You do not like looking for a text about amputation. It’s a topic that you do not want to deal with. In addition, it is better to be too early than too late. Roughly speaking, in most cases amputation is triggered either by atherosclerosis or by a subsequent damage to diabetes. If you know what to pay attention to, you can sound the alarm at the first sign and take the necessary steps.
This article has some information in the thematic complex of the amputation to give. The text is structured in such a way that it is first of all explained what amputations are about, what the causes are and what measures can be taken to prevent an amputation from becoming necessary for oneself. As the article progresses, we continue to delve deeper into the types of amputations, the ways in which we can heal, and the tools we can use. In these, we are particularly dedicated to stump stockings, prostheses, special shoes and the inserts. So that you can also read directly what interests you, this text is equipped with jump labels. This enables you to jump to the topics of interest.
A report written by the Ärzteblatt on the data of the Federal Statistical Office in the period between 2005 and 2014 shows the amputation rates in Germany. In 2014, 57637 amputations took place in Germany. These differ in major and minor amputations.
We call all amputations above the ankle region a major amputation. This begins according to the DRG billing system of the health insurance because of the increased material consumption already in the transmetarsal forefoot amputation. On the other side there is the minor ramputation. Colloquially, it is referred to as a small amputation. It starts below the ankle region and involves everything up to and including the Chopart amputation.
Although the rate of major amputation declined by 30.9 percent compared with 2005, at the same time the number of minor amputations increased by 25.4 percent. In absolute terms, in 2014: 13048 major amputations and 35513 minor amputations.
The causes of amputations are manifold. For example, amputation can be triggered by atherosclerosis associated with diabetes, neglected diabetic foot care, accidents, infections and tumors. However, the cause of amputation is 90% of the cases of chronic arterial occlusive disease, which we also refer to as arteriosclerosis, which can occur either in combination with or without diabetes.
Arteriosclerosis is a narrowing of the arteries. This often occurs in connection with diabetes mellitus. 90% of all amputations take place in Germany because of the so-called arterial occlusive disease. This high amputation rate can be explained by the fact that there is a reduced supply of oxygen in the tissue due to the narrowing of the arteries. Often, this is also associated with a metabolic disorder and associated with diabetes associated with sedentary lifestyle.
© psdesign1/fotolia Foto: psdesign1
The constriction of the arteries begins with stress pain in the lower extremities. This occurs mainly because the oxygen supply is insufficient. In this case, patients often can not walk more than 100 or 200 meters and must stop until sufficient oxygen is available. This symptom, the intermittent claudication, increases over time and in extreme cases can trigger so called resting pain.
In stage 4, the tissue dies off. In technical terms, the term necrosis is used. A first indication of this is when the arterial pulses on the lower extremities disappear and the feet are also often cold.
If they show signs of pain, such as calf pain or restricted walking distance, they should immediately contact an angiologist, a specialist in vascular disease. He will prescribe the appropriate medication and physiotherapy according to the stage of the occlusive disease in which they are present.Tipp
When it comes to amputation, the standardized lower leg amputation according to Brückner with a knee recovery rate of 93 percent is the most effective. In rare cases, amputation in the knee joint or thigh area is necessary.
With the diabetic foot it depends on the right care and the daily control – Only then can worse be prevented!
A diabetic foot is associated with diabetic neuropathy, i. with a nerve disorder. Here it does not come to a closure of the large vessels. However, the vessels are widened and the blood circulation is even partially increased. In such cases, although rarely must be amputated. Rather, the danger here is that the bones and joints (osteo-athropathy) are destroyed or severely worn over time. The diabetic foot is also the danger that one does not notice that you have sustained injuries.
Due to the numbness of one’s own feet, one no longer notices whether there are, for example, small stones in the shoe. In many cases, this can trigger infections that may be untoward and can become serious ulcers. These often occur on the sole of the foot. These infections start on the outer side of the foot and work their way into the inner of the foot over time. However, I will leave the showing of example pictures at this point, as this is not an appetizing sight. However, with the proper care and wearing of compression stockings, one can avoid this and take preventative measures. However, should it ever come to amputation, a so-called resection is often enough. an operative removal of individual bones. Hereby, the foot can be largely preserved.
Due to the nerves it comes as we already know to a widening of the vessels. This usually occurs in the foot area or in the lower extremities. Over time, this causes swelling of the foot. Due to the neuropathy there is an increasing numbness in the foot.
