Post-Amputation Challenges: Seeking Solutions for Better Mobility

Q: Post-Amputation Challenges: Seeking Solutions for Better Mobility

Hello： Based on my previous experience handling such cases, the most challenging issue is tenderness, which can lead to skin breakdown, ultimately requiring surgical intervention for resolution. <br>If possible, please provide photographs for review. <br>If amputation is not nece

Urgent Inquiry: Post-Amputation Care

My brother is 37 years old and had to undergo amputation of his foot due to diabetes, leaving only the heel.
The wound on the heel was later covered with skin from the inner thigh.
He currently has a prosthetic foot, but every time he tries to walk, he develops wounds, despite multiple attempts.
We considered consulting a second prosthetic manufacturer about his situation, and they indicated that the remaining part of his foot is indeed difficult to fit with a prosthesis.
They suggested that he undergo another amputation at the calf level to facilitate the creation of a prosthetic that would allow him to walk more comfortably.
I would like to ask the doctor if this is indeed the case.
Is it true that without further amputation, there may be no viable options? If amputation is necessary, will there be doctors willing to perform the procedure?

Ni, 30~39 year old female. Ask Date: 2020/08/25

Dr. Li Weiqiang reply Rehabilitation

Hello: Based on my previous experience handling such cases, the most challenging issue is tenderness, which can lead to skin breakdown, ultimately requiring surgical intervention for resolution.
If possible, please provide photographs for review.
If amputation is not necessary, a prosthetic limb can be attempted, but this poses a significant challenge for the prosthetist, and many individuals are hesitant to proceed.
In the event that amputation is still required, I can arrange for an orthopedic or plastic surgeon at our hospital.
Wishing you safety and health.
Sincerely, Li Wei-Chiang, Director of the Rehabilitation Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/08/25

More Info

Post-amputation challenges, especially following a diabetic foot amputation, can be quite complex and emotionally taxing for both the patient and their family. Your brother's situation, where he has undergone a partial foot amputation and is experiencing difficulties with his prosthetic limb, is not uncommon. The fact that he is developing wounds from the prosthetic indicates that the fit and design may not be optimal for his residual limb.

When it comes to prosthetic fitting, the residual limb's shape, size, and condition play crucial roles in determining how well a prosthetic will function. In your brother's case, the limited area of the foot that remains (only the heel) can indeed pose significant challenges for creating a stable and comfortable prosthetic. This is because the heel alone may not provide enough surface area for proper weight distribution, leading to pressure points and subsequent wounds.

The suggestion from the second prosthetic manufacturer to consider a more proximal amputation (to the calf) is based on the principle that a more substantial residual limb can provide a better foundation for a prosthetic. A below-knee prosthetic typically allows for a more comfortable fit and better mobility, as it can distribute weight more evenly and reduce the risk of skin breakdown. However, this decision is not one to be taken lightly. It involves weighing the risks and benefits, including the potential for improved mobility against the emotional and physical impacts of undergoing another surgical procedure.

If your brother is considering this option, it is essential to consult with a multidisciplinary team, including a surgeon specializing in limb reconstruction or amputation, a prosthetist, and possibly a physical therapist. They can provide a comprehensive evaluation of his current situation and discuss the potential outcomes of further amputation versus optimizing the current prosthetic.

In terms of whether there are surgeons willing to perform such a procedure, many orthopedic surgeons and specialists in limb salvage and amputation are experienced in handling complex cases like your brother's. It would be beneficial to seek out a medical center with a strong reputation in diabetic limb care and prosthetics. These centers often have the resources and expertise to provide tailored solutions for patients facing similar challenges.

In the meantime, there are several strategies that could help improve your brother's current situation without resorting to further amputation:
1. Prosthetic Adjustment: Working closely with a skilled prosthetist to adjust the current prosthetic can help alleviate pressure points. This may involve modifying the socket, adding cushioning, or using different materials that better conform to the residual limb.

2. Skin Care: Implementing a rigorous skin care routine to keep the residual limb clean and moisturized can help prevent wounds. Regular inspections of the skin for any signs of irritation or breakdown are crucial.

3. Physical Therapy: Engaging in physical therapy can help improve strength and balance, which may enhance mobility and reduce the risk of falls, making it easier to adapt to the prosthetic.

4. Pain Management: If your brother is experiencing pain, addressing this with a healthcare provider can improve his overall comfort and ability to use the prosthetic.

5. Support Groups: Connecting with others who have undergone similar experiences can provide emotional support and practical advice on managing life after amputation.

In conclusion, while further amputation may be a consideration, it is essential to explore all options and consult with a team of specialists to make an informed decision. Your brother's quality of life and mobility are paramount, and there may be alternative solutions that can help him achieve better outcomes without additional surgery.

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