Losing your lower limb or leg because of trauma, disease, or an inherited defect can be devastating socially, emotionally, and physically. Your life changes completely, but it is not a reason enough to give up. A physical therapist (PT) or movement professional can guide you to live an everyday and healthy life after a below-knee amputation (BKA) through education, hands-on PT, and predetermined movement. At Suarez Physical Therapy, we have experienced physical therapists in Las Vegas who will evaluate the transtibial amputation and find ways to help you live a happy and comfortable life with the new normal.
Understanding Below-Knee Amputation
Transtibial, or BKA, is a procedure that entails surgical removal of the lower limb or leg under the knee. It is done after severe leg trauma in an accident, inherited abnormalities, or illness. The primary cause of these amputations is poor blood flow in the legs, also called peripheral vascular disease (PVD), stemming from diabetes or severe circulatory abnormalities on the lower extremities. The condition slows down healing and weakens the body’s natural resistance to harm, increasing the risk of lower limb or foot ulcers. Due to the low immunity and healing power, the ulcers take long to heal, leading to polymicrobial infections. When the infection goes untreated, it spreads to the bones, putting your life at risk.
A vascular or orthopedic surgeon performs the BKA to deter the growth of infection to the area above the knee to avoid risky transfemoral amputation. The dead tissue or severely hurt section of the leg is removed, leaving the healthy part. The balance limb is then reshaped to allow for the proper fitting of the prosthetic leg.
Common conditions that lead to transtibial amputation are:
- Diabetes
- PVD
- cancer
- Foot ulcers
- An accident that shatters or crushes the leg
- Infections
- Tumors
The Intervention of a Physical Therapist
A PT is necessary not only after the surgery but also after the surgery. You will require the movement expert before the amputation to prescribe activities that can help strengthen the upper or lower extremities. Also, before removing the damaged leg, your PT will train you on how to utilize a scratch or walker after the leg is amputated.
Anxiety is common before an amputation because many patients do not know your expectations. Luckily, a PT can help reduce the stress by explaining to you and your loved ones the expectations post-amputation.
Right After Surgery
Once your leg has been amputated, you will stay in the hospital for approximately two weeks. The surgical area will be covered with a bandage, and you will have a tube inserted into the wound to drain excess fluids and enhance faster healing. Post-surgery pain is expected during the first two weeks, although your surgeon can manage it using pain relievers.
Once the wound has stabilized and you have the nod from your doctor to begin therapy, you can speak to your movement expert to start physical therapy. The PT will come to see you while still in the hospital to review your health and operative history.
After discussing your medical record, your PT will prescribe treatments. The exercises you should expect in the first 36 hours of physical therapy are:
- Range-of-motion
- Gentle stretching
- Learning bed rolling skills
- Obtaining skills to shift to a chair safely
- Learning the correct placement of the surgical limb to stop contractures means the incapacity to stretch the knee cap entirely due to extreme limb flexion. You develop this condition by keeping the surgical knee joint bent for an extended duration.
When you regain stability, the PT will move the exercises a notch higher to include movement skills. Learning to move around is crucial because you use a wheelchair, sit, or stand with scratches or other assistive devices.
Rehabilitation Post Surgery
Your PT will not wait until you are fully recovered to start rehabilitation. They will be by your side throughout the rehabilitation process to assist you in safely restoring mobility and strength. The treatments you should expect in the rehabilitation stage are:
Contractures Prevention
A contracture occurs when your soft tissue and tendons become tight and inflexible due to a lack of motion. For instance, after a BKA, if you bend your knee for extended durations because of sitting in one place, the soft tissue could become stiff, hindering your ability to move the joint. Contractures are common among patients who repeatedly lay flat on the bed with the amputated lower limb separated from the other leg by a pillow. Apart from the amputated leg developing contractures, you could suffer a stiff hip.
A contracture can become permanent when not addressed immediately during surgery, recovery, or rehabilitation. If the condition causes permanent damage, wearing a prosthesis will be challenging. Contractures will also hamper mobility, forcing you to depend more on walkers.
Thanks to physical therapy (PT), you can prevent soft tissue and muscle stiffness in the affected leg. Your movement expert will emphasize maintaining good posture and a knee and hip motion range. You will learn skills to stretch and position the leg for a standard motion range, preventing contractures. With the guidance of a mobility expert, you can maintain the ability to pull your knee.