When suffering from numbness in the foot, it is important to check whether unnoticed sharp objects have entered the shoe. This could be, for example, small stones or something similar. If you do not remove them in time, they cause the foot to become inflamed and ulcers, called ulcers. Bacteria can get into the foot and trigger serious infections there, which usually make surgical procedures necessary.Tip
If the infection spreads, either the immobilization of the foot or the surgical elimination of the infection in the foot can be necessary. It may be necessary that a resection is made. The main task here is that you have to behave according to the Stadi ums different behaviors. This is also associated with wearing the right shoes that need to be able to protect the foot from ulcers. Again, the daily care of the foot is important. In addition, a visit to a doctor is advisable with a diabetologist, no matter how small a change.
After accidents or tumors, infection can also lead to amputation. Depending on the strength and severity of the accident, the surgeon will decide whether amputation is necessary or not. In this decision, the protection of the life of the patient always comes first, even if it should thereby lose a body part. However, amputation as a result of a malformation of the extremities to improve the care with a prosthesis or with an orthosis is very rare.
When it comes to amputation, it is usually performed on the foot, leg or arm. The doctors plan exactly where the body part should be cut off. The blood circulation of the tissue is checked with an ultrasound device. The aim of this treatment is to recognize that after the operation again dead tissue at the stump does not arise.
At the beginning of amputatioone, the patient is placed under general anesthesia. In addition, the body part, on which the amputation takes place, is additionally locally dusted by the doctor. This has the advantage of facilitating postoperative pain management. In addition, this measure is less likely to cause phantom pain. In order to keep the loss of blood during the amputation as low as possible, the blood supply to the amputation area is additionally suppressed with the help of pressure cuffs.
There are two types of amputation on the foot. Once the so-called small amputation also called minor amputation, in which only forefoot parts, ie metatarsal bones and toes are surgically removed. And major amputations, so any higher amputation. However, the aim of the doctors remains to remove as few bones as possible, so that the patient can continue to stand up and walk even after the operation. Although the amputation of one or more toes is the smallest possible amputation, but this is often not enough, because the death of the tissue is already too advanced. Often, it must then be amputated at a higher place, such as in the area of the metatarsal bones.
Another possibility is the so-called Lisfranc and Chopart amputations, in which only the tarsal or the heel bone remain. In this case, however, the stability of the stand after the operation is clearly limited.
In the course of amputation on the lower leg, the doctor leaves in most cases a ten-centimeter-long stump below the knee. At this later, so after healing, attach a prosthesis. However, if this is not possible, it will lead to an exarticulation. Here the function of the knee joint is no longer given and the patient will be significantly restricted in his movement after the amputation.
When it comes to an amputation on the thigh, the bone can basically be separated at any height. However, the doctors still try to use the cut as low as possible, since many muscles attached to the bone. This should also guarantee the highest possible mobility on the thigh stump.
In a Hüfttexartikulation the entire leg is removed and it remains only the hip pan in the pelvis. If even this is not enough, the bony pelvic parts of one side are also removed. This is called hemipelvectomy.
The biggest goal in amputation in the hand area is the maintenance of the gripping function. For example, after the amputation of the patient, patients should still be able to grasp objects, even if this requires a lot of training.
A similar operation is possible on the forearm. The surgeons separate the ulna and the spokes, which are then juxtaposed like two fingers. Here, too, the patient is allowed to reach for things again. In the case of an amputation on the elbow, upper arm or shoulder, it is also the case that you want to maintain as much musculature as possible, so that the patient can also move well later.
Amputations that are scheduled have good chances of recovery as the surgery is performed under steric conditions. The stump is prepared so that a good healing of the wound is possible. Then, after the healing, the stump can then be loaded again. Complication-less wounds often heal within weeks or a few months. However, this may vary depending on the location and size of the wound. Immediately after the operation, it is therefore all the more important that your recovery and the healing of the stump are in the foreground, so that you can provide them later with a prosthesis that is optimally adapted to them.
Let them show you how to store them properly in bed. This is necessary so that the muscles and the butt-joint are not shortened or stiffened. This is necessary as they will probably not be able to turn around in bed for a long time.
Do regular breathing exercises as well as light exercise and mobility exercises. These exercises help to provide you with a prosthesis as quickly as possible. Perform targeted exercises to strengthen the torso, arm and leg muscles. Your physiotherapist will be able to show you exercises that are perfectly tailored to your needs. Ask him if he or she can specifically perform exercises that train the joints that are near the amputation site.
