Below Knee Amputation – Surgery, Recovery and Maintaining Mobility
1.8 million people in the United States are living with amputations, and between 30,000 and 40,000 amputations are performed in the United States on an annual basis (1). Below knee amputations are the most common amputation surgery and comprise approximately 23% of lower limb amputations. The majority of below knee amputations are performed on individuals aged 65 and older.
While any amputation is a life-changing event, it is important to remember that amputations are viewed as a reconstruction surgery with the goal of returning the patient to a normal life. Advances in medical technology and prosthetics have helped many patients return to a relatively pain-free and active lifestyle after amputation surgery.
This article is focused on below knee amputations (“BKA”), and the following topics will be addressed:
- Causes of Below Knee Amputation
- Helpful Hints for Successful Surgery
- Is Below Knee Amputation Right for You
- What to Expect from Below Knee Amputation Surgery
- Below Knee Amputation Recovery
- Possible Complications from Below Knee Amputation
- Living as a Below Knee Amputee
- Support Organizations for Below Knee Amputees
Causes of Below Knee Amputations
Below knee amputation surgery is generally performed if a person’s lower extremity or foot has been severely injured or if he/she suffering from chronic and sever pain in the foot or lower extremity. Causes of the injury or generally related to the following(2):
- Trauma – a severe injury resulting from and event such as a vehicle accident or serious burn causing severe fractures and/or nerve injury.
- Diabetes – people who suffer from diabetes may experience poor circulation because of the narrowing of the arteries. This is known as peripheral vascular disease (PVD). In this case, poor circulation does not allow the extremities to obtain sufficient nutrients and oxygen from the bloodstream. The affected tissue begins to deteriorate, and this can lead to amputation. PVD is the leading cause of below knee amputations.
- Cancer – untreatable tumors in the bone or muscle in the lower limb may lead to below knee amputation.
- Infections – if infections are untreatable with antibiotics or other remedies, removal of the lower limb may be required.
- Neuroma is the thickening of the nerve tissue, which can cause severe pain. Neuroma most often affects the feet.
- Congenital Limb Deficiency is a common cause of below knee amputation among small children and takes place when a limb does not completely form.
- Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that affects the limbs and is usually caused injury or trauma to that limb. It is believed that CRPS is caused by a malfunction or damage to the peripheral or central nervous system.
While there are many other reasons that a person may choose below knee amputation, those listed above are the most common.
Below knee amputation surgery is a serious undertaking aimed to address serious issues in the foot or other areas below the knee. Any decision to amputate involves multiple factors and should include many discussions between the patient and their team of doctors.
Helpful Hints For a Successful Surgery
Below knee amputation surgery is a means to improve the quality of life for many patients. There are a number of things you can do to prepare for the surgery that facilitate your transition to an independent and hopefully pain free lifestyle soon after surgery. Here are a few helpful hints that will better prepare you for surgery.
Know what to expect!
Talk to your team doctors about best practices pre-surgery and know what to expect from rehabilitation. Consult your primary care physician, orthopedic surgeon, prosthetist (specialist in the design and fit of artificial limbs), physical therapist, and rehabilitation doctor. The patient may also want to discuss the surgery with a psychiatrist, social worker, or someone who has already undergone below knee amputation.
Seek out a below knee amputee who is of a similar age to find out tips for a successful surgery and rehabilitation. Look for support groups to help you answer questions about the physical and psychological effects of amputation and tips on how to return to ideal lifestyle. Familiarize yourself with the transition to a prosthetic and seek out methods to ease that transition. A list of support and peer groups is included at the end of this article.
Begin to think about changes that need to take place at your house. Will you be confined to a wheelchair for a period of time? If so, you might need ramps positioned in your home. Think about ways to transition to independence post-surgery. You may want to reposition furniture, kitchen items, etc. to make them more easily accessible. Utilize the BKA community (blogs, YouTube, Facebook pages), and learn tips to make your post-surgery transition more comfortable.
Stay strong and healthy!
Did you know below knee amputees use approximately 25% more energy walking post-amputation? (3) It is incredibly important to maintain or increase fitness levels and muscle strength before surgery. Many doctors will prescribe exercise to maintain muscle conditioning in the upper leg and improve strength and flexibility in the hip and knee. Straight leg raises and knee extension exercises should be performed regularly before surgery.
Some below knee amputees have stated that learning to walk with a walker, crutches, knee scooter, or hands free device, such as iWALK2.0 helped them tremendously post-surgery. Learning to balance while not bearing weight on one leg can be challenging and it may take time to adjust. Advances in medical device technology, such as iWALK2.0, have enabled many BKA patients to learn to walk with a prosthetic even before amputation surgery and have eased the transition to a prosthetic foot or prosthetic leg. Utilizing this technology not only helps pre-surgery patients maintain muscle strength, but it also has shown to smooth the transition to utilizing a prosthetic.