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Below-Knee Amputation Physiotherapy
Transtibial amputation, or commonly known as below-knee amputation, is a surgical
procedure performed to fully remove a lower limb that has been damaged
- congenital defect
represents 23% of all lower-limb amputations. Amputation is possible in
any age group, but generally it affects (or is highest) among people aged 65 years
What is a Below-Knee Amputation?
Transtibial amputation, or below-knee amputation, is a surgical
procedure performed to remove the lower limb below the knee when that
limb has been severely damaged or is diseased.
Most of the time, below-knee
amputations (60%–70%) are decisions due to
- peripheral vascular disease
of the circulation in the lower limb
Poor circulation decreases healing
and immune responses to injury; and this may lead to foot or leg ulcers.
The poor circulation may compromise healing of such ulcers and may lead to an infection that can spread
to the bone and become life-threatening.
Amputation is usually a last-line of decision and performed to
remove the diseased tissue and prevent the further spread of infection.
Transtibial amputation surgery is usually performed by a vascular or
orthopedic surgeon. The diseased or severely injured part of the limb is
removed, and the doctor will try their best to preserve and keep as much of the healthy limb as possible. The surgeon
will also shape the remaining limb to allow the best use of a prosthetic leg
The need for below-knee amputation is caused by conditions including:
- Peripheral vascular disease (poor circulation)
- Foot ulcers
- Trauma causing the lower leg to be crushed or severed
How our senior physiotherapists can help
Our senior physiotherapists help people who receive a below-knee amputation
prepare for surgery, and regain strength, movement, and function
Prior/Before to Surgery
Before your surgery, our senior physiotherapist may:
- Prescribe exercises for preoperative conditioning, and to improve the strength and flexibility of the hip and knee
- Teach you how to walk with a walker or crutches
- Educate you about what to expect after the procedure
Immediately After Surgery
Your hospital stay will be between 5 to 14 days after surgery.
Your wound will be bandaged, and you may also have a drain at the
surgery site—a tube that is inserted into the area to help remove excess
Pain will be managed with medication and painkillers (this will be tapered off with time and with observing how you cope/your pain experience).
You may see our senior physiotherapy as soon as possible after surgery when your condition is
stable and the doctor clears you to start below-knee amputation physiotherapy. Our senior physiotherapist will review your medical and surgical history, and visit you
at your bedside.
Your first 2 to 3 days of treatment may include:
- Gentle stretching and range-of-motion exercises
- Learning to roll in bed, sit on the side of the bed, and move safely to a chair
- Learning how to position your surgical limb to prevent joint stiffness and joint contractures
(the inability to straighten the knee joint fully, which results from
keeping the limb bent too much)
When you are medically stable, our senior physiotherapist will help you
learn to move about in a wheelchair, and stand and walk with an
below-knee amputation physiotherapy
Our senior orthopedic physiotherapists will work with you as you heal following the
amputation, help to
- fit your prosthesis
- guide your rehabilitation
to ensure you regain your strength and movement in the safest way
Your treatments may include:
Prevention of joint stiffness and contractures. A contracture is the
development of soft-tissue tightness that limits joint motion. The
condition occurs when muscles and soft tissues become stiff from lack of
movement. The most common contracture following below-knee amputation
occurs at the knee when it becomes flexed and unable to straighten. The
hip also may become stiff.
It is important to prevent contractures early; they can become
permanent if not addressed following surgery, throughout recovery, and
after below-knee amputation physiotherapy is completed. Contractures can make it difficult to
wear your prosthesis and make walking more difficult, increasing the
need for an assistive device like a walker.
Our senior physiotherapists will help you maintain normal posture and
range of motion at your knee and hip. We will also teach you how
to position your limb to avoid development of a contracture, and show
you stretching and positioning exercises to maintain normal range of
Compression to reduce swelling. It is normal to
experience postoperative swelling. We will help you
maintain compression on your residual limb to protect it, reduce and
control swelling, and help it heal. Compression can be accomplished by:
- Wrapping the limb with elastic bandages
- Wearing an elastic shrinker sock
These methods also help shape the below-knee amputated limb to prepare it for fitting the prosthetic leg.
In some cases a rigid dressing, or plaster cast, may be used instead
of elastic bandages. An immediate postoperative prosthesis made with
plaster or plastic also may be applied. The method chosen depends on
each person’s situation. Our senior physiotherapist will help monitor the
fit of these devices and instruct you in their use. The main goal of
your care during this time is to reduce swelling.
Pain management. Our senior physiotherapist will help with pain management in a variety of ways, including:
- Manual therapy, which may include hands-on treatments performed by our senior physiotherapist, including soft tissue (ie, muscle, tendon)
mobilization, joint manipulation, or gentle range-of-motion exercises,
in order to improve circulation and joint motion
- Stump management, including skin care and stump sock use
- Desensitization physiotherapy to help modify how sensitive an area is to clothing,
pressure, or touch. Desensitization therapy involves stroking the skin with
different types of touch to help reduce or eliminate sensitivity
- Mirror therapy and/or graded motor imagery
Approximately 80% of people who undergo amputations experience a
phenomenon called phantom limb pain, a condition in which some of their
pain feels like it is actually coming from the amputated limb. We will work with you to lessen and eliminate the
Prosthetic fitting and training. We will work with a prosthetist to prescribe the best prosthesis
for your life situation and activity goals. You will receive a temporary
prosthesis at first while your residual limb continues to heal and
shrink/shape over the first 6 to 9 months of healing. The prosthesis
will be modified to fit as needed over this time.
Most people with below-knee amputations learn to walk well with a
prosthesis. Physicians use the following criteria to determine when you
are ready for a temporary prosthesis, or your first artificial limb.
- Your incision should be almost healed or completely healed.
- Your swelling should have decreased to an acceptable amount.
- You will have regained sufficient overall strength to be able to walk safely.
After the limb has reached a stable shape, and your physician
approves your condition, you will be fitted for a permanent prosthesis.
Functional training. After you move from acute care
to rehabilitation, you will learn to function more independently. We will help you master wheelchair mobility and walking
with an assistive device like crutches or a walker. We also
will teach you the skills you need for successful use of your new
prosthetic limb. You will learn how to care for your residual limb with
skin checks and hygiene, and continue contracture prevention with
exercise and positioning.
We will teach you how to put your new prosthesis
on and take it off, and how to manage a good fit with the socket type
you receive. We will also help you to gradually build up
tolerance for wearing your prosthesis for increasingly longer times,
while protecting the skin integrity of your residual limb. You will
continue to use a wheelchair for getting around, even after you get your
permanent prosthesis, for times when you are not wearing the limb.
Guided rehabilitation. Prosthetic training is a
process that can last up to a full year. You will begin when your
physician clears you for putting weight on the prosthesis. We will help you learn to stand, balance, and walk with the
Most likely you will begin walking in parallel bars,
then progress to a walker, and later as you get stronger, you may
progress to using a cane before walking independently without any
assistance. You will also need to continue strengthening and stretching
exercises to achieve your fullest potential, as you return to many of
the activities you performed before your amputation.
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Phoenix Rehab Group works with specialist physiotherapists and rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.
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Sports and deep tissue release massage helps to increase nutrient-rich blood
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At the first session, our specialist physiotherapists will carry out a thorough
assessment, helping them to select the most appropriate treatment to
help you recover as well as provide treatment in the same session.
Follow up sessions are inline to provide
expert treatment for your pain as well as prescribing specific
exercises to reduce your risk of re-injury and giving you a long term
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