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Amputation of your leg

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Amputation is the removal of a limb, such as a leg. You might have a leg amputation if you have had an accident, or you might have surgery to remove your leg if you have a serious problem in the leg that needs treating. 

On this page there is information about:

Needing an amputation

The main reasons someone might need an amputation are:

Not having enough of blood flowing to the leg

When you walk, your muscles need more blood supply to work properly. In some people, particularly people who smoke or have diabetes, blood vessels in the leg can become more narrow. This can happen over a few years. You might get pain in the thigh, calf or foot when you walk. The pain goes away when you rest. This is called intermittent claudication.

There might be a blockage in a large blood vessel that stops blood getting to the leg. If this happens, you might have a bypass operation so the blood can flow past the blockage. Smaller blood vessels can also become blocked.

If a bypass operation is not possible, or does not work, an amputation might be needed.

An infection in your leg

People with poorly controlled diabetes are more likely to get infections. An ulcer or seriously infected toe that does not heal properly can spread infection into the tissues and bones of the leg. An amputation might be needed to remove the infection. 

A serious accident

Sometimes, after an accident the broken bones do not heal. Or the injury to the blood vessels and nerves means that the damaged part of the leg needs to be removed.

Removing a tumour in your leg

Amputation might be the only way to remove a tumour in the muscle, bone or skin. If you have had an amputation for this reason, you might have chemotherapy or radiotherapy. You might need to finish this treatment before start using a prosthesis (artificial limb).

Severe pain and not being able to walk on the leg

An amputation might be done if you are not able to use your leg, you find it very difficult to walk, or you cannot walk. This situation often causes severe pain. For some people, amputation will allow them to wear a prosthesis and be more mobile.

Severe ulceration of the leg

When an ulceration (sore) on the leg is so bad that healing is impossible, an amputation might be needed.

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Having an amputation

Levels of amputation

The amount of the leg that is amputated will depend on how good the blood supply is to the leg, how far the infection has spread, or where the tumour is. Your doctor will talk to you about the level of amputation that is best for you.

It is very important that the leg is amputated at a level where there is a good blood supply, no infection and no tumour. This gives the area the best chance of healing after the operation.

It is also important for the amputation to be at the right level so that if you use a prosthesis it will fit properly.

Amputation can be at any level, but the most common are:

  • a single toe
  • through part of the foot
  • below the knee
  • through the knee
  • above the knee
  • through the hip joint

Not everyone who loses part of their leg will be able to use a prosthesis. This depends on many different things. For example, your healing after the amputation, your overall health, the condition of your remaining limb, and how you were able to walk before the amputation.

Your physiotherapist and rehabilitation consultant will talk to you about your amputation and wearing a prothesis.

Medical team

There will be a team of people who look after you if you have an amputation

Consultant and doctors

Your consultant is a senior surgeon and is responsible for your care. Doctors supports your consultant. Either the consultant or one of their team will do the surgery.

A rehabilitation consultant is a senior doctor who is an expert in rehabilitation and amputee care. They will visit you once a week, with the rehabilitation team, and talk to you about your progress.

Nurses

Nurses will care for you 24 hours a day in hospital. They will look after your wound, give you medicines and work with other members of the team. Please ask them about any questions or concerns you have.

Physiotherapists

Physiotherapists teach you exercises for your arms and legs, how to move around (for example, from a bed to a wheelchair), and how to use a wheelchair. They will also teach you to use a prosthesis if you have one. They will visit you on the ward and, when you are ready, you will go to the physiotherapy gym. Many people have physiotherapy at their local centre when they leave hospital.

Occupational therapists

Occupational therapists help you to become as independent as possible, and return to your everyday life. They help you with personal hygiene and preparing meals. They also teach you how to move around, and how to use a wheelchair. 

They will lend you a wheelchair for your rehabilitation on the ward, and order one for you to use when you are at home. They will visit your home to see if you need any equipment or changes to your home to help you. They can also talk to you about returning to work, driving or other activities. 

Prosthetists

Prosthetists make and fit artificial limbs, called prostheses. If you can have a prosthesis, a prosthetist will visit you after surgery and give you more information.

Podiatrists

Podiatrists are foot care specialists. They work in the hospital and in the local community. They might be involved in planning your care and treatment. You might already have treatment with a podiatrist. If not, you should ask for a referral to a local service through your GP, or contact our Podiatry service, phone 020 7188 2449

Counsellor

Many people who have had an amputation have said that they found it helpful to talk about their experience and emotions with someone. Your physiotherapist can arrange a confidential visit with the counsellor.

Social worker

The nurses will make a referral to a social worker if it is needed. They might visit or contact you while you are in hospital, or at home. Social workers help you with any personal, financial or housing problems.

Before surgery

Where possible, the physiotherapist will meet with you before your surgery. They will explain what physiotherapy you will have. They will encourage you to keep walking regularly until your surgery if you are able to. They will also give you walking aids and some exercises to do.

They might check your muscle strength and your joints. The fitter and stronger you are before your surgery, the easier you will find moving around after surgery.

Speak to your physiotherapist if you would like to meet other people who have had an amputation, and see the exercises and training they are doing. You can also talk to someone about how you are feeling, and your emotions, before your surgery. 

During surgery

The surgery will usually be done using a general anaesthetic, which is medicine that means you will be asleep for the whole surgery.

