Foot amputation: rehabilitation, possible consequences

There are situations when it is simply impossible to cope with the problem without surgical intervention. In this article I want to talk about rehabilitation measures after amputation of the patient's leg.

Basic terms

At the very beginning, you need to understand the terms that will be actively used in the article.

1. So, the amputation of the leg is the removal of the diseased limb by surgical means. The purpose of this action is the saving of human life. It is worth saying that the decision to surgical intervention of the doctor is taken only in the most extreme case.
2. The level of amputation is the place where the leg is cut off.
3. Rehabilitation is a complex of measures by which specialists of various profiles (doctors, psychologists, orthopedists, prosthetists) teach a person to adapt to everything around him without a lost limb.

Diabetes

Indications for amputation of the lower limb can be set. One of the reasons is diabetes mellitus. The disease itself can not lead to this problem. However, in some cases (neglect of the disease, its transition into a decompensated form), medical indications for amputation are possible (this occurs in about 8-10% of patients). In what cases can an amputation of the foot be prescribed for diabetes?

1. Neuropathy, associated specifically with nerve damage.
2. Micro- and macroangiopathy (this is a violation of the structure and normal functioning of both large and small vessels).
3. Necrotic changes occurring in the lower extremities.

As it became clear, the very first and main indication for amputation is a disruption of the functioning of the vessels of the leg. This is due to disruptions in the metabolism and the development of such a process as autoimunizatsiya. In the vessels stagnation occurs, oxygen starvation occurs, which makes the legs vulnerable to various infections. And even the slightest bruise can provoke the development of the most terrible purulent processes. To avoid a fatal outcome, in such situations, doctors make a radical decision. That is, the patient needs an amputation of the foot (in diabetics such cases are not unique). Often, only this way you can save a patient's life.

What is important

As it became clear, amputation of the leg is a serious interference in the life and health of the patient. That is why after the operation a person expects a rather long period of rehabilitation. It is worth saying that the success of restorative treatment depends on several factors:

1. A good stump (the quality of the operation itself is important).
2. A suitable prosthesis (important is the qualitative work of the prosthetist).
3. Rehabilitation program.

If at least one of these items is performed is not perfect, the rehabilitation process can be significantly delayed.

Postoperative period

Regardless of whether an amputation of the toe or most of the limb has been performed, the early postoperative phase of restorative treatment remains critical. What is important in this case:

1. It is necessary to prevent various types of complications, for example, infection of the stump.
2. It is very important to monitor blood and lymph circulation in the limb.
3. It is necessary to prevent stiffness in joints and muscle hypotrophy. In this case, you need massage and therapeutic gymnastics.
4. It is also necessary to regulate painful sensations, as much as possible avoiding them.
5. And, of course, need psycho-emotional support for the patient. After all, for almost all people, the loss of a limb is a huge blow.

Stage of rehabilitation 1. Stump preparation

If the patient undergoes an "amputation of the leg" operation, several levels of rehabilitation will have to be completed within the first year after surgery. So, as has already been said above, the quality of the stump is of the greatest importance. It depends on many factors:

1. The length of the stump.
2. Level of amputation.
3. Postoperative scar (it should be located away from the places of maximum axial load).
4. Forms of stump (it depends on the technique by which the surgical procedure was performed).
5. Contractures, that is, restrictions on the volume of motion. This is of great importance, since it is on this factor that the quality of the person's further walking depends.

What else is important to know about the care of the stump

After the leg was amputated, it is very important to take care of the postoperative suture. In the early days, he will be supervised by a doctor and a nurse. Here we need to clarify that patients with vascular pathology and diabetes mellitus deserve special attention, since it is these diseases that increase the risk of infection of the stump. What is important:

1. The hygiene of the stump is very important. Daily contrast shower is desirable. You can wash your foot with baby soap, after wiping it dry with a towel.
2. The cult should be examined daily for changes in skin color. This is very important, and with the slightest changes you need to seek advice from a doctor.
3. After the operation, the skin of the stump becomes very sensitive. You can cope with this with a massage. You can do it with both hands and a small rubber ball, making circular motions. Periodically, the stump must be rubbed with a towel. Do these procedures as often as possible, preferably several times a day.
4. It should be remembered that the postoperative scar needs to be moistened. This is especially important in the first few weeks after the leg was amputated.

The period of postoperative adaptation in patients with diabetes is usually longer.