- Exercises can be done with light weights and thera bands. It does not matter if they are standing, sitting or lying down. Try to include your stump in the exercises.
Maintain your stump intensively. This can be done using compression therapy and creams. It is important that the scar tissue remains soft and supple, and thus becomes equally resilient. Only when this is completed, you can start to wear a prosthesis.
Make a compression therapy on your stump. After the operation, the stump usually swells strongly. This swelling is called edema and is a normal reaction to the surgery. After about a week, it usually goes away. Then it is time to apply pressure on the stump with the help of elastic bandages, compression stockings of the other aids. The goal here is to reduce blunt edema and to optimize the stump for adaptation to its future prosthesis. The compression improves the perfusion of the stump. This directly results in less pain and better healing of the scar.
Do a so-called mobility training. In the beginning, it will probably be difficult for you to sit up in bed on your own and then put yourself in a wheelchair. But with time and a little practice, this will always be easier. Soon after, they will be able to get up for the first time. However, they must assume that they will have initial balance problems, since the usual counterweight of the amputee body part is missing.
- Wash the stump with a rough washcloth. Terry the skin and dry well
- Do something good for the skin of the stump and massage it with a soft brush or a sisal glove.
- Carry out cold warm alternating baths. Start with slight temperature differences and increase slowly.
- Put your stump light and air out. Although this requires quite a bit of overcoming, it contributes to healing in the long term.
- Move the stump in a box filled with natural items that promote blood circulation. These can be, for example, small rounded stones, peas or sand.
- Apply skin as little as possible. Apply only cream if it is very dry.
- Check the skin of the stump daily for injuries. Even small injuries can develop into a dangerous ulcer under stress.
- Showering is preferable to bathing, as the skin swells and becomes more sensitive during a bath.
Before you can ask yourself this kind of question, you have to go through a post-treatment with so-called aids after the operation. The operation is basically only part of the chain, which, as it is colloquially spoken, can only be as strong as its weakest link. After the operation, the foot must be relieved for at least a few weeks and, above all, spared. Meanwhile, you can do an early rehabilitation in the acute hospital. Here, in the time after the operation, first a supply of aids and then a step-by-step mobilization are forced.
Once the early rehabilitation measure is completed, patients can be returned to their home environment. The walking training can only begin when the wound caused by the amputation is stably scarred. This is to ensure that the wound does not pop up immediately when loaded. The first aid that is used here is an interim prosthesis. This remedy is usually used for a period of several weeks to months. It should reduce the pressure and shear forces in the foot stump area by the rigid connection of the foot part with reaching up to the knee shaft.
In the further course, it all depends on whether one still has a forefoot stump or whether the amputation has been performed on the thigh or lower leg. Here is the following question:
- If the shoe or a prosthesis is chosen as the final solution.
In summary, the process will take several months to go back. Especially because the stump first has to scarify moderately and then you can start with the walking training. Since all this takes time, one should plan a few months for his recovery.
Depending on the type of amputation, different stockings will be suitable for you. In short, these are either thigh stump socks, shank stockings and Lisfranc-Chopart stockings. These are each adapted to your needs with regard to the level of amputation.
The goal of a stump sock is to protect the sensitive areas of the stump. At the same time, it contributes to a compression acting on the stump. This assists the stump in scarring. The stump sock helps you to ensure that the stump gets an optimal shape for the prosthesis to be worn later.
As you already know, the stump tends to swell in especially after the amputation. With a compression stocking you can effectively prevent swelling. This is especially important if you have to rely on the denture to sit perfectly all day long.
In the production of buttocks, attention is paid to the material used. The materials range from wool to cotton, nylon and silver fibers. Often it is recommended to grab silver stockings. Although these are a bit more expensive than the other two variants, but they lead to prevent unpleasant odors. The high silver content in these socks ensures that the stump is kept dry and it also feels fantastic when the sweaty stump is a thing of the past.
Thigh stump socks come in different lengths. These start at 30 cm and go in steps of 5 up to a length of 45 cm. The circumference moves proximally, i. closer to the center of the body, between a maximum of 60 to 65 cm and distal (farther from the middle of the body) between a maximum of 40-45 cm. However, this can vary depending on the chosen stocking. These details can be found in the corresponding product description. Here as well, as described above, one can resort to different materials. When choosing the material you should inform that you are not allergic to any of the materials used.