Compression Therapy to Reduce Inflammation or Swelling
Inflammation after a BKA is joint. With the guidance of your movement expert, you will acquire skills to keep compression on the remaining limb, reduce and manage swelling, and promote faster healing. The two primary ways of obtaining compression are putting on an electric shrinker sock or wrapping the remaining limb with an elastic bandage.
Compression reduces swelling and helps shape the balance of the limb, making the prosthesis leg a perfect fit.
You must know that elastic bandages are not always required for compression. You can replace them with a plaster, plastic cast, or dressing. Alternatively, an immediately postoperative prosthesis can be applied to compress the limb to prevent inflammation.
You can use any of these compression techniques depending on your unique circumstances. Your mobility expert will help you pick the method that perfectly fits the remaining limb and educate you on utilizing the device for minimal swelling post-surgery.
Pain Management
Pain is a significant concern after an amputation, so you must know how to manage it. One common technique the therapist will use is manual therapy, like massage or joint manipulation. Massaging tendons and muscles enhances joint mobility and circulation, alleviating pain.
Similarly, the PT can encourage you to use skincare and correct utilization of the prosthetic shrinker to manage the remaining limb.
The amputation area is usually susceptible to contact or force from your clothes. A movement expert can help minimize or eliminate sensitivity through desensitization, a technique that entails stroking the limb's skin with different touch forms.
Additionally, mirror therapy can lower phantom discomfort or sensation. Phantom discomfort is an abnormality in which you feel pain emanating from the balance limb. Your PT can eradicate the sensation through rehabilitation.
Several pain control techniques exist that your PT can use after a BKA to control pain. Therefore, speak to your PT for an evaluation and recommendation on the most efficient pain control method to avoid undergoing rehabilitation while experiencing excruciating pain.
Acquiring Skills in Prosthetic Wearing and Maintenance
During rehabilitation, you will also learn how to fit your prosthesis. Your movement expert engages the prosthetist to develop a device tailored to your mobility needs, life circumstances, and activity goals. Tolerance to the prosthesis does not come immediately. You will begin with an interim prosthesis, which you will wear during recovery to help compress and shape the balance limb for the final prosthesis. You will use the interim prosthesis for at most nine months after the BKA, after which you will be ready for the final prosthesis. Many people who undergo a BKA learn to use a prosthesis quickly and comfortably.
Timing is critical when it comes to using the prosthesis. Training does not begin immediately after the leg is amputated. Your PT must thoroughly evaluate to determine if you can start training using the temporary artificial limb. The factors the therapist takes into account when deciding on prosthesis training include:
- Whether your incision site is almost or fully healed
- Whether the swelling on the wound has considerably decreased for safe and easy fitting of the temporary prosthesis
- Whether you have restored enough strength to walk safely
If your limb is almost healed or has already healed, you will be eligible for the prosthesis training. Besides, decreased swelling means the wound is recovering well, and you are fit to wear the artificial leg. Lastly, you must have the strength to walk safely for the PT to recommend a prosthesis.
After you undergo training using the interim artificial leg and your therapist is satisfied that the remaining limb has attained the required shape and fully healed, they will prescribe the permanent artificial leg.
Functional Recovery and Prosthetic Training
Once you acquire the permanent prosthesis, you will become more independent. A prosthetic eliminates the need for a wheelchair. Additionally, your mobility expert will train you to perform mobility tasks, engage in your routines, and walk comfortably using assistive tools, helping you engage in many activities without relying on a caregiver.
The training also involves a skincare routine to help your skin around the limb area develop resistance to redness or bruises that could stem from prolonged prosthesis use. Even with the prosthetic, proper positioning of the legs and performing contracture prevention exercises are recommended to lower the risk of permanent contractures that could hinder your capacity to wear the prosthesis.
A lot of work goes into effectively managing a prosthesis for maximum benefits. Therefore, your PT will equip you with the necessary skills to fit and remove the artificial leg and ways to control the socket fit of the prosthesis.
Even after learning to use a prosthesis, you will sometimes require a wheelchair because of the sores or blisters on the limb, as well as prosthesis repair or replacement.
Guided Rehabilitation
Your rehabilitation journey will start when your PT gives you a nod to begin bearing weight on the prosthesis. This happens after you have mastered balance and how to walk and stand with the prosthesis. The rehabilitation journey after a BKA is lengthy and can take approximately twelve to eighteen months to recover completely and regain your normal self. The rehabilitation journey will not be smooth one because you will encounter many challenges along the way. However, with practice and training, you will overcome these challenges and learn how to control the artificial leg.
