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Patient GuideBELOW-KNEEAMPUTATION CARE

TABLE OF CONTENTSWHERE TO BEGIN.1Who will provide my prosthetic care?.2What will my insurance cover?.3How long does rehabilitation take?.4What is going to happen next?.6RECOVERY AND HEALING.7How wilI I recover physically?.7How to keep your limb healthy.8How will I heal emotionally?.9INITIAL MOBILITY.10What happens at my first prosthetic evaluation?.10What are the parts of a prosthetic leg?.11How is the prosthesis held to my limb?.12How will I learn to use my prosthesis?.13LIFELONG CARE.14How do I care for my limb?.14Common limb problems.15How do I care for my prosthesis?.16What shoes can I wear?.17What home aids and modifications will I need?.17When will I get a replacement?.18What’s next?.19

WHERE TO BEGINWhat do you do when an injury turns your life upside down anddoctors say you’ll never walk again? Find someone who believes,like you, that your potential is unlimited. After Cameron Clapp lostboth legs and an arm in a train accident, he surrounded himselfwith people who supported his vision of a future that includedwalking, surfing and motivating others. The people at Hanger Clinichave been behind him every step of the way.“Impossible is not afact; it’s an opinion.”– Cameron ClappLosing your limb can be overwhelming, but you are not facingthis challenge alone. Many people will help you adjust to youramputation and return to a healthy, active lifestyle. This includesyour team of healthcare professionals, such as your physician,prosthetist, physical therapist, nurse and occupational therapist.YOUR PROSTHETIST:LOCATION:PHONE NUMBER:1

Who will provide my prosthetic care?As you begin your rehabilitation, you will work with a prosthetistwho is trained in the design, fabrication and fitting of artificial limbs(prostheses). Your prosthetist has skills and experience that willempower you to achieve your goals. It is important to talk to yourprosthetist about your desires, expectations and concerns so that heor she can best address your needs. You will continue to partner withyour prosthetist for routine maintenance, expected adjustments andfuture prosthetic care.Hanger Clinic prosthetists are board certified. A certified prosthetisthas successfully completed years of specialized training and passeda thorough examination administered by the American Board forCertification in Orthotics and Prosthetics (ABC) or the Board ofCertification (BOC).Your prosthetist will work closely with your physician, who willmonitor your health, and your physical therapist, who will teach youhow to use your prosthesis.2

What will my insurance cover?The cost of a prosthetic leg includes the specialized serviceswe provide. Your prosthesis is a custom-made device that takestime and skill to design and fit. The cost of your device can varygreatly depending on the design that is medically necessary foryou. Fees may be charged for modifications and adjustmentsthat are necessary as your limb changes shape and size, butmost initial adjustments and follow-up appointments areprovided at no charge. Please contact your prosthetist with anyfinancial concerns.Prosthetic care is covered under most health insurance plansonce deductibles and copayments are met. Our staff will helpyou understand your coverage and coordinate with your insurer.Please let our office know about any changes in your insurance.In addition, there are government funded programs available forpeople with physical challenges which may provide additionalsupport.IMPORTANT THINGS TO REMEMBER:Hanger Clinic generally requires a physician’s prescriptionfor all prosthetic services, supplies and devices; especiallyif we are billing an insurance company.Insurance approval for new supplies or devices may taketime. Do not wait until the last minute.Our team of prosthetists and office administrators wantthe best results for you. Please be patient as we partnerwith your physician’s office and your insurance companyto get approval for your supplies. Feel free to follow upwith us about the status of your claim.3

How long does rehabilitation take?This is a general rehabilitation timeline for lower limb amputation.You may not experience all of these steps in exactly these timeframesbecause everyone’s experience is unique. Talk to your prosthetist if youhave questions about the expectations for your individual IROAIOLVCEAMEIHRYLVITERICAIONTIGPENRIVNERYST-O NEGACILPOPOHITA-LOHINEGAL REPOSPRE-OPEYPROHTESVOOPCPRE-OPYRVEYRPP ORRCOEVPRET-OC-ORE Incision healed-OOPSSTPST-POOP Post-op protectoror dressing applied Arrange peer visit Begin limb shapingand pre-prosthetictraining43-4WEEKS5-8WEEKS Suture removal Evaluation forfirst prosthesis Measurements,casting and/orscanning forprosthesis

LLFEGOINRELLAENER CLTIFIORE CA GORNACANGELONIUTGO Receive definitiveRNAMIOON ELLIFYAATTUEL LIFTRMprosthesisIFUILL IONBAITTMYMIOTLNLIAOAI BYTTI R INORNA Follow-up careLIOTLIIMATU TIOABAATTIUMRIM Limb volumeNUGILT IMNYIAALITEA ITMYBIL Hstabilization Maintenance andLING INAEGNreplacements Fit initialprosthesis Ongoing therapyand prostheticadjustments Begin prostheticgait trainingIndividual experiences will vary.5

