I Just Had an Amputation. Now What?

Top 10 Things Your Therapist Recommends to Prepare You for a Prosthesis

Having an amputation is scary and difficult. It's understandable that your goal is to get a prosthesis, walk and get on with your life. Between the time you leave the hospital and get your prosthesis, your therapist will share what's necessary to improve your prosthetic use success. 

#1 Protection for amputated limb injury

“It’s not if you fall; it’s when you fall." 

Falls happen and for this reason, there are ways to protect your limb. If you have an amputation below the knee, you should be given a limb protector. For an above-the-knee amputation, depending on your limb length, you may or may not have a protector. 

The protector should be worn at all times when getting up and moving around. The protector helps keep your knee straight, which is important for prosthetic fit. A long sock should also be provided to place under the limb protector to shield your skin from rubbing against the brace. 

#2 Phantom limb sensation treatment

“I can still feel my foot.” 

Feeling the missing extremity is a normal and common experience. In fact, you may wake up, attempt to walk, forget that your leg is gone and fall. There are different ways to minimize sensations and pain, including rubbing, tapping or massaging the limb. Additionally, mirror therapy can also be effective when instructed by your therapist and should be done on a consistent basis to reduce pain. Lastly, talk to your provider about medication options.

#3 Desensitization techniques and scar management

Your therapist will teach you different ways to make your limb less sensitive, including rubbing, tapping and using a shrinker. If your limb is too sensitive, it will make it difficult to put on a prosthesis. Once your incision is healed, it is also important to massage the incision to prevent your skin from getting bound down. If your skin is bound down, it increases your chance of getting skin breakdown when wearing the prosthesis. It is also one of the biggest causes of pain during prosthetic wear.

#4 A shrinker or ace wrap for the limb

After your surgery, a shrinker or ace wrap may be used on your limb, depending on your surgeon’s recommendations. The purpose of using the shrinker or ace wrap is to control swelling, to begin shaping the limb for prosthetic fit and use. It additionally helps keep the dressings in place over your incision. The shrinker should be on the majority of the day with occasional breaks to check your skin or when showering. If ace wrapping is used, it is recommended that it be rewrapped every four to six hours. Your therapist should provide guidelines on use. If either one is causing an increase in pain or drainage, let your provider, therapist or prosthetist know immediately.

#5 Daily skin inspection and good hygiene techniques

You should receive an inspection mirror during your rehabilitation stay and should be instructed on its use. It is important to inspect your amputated limb as well as your non-amputated extremity. You know your body best and will be the only person who sees your limb every single day, so keep a close eye on it, and let your provider know if something isn’t right. After your staples or stiches are removed, practice good hygiene by washing your limb with mild soap and water; then thoroughly dry and moisturize your skin.

#6 Strengthening and stretching

“If you don’t use it, you lose it.” 

Your therapist should provide you with exercises to strengthen and stretch your amputated limb as well as your other extremity. Keeping your legs and core strong and keeping your hips and knees stretched will prevent tightness and weakness. These can be major limiting factors in your ability to fit into or walk with a prosthesis. They can lead to long-standing pain not only in your hips and knees but also in your lower back. If you continue with a good strength and stretch program at home, you will likely have an easier time applying your prosthesis and walking. It is also important to indulge in activities you enjoy after you get your prosthesis to stay active.  

#7 Preservation of the non-involved limb

Conditions, such as peripheral vascular disease and diabetes can lower the blood supply to your legs and feet. The reduced blood flow can cause damage to your nerves and affect your ability to feel if something goes wrong with your legs or feet. You may be unable to feel if you have pain, burning or open wounds. Being diligent with the care of your non-amputated limb prevents injury and wounds that may cause delay in walking. See your podiatrist for nail care. Make sure you wear shoes that fit properly in width, length and depth to prevent blisters or sores that may cause issues or wounds. Inspect your feet daily for areas of pressure and don’t forget in between your toes! Keep skin well moisturized. Minimize or eliminate any “hopping” on this leg unless completely necessary or recommended by your therapist. This will protect your joints from unnecessary injury due to the impact from “hopping.” 

