within the postulated time that the injured lower limb could be saved from infection or disease is crucial.
Common causes for amputation
Road crashes and landmines
In India alone, the country has the highest number of road accidents, according to a report conducted by the World Health Organization (WHO) entitled “Global Status report on road safety 2009.” The road accidents would be the major cause of traumatic lower extremity injuries that result in amputation. Apart from vehicle accidents, landmines are also a major cause for severe injuries of the lower limb.
Polio comes in as another cause of lower limb amputation in India. Polio also referred to as poliomyelitis or infantile paralysis, is a deadly infectious disease caused by the poliovirus. This lethal virus can weaken the muscles and infect a person’s brain and spinal cord, thus resulting in paralysis and permanent disability, especially in the lower limbs.
According to the World Diabetes Foundation, around 40,000 lower extremity amputations are being performed in India each year because of diabetic complications. WHO estimates that by 2030, India will have the highest tally of diabetics in the world.
In a study, called Int J Low Extrem Wounds, the author Viswanathan confirmed that there is a 52% “recurrence of foot infection was common among Indian diabetic patients.” (Viswanathan, 2007).
Peripheral vascular disease
Peripheral Vascular Disease (PVD) is also on the rise targeting elderly populations. It is also a common reason for amputation because of blocked blood flow to the arms and legs. This often leads to the lower limbs suffering from the trauma that affect the veins, nerves, and arteries. Once the leg muscles don’t get sufficient blood, patients would experience painful cramps when they walk or exercise.
Other reasons for lower limb amputation include tumors, infections, and congenital limb deficiencies.
Categories of lower limb amputation
Lower limb amputation is classified into several categories:
- Foot amputation: It is the removal of any part of the foot or toes.
- Below knee amputation: It is the amputation of any level from the knee to the ankle.
- Above knee amputation: It is the amputation at any level from the hips to the knee joint.
- Knee disarticulation: Amputation ensues at the level of the knee joint.
- Hip disarticulation – Amputation occurs at the hip joint involving the entire thigh and lower leg portion.
Importance of exercise pre- and post-fitment
Prior and after prosthesis fitment, patients will undergo physiotherapy services for muscle strength and joint movement. A certified healthcare team will help patients learn how to do this.
Undergoing physiotherapy is important because:
- It keeps the remaining leg in good condition
- It helps to decide whether the patient has the strength and balance to walk with a prosthesis
- It enables a way of walking if the prosthetic limb needs to be repaired or if a patient suffers from a painful leg.
If a patient is fitted with prosthesis, it is crucial to continue exercising even without the prosthesis.
Overall, lower limb amputation is considered a life-saving operation involving reconstruction and replacement instead of just removal of the limb. It also takes into consideration the patients’ future life and their independence.