Limb Amputation: Physical Therapy Management

Question 1

Reasons for Amputation
Most Common:

Answer 1

Peripheral Vascular Disease (PVD) – ~93% of LE amputations

Diabetes – Often leads to foot ulcers and infections (e.g., gangrene)

Question 2

Other Causes:

Answer 2

Trauma (crush injuries, frostbite)

Severe infection (MRSA, sepsis)

Cancer

Congenital deformities or functional limitations

Question 3

5-year mortality post-amputation:

Answer 3

Minor amputations: 29–69%

Major amputations: 52–80%

Question 4

Risk factors:

Answer 4

Age >65, cardiovascular disease, renal failure, depression

Question 5

___ precede >80% of amputations in people with diabetes

Answer 5

Diabetic foot ulcers

Question 6

Primary surgery goals:

Answer 6

Preserve bone/joint length

Ensure soft tissue coverage

Prevent neuroma and contractures

Enable optimal prosthetic fitting

Neuroma Prevention: Major nerves are stretched, cut cleanly, and allowed to retract into soft tissue

Question 7

Flap Types

Answer 7

Equal A/P flaps – Used for transfemoral and some transtibial cases

Long posterior flap – Used in compromised circulation (e.g., vascular disease)

Question 8

Myoplasty:

Answer 8

Muscle to muscle closure

Not considered gold standard but used more often if the patient demonstrates decreased vascularization

Question 9

Myofascial:

Answer 9

Muscle to fascia closure

Ensure that the muscles do not slide over the end of the bone

Question 10

Myodesis:

Answer 10

Muscle anchored to bone

Considered the gold standard as it offers best form of distal stabilization

Provides very stable muscle attachment

Question 11

Tenodesis:

Answer 11

Tendon to bone

Rarely used - to assist with muscle stabilization

May be used for muscle stabilization particularly in partial foot amputations

Question 12

Determining Amputation Level (Vascular Cases)

Perfusion Tests:

Answer 12

Skin perfusion pressure

Laser Doppler

Transcutaneous oxygen measurement (TcPO₂)

Question 13

Levels of Lower Limb Amputation

Answer 13

Partial Foot: Toe, Ray, Transmetatarsal, Lisfranc, Chopart

Syme’s: Ankle disarticulation

Transtibial (BKA)

Transfemoral (AKA)

Question 14

PT Considerations for Rehab
Key goals:

Answer 14

Independence in mobility (not just walking!)

Prevent contractures

Improve prosthetic tolerance

Address psychosocial needs

Question 15

Prosthetic Use in Vascular Amputees:

Answer 15

85% receive prosthesis

Only 5% use >50% of waking hours

26% walk outdoors at 2 years

Use decreases significantly after 5 years

Question 16

Amputation Considerations Zone of Injury

Answer 16

Entire area of the limb affected by the disease/trauma

Amputating above zone of injury offers optimal vascularization/wound healing and healthy soft tissue coverage

Question 17

Traumatic Amputation Surgery

Answer 17

Surgeon attempts to save as much of the bone length and viable skin tissue

Preserve proximal joints while providing for appropriate healing of tissues without secondary complications

Question 18

Amputation for Vascular Disease

Answer 18

Generally considered an elective procedure

Surgeon determines level of amputation by examining tissue viability

Transcutaneous oxygen measurement (TCOM) or tcpO2can predict the presence of vascular disease