Edema

The field of how the leg was amputated in diabetes mellitus or any other disease, the patient often develop swelling. This is not terrible, because it is a normal reaction of the human body to surgery. However, the situation still should not be allowed to run its course. Measures to be taken:

1. In the first time after the operation on the wound, pressure can not be exerted. Therefore, the bandage is superimposed on the stump.
2. In order to cope with swelling, you can use the following tools: compression knitwear, elastic bandage, silicone cover.
3. If a high leg amputation was performed, the patient is recommended to lie down twice a day on the stomach (for half an hour), turning his head in a comfortable direction. This is necessary for the muscles on the cult to stretch and thus train and relax.

Contracture of a joint

Another problem that can arise after amputation of the leg is the contracture of the joints. That is, the restriction of passive movement in the joint, which can be caused by deformation of muscles, tendons, skin, etc. Preventive measures:

1. The most important thing is to provide the patient with the correct position of the limb. The cult should be straightened, it can not be left in a bent position for a long time.
2. Important is the timely elimination of swelling and pain. To prevent deformity of the spine, you must use an armchair with a special stump for the stump in the first postoperative period.
3. The patient will also need both passive and active therapeutic gymnastics. However, one must remember that one should avoid those exercises that cause pain.

An important point: as soon as possible after surgery, the patient should appear to the prosthetist. After the earlier a person stands on the prosthesis, the less he will lose the most important dynamic skills, and the easier and sooner the rehabilitation process will finish.

Phantom pains

Regardless of whether the leg was amputated above the knee or lower, the patient may be suffering from phantom pain. This is the pain that the patient feels in the limb, cut off surgically. To avoid this, the following points are important:

1. The patient should be activated as soon as possible, i.e., transferred to a sitting position.
2. Massage and lymphatic drainage of stump is necessary.
3. The pressure in the cult should be uniform. Therefore, it is very important that the limb is properly bandaged.
4. You can avoid phantom pains if a person starts exercising as early as possible. Physiotherapy is also important.
5. And, of course, the most important is the earliest possible prosthetics.

If the phantom pains appeared in the late period (not immediately after the operation), this means that care for the stump was carried out incorrectly or insufficiently. However, in such cases it is possible to cope with the problem. This can help mirror therapy.

Stage of rehabilitation 2. Prosthetics

After the leg was amputated, rehabilitation begins with the preparation of the stump for prosthetics and the prosthesis itself. What does this concept mean? Thus, prosthetics is a specialized type of care for patients who have lost part of the desired organ. That is, with the help of a prosthesis it is possible to restore the normal or close to normal functionality of the lost organ.

About the prosthesis itself

Modern doctors say that after leg amputation, it is important to have limb prosthetics as early as possible. So, primary prosthetics should be carried out already on the 14-21th day after surgery. Repeated prosthesis is prescribed already as and when the wear of the primary product occurs.

Stages of prosthetics

The process of prosthetics consists of a number of stages:

1. The choice of the design of the product, i.e., the prosthesis.
2. Removing the measurement from the stump.
3. Preparation of gypsum positive and negative.
4. Assembling the product to fit.
5. The final finishing taking into account all the moments and wishes.
6. Prosthesis delivery.
7. Training for use.

If to speak in general, the success of professional rehabilitation of a patient depends almost entirely on the quality of the prosthesis made. Its weight, dimensions, control method, design, aesthetics and cosmeticity are important. Also, you need to properly adjust the product for a single patient. And, of course, the final stage of rehabilitation is the very mood of the patient and his desire to return to normal life as soon as possible. If a person had an amputation of the toe , the prosthesis would not be needed. This point of rehabilitation can be avoided.

About prostheses

It should be said that the prosthesis itself is of two types: primary and secondary.

1. Primary prostheses are also called training. They are necessary in order to properly form the stump, as well as to teach the patient the primary skills of their use. It should be said that as early as possible, initial prosthetics makes it possible to prevent the occurrence of movement limitations in large joints. It is also important to clarify that this prosthesis is carried out in a hospital, because it requires the participation of many specialists.
2. After the stage of primary prosthetics, the patient is given a permanent prosthesis (an average of two years).

Types of prostheses

Prostheses are made by the most different technologies. They are modular and non-modular (however, modular prostheses are most often used). They consist of the following parts:

1. Receiving sleeve, which is made depending on the impression of the stump of the patient.
2. Adjusting-connecting devices.
3. The carrier module. Varies depending on the required length of the prosthesis.
4. The module of the foot.
5. Fixation of the prosthesis.

Also worth mentioning is that the permanent prosthesis, unlike the training, is also provided with a cosmetic lining, on top of which a special stocking is put on. This is to ensure that the prosthesis is as much like a real leg.

About disability

It should be said that a person is disabled on amputation of a leg. So, most likely, at first it will need to be confirmed once a year. However, after a certain time (no later than four years) you can apply for a so-called permanent disability. If there is an active development of the prosthesis, a decision of the commission may reduce the disability group.