Thigh stump Stockings are available in copies with as well as without silicone hole. If you intend to wear the stump stocking in combination with a prosthesis, a stocking with a silicone hole is recommended. From the color choice, most stump stockings for the thigh are available only in the colors white, silver (silver stump stocking) as well as nature. If you have a desire to have a different color, feel free to contact us. For some thigh stump stockings, this is included in the color picker below the item on request.
Lower leg stockings behave in their properties largely similar to the thigh stump stockings. These are also available with and without silicone hole. Of course, the length of the lower leg stump sock differs. This starts here at 20cm and goes as well as the thigh stump stocking in 5-steps up to a length of 60cm. Depending on the selected stocking the size varies from a maximum of 40cm to a maximum of 70cm. In the choice of material, they are equal here as in the previously explained stocking.
Previously, I have not mentioned that the stocking has different properties depending on the selected material. These start with the fact that the stocking is seam-free, that it is particularly stable and boil-proof, up to the characteristics, which brings a silver stocking with itself. In order to guarantee a good scarring of the stump, you should also make sure that the degrees are handcorded. This leads to the fact that it can not come to bruises on the leg.
The name Lisfranc amputation comes from the French surgeon Jacques Lisfranc. This one served in the army of Napoleon and observed there that riders often got stuck on their stirrups when they fell off their horses. As a result, a pre-foot fracture often occurred in connection with a displacement of the metatarsal bones away from the tarsal bones. This is the so-called Lisfranc dislocation fracture. At this point between mid-foot and tarsal bone, the Lisfranc amputation named after him is made.
At this point, the so-called Lisfranc joint line is important. This is an imaginary line at the foot, which is formed by the three Tarsometatargelenke. It marks the border between the metatarsal and forefoot.
Before we can deal with the stockings, we must first clarify what the second term, Chopart means. Similar to the Lisfranc joint line, we also speak of a Chopart joint line. This is located between the talus and calcaneus on one side and os naviculare and cuboid on the other side and runs almost perpendicular to the longitudinal axis of the foot.
Now one will think, since one needs different stockings because of the different place of the amputation. However, one is wrong about that. The Chopart-Lisfranc stockings are delivered with a different length. This starts at 11cm and reaches up to 22cm. For this reason, the use of one type of stockings of the so-called Chopart-Lisfranc socks is sufficient for both levels of amputation.
Of the material properties, most of the Cho-part-Lisfranc stockings in our assortment have a shoulder edge and are also made without a rubber edge and also handknitted. In terms of size, the length ranges as just explained, from 11cm to 22cm. You will also receive a second stocking that is either for the non-amputee foot, or both feet should be amputated, as well as a second forefoot stocking.
Now that you have completed the mobility training as well as the rehabilitation training, now comes the next important step. Now is the time to decide if you will be using a prosthesis or other supplies in the future. This depends on the degree of amputation. More on that later.
In the course of the rehabilitation, the doctors try to equip the patients as soon as possible with a first and therefore provisional prosthesis. This prosthesis is called an interim prosthesis. It serves to bridge the first phase after the amputation, in which the stump basically changes permanently. The stump is still here in education and has not yet reached its final shape. After some time, your doctor will tell you after consultation with an orthopedic technician that it is time for the interim prosthesis. This will now be prepared by the orthopedic technician for you and depending on the course of wound healing you can do first standing and walking tests. Regarding the period, we speak about 4-6 weeks after the amputation. However, as I said, this can vary greatly, because first the healing of the stump is in the foreground.
Only after 3 to 6 months is the interim care completed in most cases. The stump has now formed its final shape and it can be started with the preparation of the first correct prosthesis. Depending on the type of amputation and degree of amputation different prostheses have to be manufactured. Prostheses for upper and lower leg amputations differ significantly from prosthetics for knee extraarticular amputation and foot amputation (forefoot). In order to make this better and, above all, clearer, we divide the following chapters into one about prosthetic legs and one about prosthetic feet in connection with custom-made shoes and insoles.