#8 Diet management and lifestyle

“It isn't just a waiting game.” 

It makes sense that you want your incision to heal overnight. An appropriate diet is key to proper wound healing. Eating foods high in protein gives your body the essential nutrients it needs for the process of wound healing. Some of the best foods are beans, nuts, eggs, chicken and milk. Protein supplements are advised if you are unable to eat the previously recommended foods. For diabetics, managing your glucose level and keeping your A1C at an optimal level are very important. Diabetes can damage nerves that lead to impaired blood circulation, which is important in healing. Other healing impairments are smoking and drinking. Nicotine is a known vasoconstrictor (narrows blood vessels) that prevents blood circulation to areas in need of wound healing. Most patients who have an amputation have time away from smoking due to hospitalization. Use that time as an opportunity to start the cessation process available through Quit With WakeMed. Speak to your surgeon/physician about options. They can prescribe you medication to curb your nicotine craving as well as refer you to dieticians to aide with glucose management.

#9 Provider follow-up appointments

It is important to see your provider to monitor your incision healing and to manage your pain. If you are concerned about wound healing, do not hesitate to call your surgeon and make him/her aware of changes. Taking pictures of your incision and limb can help your provider view changes that may require an earlier appointment. Changes in pain, odor or color should be noted immediately. 

Good communication is also necessary with your prosthetic company. Inform your prosthetist of your first follow-up appointment. Your prosthetist may join to stay abreast of your progress and any issues. Call your prosthetist if your shrinker or limb protector is uncomfortable, especially if causing redness or pressure. If you note significant change in the size of your limb or the shrinker is too big, reach out. Your prosthetist is available. He/she will be with you for adjustments, alterations and changes throughout your life. Asking questions and communicating your needs will increase your success.

#10 Body image and coping

"Losing a limb is a life-altering event." 

Many people experience grief just as if they had lost a close family member. It may be difficult to visualize your new life or how it may change your work, leisure activities, relationships and overall future. You are not alone. Support and education are available. Ask your therapist, prosthetist or case manager about the availability of peer mentors and amputee education/support groups in your area. Meet other amputees who have gone through similar experiences. Ask them questions to learn what adaptations they may have needed to help them get back to driving, working and enjoying life.

Also, outpatient mental health counseling and psychiatric care could help. Limb loss is a life-changing event, and professionals can provide talk therapy and mood medications (if needed).

Amputation is life-changing, not life ending. We are here to help you through this new journey.  

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About WakeMed Amputee Program

At WakeMed, we understand the physical, social and emotional challenges that patients face when they’ve experienced a amputation. That's why compassion, support and individualized care planning are key components of the WakeMed Amputee Program. Our amputee programs are CARF accredited. We have structured rehabilitation programs designed for you immediately following your surgery and when you receive your prosthesis. We also connect your with lifelong support and care.

Helping Amputee Patients Achieve Independence

Helping patients achieve their highest level of independence and enjoying life is our focus. We care for adults and children from surgery through rehabilitation and beyond and welcome them to join our program at any stage of their journey.

• Emergency/Trauma Care
• Surgery
• Multi-Disciplinary Care Planning
• Wound Care
• Intensive Care
• Acute Medical Care
• Inpatient Rehabilitation
• Outpatient Rehabilitation
• Fitness & Wellness Programs
• Home Health
• StepForward — Prosthesis Training Program
• Amputee Support Group

About WakeMed StepForward Prosthesis Training Program

Once you have recovered from your surgery and you have your prosthetics, it's time to start thinking about relearning how to do the things you enjoy with your new prosthetic limb.

WakeMed StepForward – a comprehensive, structured program for people who have had amputations – will help you:

• Safely and confidently use your new limb
• Use your prosthesis to its fullest potential
• Care for yourself and your prosthesis
• Troubleshoot issues and who to call for assistance