special subjects
Leg Amputation Rehabilitation
Complications
 is the most common complication (see Pain in the Residual Limb ). Common causes of pain include A poorly fitted prosthetic socket: This cause is the most common. Neuroma: An amputation neuroma is usually palpable. Treatments include ultrasound therapy, injection of corticosteroids or analgesics into the neuroma or the surrounding area, cryotherapy, and continuous tight bandaging of the residual limb. Surgical techniques are available for refractory pain. Spur formation at the amputated end of the bone: Spurs may be diagnosed by palpation and x-ray. The only effective treatment is surgical resection. Phantom limb sensation(a feeling that the amputated part is still present possibly accompanied by tingling) is experienced by some people with recent amputations. This sensation may last several months or years but usually disappears without treatment. Frequently, patients sense only part of the missing limb, often the foot, which is the last phantom sensation to disappear. Phantom limb sensation is not harmful; however, patients, without thinking, commonly attempt to stand with both legs and fall, particularly when they wake at night to go to the bathroom. Phantom limb painis less common and can be severe and difficult to control. Some experts think it is more likely to occur if patients had a painful condition before amputation or if pain was not adequately controlled intraoperatively and postoperatively. Various treatments, such as simultaneous exercise of amputated and contralateral limbs, massage of the residual limb, finger percussion of the residual limb, use of mechanical devices (eg, a vibrator), and ultrasound, are reportedly effective. Medications (eg,gabapentin) may help. Skin breakdowntends to occur because the prosthesis presses on and rubs the skin and because moisture collects between the residual limb and prosthetic socket. Skin breakdown may be the first indication that the prosthesis needs adjustment and needs to be managed immediately. The first sign of skin breakdown is erythema; then cuts, blisters, and sores may develop, the prosthesis is often painful or impossible to wear for long periods of time, and infection can develop. Several measures can help prevent or delay skin breakdown: Having an interface that fits well Maintaining a stable body weight (even small changes in weight can affect fit) Eating a healthy diet and drinking lots of water (to control body weight and maintain healthy skin) For patients with diabetes, monitoring and controlling their blood sugar level (to help prevent vascular disease and thus maintain blood flow to the skin) For patients with a lower-limb prosthesis, maintaining body alignment (eg, wearing only shoes with a similar heel height) However, even with a good fit, problems can occur. The residual limb changes in shape and size throughout a day, depending on activity level, diet, and the weather. Thus, there are times when the interface fits well and times when it fits less well. In response to such ongoing changes, people can help maintain a good fit by switching to a thicker or thinner liner or sock, by using a liner and a sock, or by adding or removing thin-ply socks. But even so, the residual limb’s size may vary enough to cause skin breakdown. If there are signs of skin breakdown, patients should promptly see a health care professional and a prosthetist; when possible they should also avoid wearing the prosthesis until it can be adjusted. (See also Loosening of the Prosthesis .) 