After an amputation of the lower leg patients can be equipped with a prosthesis for the lower leg. The knee joint and its function are usually preserved. As soon as it is time to choose a lower leg prosthesis for yourself, you have to deal with the species available here. So one must first know that one differentiates between a prosthetic stem and a prosthetic foot. When we talk about the fact that certain systems are in use, we mean the prosthesis shaft. Nowadays the mainly used prosthetic socket systems can be classified into the following types:
- lower leg stems with liner system
- Lower leg stems with soft wall funnel and condylar clamp
Liner systems are usually made of silicone or gel and connect the stump with a PIN with the lower leg prosthesis. If you decide to use silicone liner, the liner will be rolled airtight on the stump and the prosthesis will be connected to the liner via a valve and a knee cap. The liner also leads to a regular and especially uniform compression on the stump acts. As a result, swelling decreases faster and it comes to a better circulation of the stump. The lower leg prosthesis can be easily connected to the stump. The foot systems can also be selected as needed and connected to the lower leg shaft. If you are going to lower leg stump stockings, you can wear these over their liners. For this, however, it is necessary that you reach for lower leg stump socks with PIN opening.
The other commonly used prosthetic socket system are lower leg stems with soft wall inner funnel. This shaft system consists of a shaft made of carbon and an inner shaft made of soft material, which connects the prosthesis shaft with the stump. The shaft is here clamped with a condylar clip of the inner shaft above the largest knee width (condyles) on the leg. The prosthesis is fixed to the stump. It is important that the stump should have a full contact in the shaft. Basically, we could add a few more systems to this list, some of which are no longer in use or others that are more likely to be used in specific cases. For a first overview, however, this should be enough.
The thigh prosthesis is a so-called body replacement, which comes after an amputation of the leg above the knee joint when transection of the femur used. They consist of a custody, a mechanical or electronic knee or hip joint, as well as a skeleton and a foot. Similar to the lower leg prostheses, there are also various prosthesis systems that are used in the thigh prostheses. Here is a distinction between the following systems:
- Transverse oval shaft system
- hybrid form
- Seated leg system (MAS)
- longitudinal oval (CAT-CAM shaft)
The transverse oval and the hybrid stem represent a kind of functional form, while the ischial bordering shaft and the longitudinal oval shaft are considered anatomical shaft shape. Thus, the advantage of the Querovale shaft system is that there are good post-processing possibilities for volume fluctuations and that the load is mainly absorbed by the so-called ischium. In other words, this type of shaft is often chosen in interim supplies, since the stump here is still little loadable and this suffers from fluctuations in volume.
The structure of the Sitzbeinumgreifenden shaft system is based on anatomical conditions. The goal here is that the gait pattern is improved by an effective, energy-saving guidance of the prosthesis. This can be achieved primarily by the exact connection of the so-called Ramusanstützung. In short, the M.A.S shaft is much more optimized than other shaft systems. The Mexican Marlo Ortiz, who developed this system, has achieved a significant optimization in the field of prosthesis control, mobility, wearing comfort and cosmetics.
The longitudinal oval shaft causes no sitting on the seat leg. Therefore, body weight can be carried by the entire stump surface. In addition, the lateral support is strengthened. This is done by the longitudinal oval compression of the stump. In this stem form, the seat is enclosed by the prosthesis stem, with a bony locking occurring. Therefore, the shaft can not migrate to the outside. In other words, a better control when wearing the prosthesis can be guaranteed.
Similar to the lower leg prosthesis, thigh prosthesis stems can also be worn with a liner system. Here, too, we can pull the liner over the stump and, if necessary, pull the thigh stump with PIN over it.
With amputation of the toes and long- or medium-long forefoot stumps, such as in Lisfrance, you can get an orthopedic custom shoe with forefoot compensation made. However, this should then have a special bedding, sole stiffening and rolling possibilities. Likewise, it is also possible here to have a silicone forefoot prosthesis made. For smaller amputations, a customized insole may be sufficient. Although it does not have the purpose of restoring lost function, it can help to stabilize the footbed in very light amputations.
For short forefoot stumps such as Chopart on the other hand, the choice of a forefoot prosthesis made of cast resin or silicone with tibia attachment is more suitable. With this, the force that arises during unrolling can be better transferred from the prosthetic forefoot to the anterior tibial attachment. This is immediately possible without damaging the amputated area and pressure points are avoided in this way as well. If they use silicone forefoot prostheses, they can go even longer distances and wear conventional shoes. This is possible because of the flexible material.
In the course of this text, we have seen that the topic of amputation covers many areas. If you are suddenly confronted with this issue, you will inevitably be forced to deal with this issue. In this text, I have therefore tried to roughly circumscribe this topic and have now come to a text length of about 4800 words. Despite this length, the subject is not fully addressed. For example, there are no topics such as phantom pain and how to deal with the new situation after the amputation, complete in this text. However, I think that the topics covered are sufficient to get a good first overview of the topic. We also look forward to sharing your thoughts with us. We are happy about every comment.