Definition

Leg or foot amputation is the removal of a leg, foot or toes from the body. These body parts are called extremities. Amputations are done either by surgery or they occur by accident or trauma to the body.

Alternative Names

Amputation - foot; Amputation - leg; Trans-metatarsal amputation; Below knee amputation; BK amputation; Above knee amputation; AK amputation; Trans-femoral amputation; Trans-tibial amputation

Why the Procedure Is Performed

Reasons for having an amputation of a lower limb are:

• Severe trauma to the limb caused by an accident
• Poor blood flow to the limb
• Infections that do not go away or become worse and cannot be controlled or healed
• Tumors of the lower limb
• Severe burns or severe frostbite
• Wounds that will not heal
• Loss of function to the limb
• Loss of sensation to the limb, making it vulnerable to injury

Risks

Risks of any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Bleeding
• Poor wound healing that requires more surgeries

Risks of this surgery are:

• A feeling that the limb is still there. This is called phantom sensation. Sometimes, this feeling can be painful. This is called phantom pain.
• The joint closest to the part that is amputated loses its range of motion, making it hard to move. This is called joint contracture.
• Infection of the skin or bone.
• The amputation wound does not heal properly.

Before the Procedure

When your amputation is planned, you will be asked to do certain things to prepare for it. Tell your health care provider:

• What medicines you are taking, even medicines, supplements, or herbs you bought without a prescription
• How much alcohol you have been drinking

During the days before your surgery, you may be asked to stop taking aspirin, ibuprofen (such as Advil or Motrin), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.

Ask your provider which medicines you should still take on the day of your surgery. If you smoke or use tobacco, stop, ideally at least 4 weeks before your surgery.

If you have diabetes, follow your diet and take your medicines as usual until the day of surgery.

On the day of the surgery, you will likely be asked not to drink or eat anything for 8 to 12 hours before your surgery.

Take any medicines you have been told to take with a small sip of water. If you have diabetes, follow the directions your provider gave you.

Prepare your home before surgery:

• Plan for what help you will need when you come home from the hospital.
• Arrange for a family member, friend, or neighbor to help you. Or, ask your provider for help planning for a home health aide to come into your home.
• Ensure that your bathroom and the rest of your house are safe for you to move around in. For example, remove tripping hazards such as throw rugs.
• Ensure that you will be able to get in and out of your home safely.

After the Procedure

The end of your leg (residual limb) will have a dressing and bandage that will remain on for 3 or more days. You may have pain for the first few days. You will be able to take pain medicine as you need them.

You may have a tube that drains fluid from the wound. This will be taken out after a few days.

Before leaving the hospital, you will begin learning how to:

• Use a wheelchair or a walker.
• Stretch your muscles to make them stronger.
• Strengthen your arms and legs.
• Begin walking with a walking aid and parallel bars.
• Start moving around the bed and into the chair in your hospital room.
• Keep your joints mobile.
• Sit or lie in different positions to keep your joints from becoming stiff.
• Control swelling in the area around your amputation.
• Properly put weight on your residual limb. You will be told how much weight to put on your residual limb. You may not be allowed to put weight on your residual limb until it is fully healed.

Fitting for prosthesis, a manmade part to replace your limb, may occur when your wound is mostly healed and the surrounding area is no longer tender to the touch.

Outlook (Prognosis)

Your recovery and ability to function after the amputation depend on many things. Some of these are the reason for the amputation, whether you have diabetes or poor blood flow, and your age. Most people can still be active following amputation. You may feel sad or depressed about the surgery. It is important that you talk with your surgeon or doctor about your feelings.

References

Bastas G. Lower limb amputations. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 120.

Grimm PD, Potter BK. Amputation surgeries for the lower limb. In: Chui KK, Jorge M, Yen S-C, Lusardi MM, eds. Orthotics and Prosthetics in Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 19.

Rios AL, Eidt JF. Lower extremity amputations: operative techniques and results. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 115.

Toy PC. General principles of amputations. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 14.