Before you start rehabilitation, you should share your goals with the therapist. Talk to them about your normal life before the amputation, including your family activities, job-related tasks, and hobbies. That way, the PT can tailor the rehabilitation to attain or exceed these objectives. Rehabilitation depends on your efforts and the efforts of your movement expert. Therefore, you must find a PT who is a team player and one you are comfortable around because you will be spending a lot of time together.
Resuming Activities
Before you can return to your favorite recreational or sporting activity, you need a go-ahead from your therapist. The PT can focus on adaptive sports to help you pick the best assistive equipment for the sport or recreational activity. Based on your goals, the PT can assist you in resuming playing sports or recreational activities like golf, cycling, swimming, or running. The prosthetist working with your movement expert can also help you pick the correct artificial leg for the activity you are interested in.
Homecare Techniques
When you return home from the hospital after a BKA, you should follow these guidelines for quick healing:
1. Engage in Activities
If you stay in bed the whole time after leaving the hospital, the remaining limb will not heal as fast. Therefore, you should remain active and utilize the limb. However, you should discuss these options with your surgeon. You can also take showers with the physician's approval, but ensure you clean the wound dry to remove all water and soap residue. Driving is also recommended, but you should adjust the seat to ensure comfort. With these activities, it is easy to recover within one to two months.
2. Check your Nutrition
If your stomach is settled, you can continue with your regular diet. However, when unsettled, consider diets low in fiber, like plain rice, bread, or boiled chicken. Besides, irregular bowel movements are common after a BKA. Therefore, take daily fiber supplements to avoid constipation.
3. Take Medication
Your physician will prescribe medication for you to take home. Ensure that you understand the prescription instructions for quicker healing. If you are on pain medication, follow the dosage provided. Do not be tempted to take more than the recommended dosage. Also, you should talk to the doctor before taking OTC painkillers. If you need pain medication, request it from the physician.
The surgeon’s post-surgical instructions are not an option. You must do as instructed and take medication.
4. Care for the Balance Limb
When leaving the hospital, the remaining leg will have a cast, stiff dressing, and a bandage. Your physician will only let you leave the hospital with instructions on how to care for the dressing. The doctor will encourage you to look out for signs like redness or irritation on the skin in the limb area. If you see these signs, you should return to the hospital.
Again, they encourage you to gently wash and pat the limb with warm water and soap. You will also be instructed to remove the prosthetic before bed.
5. Engage in Exercises
Training the remaining leg and prosthesis is essential in rehabilitation. Therefore, you should partner with a physiotherapist and doctor to develop tailored exercises to make your rehabilitation successful.
Pointers for Finding the Right Therapist
Your choice of physiotherapist will significantly impact your quality of life after the BKA. The quality of rehabilitation you undergo after the BKA will determine your capacity to engage in family activities, job tasks, and recreation. Therefore, you want a therapist with a proven track record in helping people who have undergone BKA.
Certified PTs or movement experts possess the proper education and skills to help you after a BKA. However, apart from education and training, you must consider a PT with experience handling patients who have undergone lower-extremity amputation.
Besides, your PT must possess the knowledge to equip you with skills and training to utilize and control the artificial leg.
Additionally, seek out a physical therapist with residency training in physical rehabilitation. These movement experts have all the skills and knowledge required to live an everyday life after amputation.
If you are wondering where to begin your search for a physiotherapist, speak to friends, family, colleagues, or relatives for referrals. These people know one or two persons in your position but successfully underwent rehabilitation. You want the names and contacts of experts who helped these people regain their daily lives.
Once you have a list of PTs in your locality, you should contact them to arrange a face-to-face or over-the-phone meeting. During the consultation, ask questions about the expert's training and experience handling BKA patients. If you are happy with the responses you receive from an expert, you can consider them for your rehabilitation.
Find a Competent PT Near Me
A BKA, or transtibial amputation, can adversely affect your life. Luckily, you do not have to undergo these difficult times alone. With the guidance and training of competent physiotherapists and rehabilitators, you can restore your mobility, health, and independence. Suarez Physical Therapy can assist if you have undergone a BKA in Las Vegas and are considering rehabilitation. Our movement experts will offer quality therapy and rehabilitation services. Contact us at 702-368-6778 to arrange a meeting.
