In a recent blog, we discussed how injuries in people with diabetes can lead to complications such as amputation, so we thought it would be a good idea to provide some information on amputations. According to the Amputee Coalition of America, there are more than 2 million people in the United States living with limb loss, and another 500 people lose a limb each day.
The most common cause of amputation is poor circulation or peripheral arterial disease (PAD), usually due to diabetes or atherosclerosis (plaque buildup in the arteries). PAD frequently occurs in individuals between 50 and 75 years old. More than half of all amputations occurring in the USA are in people diagnosed with diabetes. Various studies have shown that 28-51% of amputees with diabetes will undergo a second amputation within 5 years. In a 2011 study published in Diabetes Care, researchers found that males with diabetes, who were heavy smokers, with high blood pressure and diabetic eye disease, and had less blood glucose control, were more likely to have lower limb amputations. If you are diabetic, controlling your blood glucose and blood pressure and not smoking can reduce your risks of amputation.
Other causes of amputation are trauma and cancer. Trauma is the major cause of amputation in younger people. Large numbers of amputations have occurred as a result of the wars in Iraq and Afghanistan. Between 2000 and 2011, there were over 6000 traumatic amputations in US service members. Many of the combat related amputations involve more than one limb. Amputations due to cancer make up less than 2% of all amputations.
Amputations can occur in the arms or legs and are described by the level at which the limb is removed. For example, loss of a leg somewhere between the ankle and the knee would be described as a below knee or transtibial amputation. Amputations occurring through a joint are called disarticulations.
Rehabilitation for amputations begins very soon after surgery. Tight fitting garments or sometimes casts are used to assist with control of swelling and residual limb shaping. For lower limb amputations, upper body strengthening is important, especially if the individual will need to use a walker or crutches before being fitted for prosthesis (artificial limb). The amputee’s prosthetist, physical and occupational therapists, and physician should work closely together to achieve the best function possible for the individual. Often psychological counseling or support groups such as the Amputee Support Team of Central Pennsylvania (www.astamputees.com) can be very beneficial to those individuals about to undergo an amputation or who have just had an amputation. There are many other support groups throughout the United States which can be found at www.amputee-coalition.org.
There are a great variety of prosthetic arms and legs available and there is not one “best prosthesis” for a given type of amputation. Prosthetic prescription and fitting are very individualized and most likely will be changed during the course of an individual’s life due to technological advancements, changes in the individual’s size or functional ability. Prostheses have come a long way from the “wooden leg” of the Civil War era to the advanced myoelectric, “bionic” and osseointegrated (attached to the residual limb by the bone rather than suspended from it by one of several methods) prostheses of today. There are also specialized prostheses for different activities such as running.
Physical therapy for individuals with lower limb amputations consists of overall conditioning, strengthening and flexibility of both lower limbs, as well as gait (walking) and balance training. For upper limb amputations, strengthening and flexibility of both arms is important as well as mobility and strength of the muscles around the shoulder blades. Use of myoelectric prostheses requires special training in use of residual muscles to make the hand of the prosthesis function optimally.
If you have any questions about this topic or any other physical therapy topics, please feel free to leave any questions, comments or suggestions. Thank you for reading and stay active.
Sahakyan K et al. The 25-year cumulative incidence of lower extremity amputations in people with type 1 diabetes. Diabetes Care. 34:649-51, 2011.
Rieber GE et al. Lower Extremity Foot Ulcers and Amputations in Diabetes found at http://www.diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter18.pdf