What is going to happen next?POST-OP LIMB CAREYour doctor may prescribe a shrinker to help shape yourresidual limb and/or an AmpuShield to protect your leg frominjury (see page 8).FIRST PROSTHETIST MEETINGYour prosthetist will get to know you and ask about your dailyactivities. He/she will listen to your goals and then use his/herclinical expertise to design the right prosthesis for you.INITIAL PROSTHESISWhen your residual limb is sufficiently healed, you will bemeasured and fit with a prosthesis. The prosthesis you takehome will be custom made using materials most appropriatefor your needs. Your prosthetist will teach you how to put onand care for your prosthesis and supplies, as well as how totake care of your limb.PHYSICAL THERAPYYour physician, prosthetist and/or physical therapist willteach you how to use your prosthesis. You may be able toresume physical activities such as walking up and down stairs,driving and participating in sports and hobbies once you havemastered these skills.FOLLOW-UP CAREYour prosthetist will continue to make adjustments, fittingsand replacements as necessary. It is important to follow upwith your prosthetist at least every six months to address anyissues, especially as your residual limb is changing in size.6

RECOVERY AND HEALINGHow will I recover physically?Some people are slow to heal after amputation due to other healthcomplications, which may delay prosthetic fitting. Be patient andremember that your goal is long-term success.After amputation surgery, it is very important toprotect your residual limb and to prevent falls.Falls can cause your sutures (stitches) to reopen,which delays the healing process. Removablerigid dressings such as AmpuShield are provento protect your limb, speed the healing processand shorten the time to prosthetic fitting.Another post-operative dressing option is ashrinker or compression sock. The shrinkerwill prepare your limb’s volume and shape fora future prosthesis.AmpuShield ShrinkerIf you see sores or blisters on your limb and/or near your sutureline, you should speak to your doctor. Your doctor or physicaltherapist may suggest exercises you can do while healing.7

HOW TO KEEP YOUR LIMB HEALTHYExercising is important preparation for gait training. Your prosthetistand/or physical therapist will teach you specific exercises and giveyou an exercise schedule.You can also perform easy tasks at home: Keep knee straight while sitting in wheelchair or on the bed Stretch your limb daily Wear your shrinker or compression sock according to yourdoctor’s instructions Massage and desensitize your limb according to your doctor’sinstructions Safely practice transferring from chair to bed (toileting, bathing, etc.) Safely practice balancing on one leg on a stable surface with yourassistive deviceEXERCISE EXAMPLESHome exercises are provided by the Amputee Coalition rcisesTo prevent muscle tightening, DO NOT:Keep leg in a bent position while in bed or sittingCross your knees while sittingPlace pillow under hip or knee8

How will I heal emotionally?Losing any part of your body can be traumatic and lifechanging. Everyone has their own way of coping, and itis OK to grieve. Counseling and support groups can helpyou process the many emotions you may experienceafter amputation. Speak to your doctor if you’re feelingoverwhelmed.Family members and friends may be a source ofencouragement and support even if they do not fullyunderstand what you are going through.Other people living with amputation can also provide inspirationand information. Our AMPOWER support program has 1,000certified peer visitors who understand what you’re going throughfrom personal experience and can meet with you in-person, byphone or online. You can also ask your prosthetist who he or shewould recommend.CONTACT THE AMPOWER TEAMCall 1-844-AMPOWER (1-844-267-6937), visitHangerClinic.com/AMPOWER and join EmpoweringAmputees.org9

INITIAL MOBILITYWhat happens at my first prosthetic evaluation?At your first meeting, your prosthetist will take your completehistory including:Current health and physical conditionActivity level and recreational interestsExpectations and goalsOccupation and career goalsHobbies and interestsYour prosthetist will take measurements and/or a cast or 3-Dscan of your residual limb. This information will be used tocreate a “test” socket, also called a “check” or “diagnostic”socket, which allows you to try it on to see what changes need tobe made to the fit. The socket will be designed to be comfortableand supportive.Be sure to ask questions and express any concerns you may haveabout what to expect. Significant family members or caretakerscan attend any or all appointments. Their understanding of lifewith a prosthesis can be vital to your ongoing care.10

What are the parts of a prosthetic leg?SOCKETPYLONFOOT1After taking measurements and/or a cast or scan, yourprosthetist will design a prosthetic leg that will be carefullycustomized to your residual limb to help you meet yourgoals. The prosthesis may seem tight at first as you get usedto it. Let your prosthetist know if you have any pain.2This socket will be attached to a pylon that connects to a foot.Your prosthetist will begin a procedure known as dynamicalignment, in which he/she lines up the components of yourprosthesis for optimal walking and balance.3The prosthesis may be covered for protection with soft foamand shaped to match your other leg.11

How is the prosthesis held to my limb?There are several ways the prosthesis can be held to or suspendedfrom the limb. Your prosthetist will discuss with you which methodis most appropriate for your needs.SUCTION SUSPENSIONA gel liner is rolled onto the residual limb and a gelsleeve is pulled around the prosthesis and the thigh,holding the prosthesis in place. A suction valve, attachedto your socket, allows air to flow out but not in, creatinga seal around the limb for suspension. In some cases, avacuum pump is added to help manage changes to yourlimb volume.PIN LOCKING SUSPENSIONA gel liner, which includes a pin attachment at the veryend, is rolled onto the residual limb. As you put on theprosthesis, a mechanism at the end of the socket locksonto the pin, holding the prosthesis on the limb. Thelock will not disengage until a release button is pushed.STRAPSA leather or nylon strap attached to the prosthesiswraps around your lower thigh to hold the prosthesis on.SUPRACONDYLAR SUSPENSIONLess commonly, prosthetic sockets can be suspendedusing the anatomy of the limb.112