Sometimes, a regional anaesthetic is used. This is an injection in your spine, which numbs a large part of your body (such as a leg). You will be awake, but you should not feel any pain. If you are having a regional anaesthetic, you might also be given some sedation or a general anaesthetic.

Your anaesthetist will decide the best type of anaesthetic for you, and talk to you about which one you are having. You can speak to them about any concerns you have. 

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After surgery

You will probably feel some discomfort after surgery, but you will be given pain medicine to help. Tell your nurse if you are uncomfortable.

The remaining part of your leg (called the residuum, or stump) will have stitches. Sometimes these stitches are dissolvable and do not have to be removed. Your nurse will explain what kind of stitches you have.

You might have a drain, which will take away any blood and fluid from your wound. This is usually removed about one day after surgery.

Your leg will be covered with a bandage.

You might have a small tube in a vein in your arm. The nurses will give you fluids through this tube until you are able to eat and drink as usual.

You might have a catheter going into your bladder. This is used to monitor the amount of pee (urine) you are producing after surgery, and make sure your kidneys are working well.

Phantom pain and sensation

It is not unusual to feel that your leg is still there after surgery (phantom sensation), or to feel pain in the leg that has been removed (phantom pain).

We do not know what causes phantom pain. Scientists believe that both phantom pain and phantom sensations come from the spinal cord and the brain. It is thought that the brain has had an imprint of that limb on it since you were born, so it can feel as though the limb is still there.

Phantom pain can be severe, but pain medicine can help. Tell your doctor, nurse or physiotherapist if you have any pain. The pain can be treated. It is important that you tell your nurses if you have phantom pain, or pain in the part of your leg that is left, as you will need different painkillers for the different types of pain.

Risk of falling

If you are having phantom sensation you are at a very high risk of falling. A lot of new amputees fall because, for a very short amount of time, they might think their leg is still there and try to walk.

A fall could damage the stump. Any damage to the stump might need surgery to repair it.

It is very important that you do not hop anywhere, even if it is a short distance. Hopping is dangerous and can easily lead to a fall because your balance will be different after your surgery. It also puts an added strain on your other leg.

It is important that you take your time and think carefully before you move, especially when moving on and off a bed or chair. Being careful can help to prevent falls.

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Your feelings and emotional support

You might feel lots of different emotions at different times after having an amputation. Talking to someone who is trained to listen and support you can make it easier to understand and cope with your feelings and concerns.

Counselling

The counselling service is available to you if you have had, or might be having, an amputation. Counselling sessions are confidential and usually take place once a week.

Some people find 1 or 2 sessions helpful, while others prefer an arrangement that lasts during their whole hospital stay.

A family member or anyone else who is close to you can also have counselling.

If you would like to speak to the counsellor, your physiotherapist or any other member of staff caring for you can arrange this. Or, you can contact the counsellors on phone 020 3049 7726

Spiritual support

The Spiritual healthcare team support people of all faiths, as well as people who do not have particular religious beliefs. They can talk to you about how you are feeling.

If you would find this helpful, ask a member of staff to arrange this for you. Or, contact the Spiritual healthcare team, phone 020 7188 5588

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Your rehabilitation – what to expect after surgery

Everybody recovers at a different rate after their surgery. Your recovery depends on your health condition and your own experience.

The following information is a guide to give you an idea of the physiotherapy you will have after your surgery.

Day 1 and 2 after surgery

You will probably feel sleepy for the first day or two after surgery. This is because of the anaesthetic.

Pain 

You will be given pain medicine to keep you comfortable. Tell your nurse if you have any pain, including phantom pain.

You might not feel any pain when you are lying in bed, and think you do not need any pain medicine. However, you will be doing exercises during your physiotherapy sessions, so it is important to take your pain medicine regularly so your pain is well controlled when you are resting and during movement.

Your wound

Your stump will be covered with a bandage. Do not remove the bandage yourself, as this could lead to an infection.

Your physiotherapist will encourage you to look at your stump, and touch it on top of the bandage if you can. This is to stop your stump becoming sensitive to normal sensations.

Moving around

The occupational therapy team will lend you a wheelchair so you can start moving around again. They will teach you how to use it safely.

If you have had a below the knee (trans-tibial) or through the knee amputation, you will have a ‘stump board’ attached to your wheelchair. This will support your stump when you are sitting in your wheelchair. It also helps to reduce any swelling.

An occupational therapist will help you get into your wheelchair and position your stump on the stump board. You will be shown some simple exercises to keep the joints moving.

If you have had a below the knee amputation, please do not support your stump with pillows, or have the electric bed bent up under the knee. This can make your knee stiff. It is important that your knee can straighten fully if you will be walking with a prosthesis (artificial leg).

Days 3 to 5 after surgery

The rehabilitation consultant will come to see you and talk to you about your treatment and progress.

If you can, it is helpful to lie as flat as you can for an hour each day. This means you can straighten your hip as much as possible, and lower the risk of your hip tightening. Doing this might make it easier to walk with a prosthesis.

As you start to feel better, and have less pain, you will find that you can do more yourself. The occupational therapists and nurses will help you to be as independent as you can be.

You will slowly be able to do more exercises as you gain strength and confidence. You might go to the gym in the physiotherapy department. If you do, please wear loose, comfortable clothing, such as shorts and a t-shirt. This will make it easier for you to move around. You can meet other people who have had an amputation at the gym sessions.

Days 6 to 10 after surgery

You will be going to the gym once, or maybe twice, a day.

You can start using a walking aid when your surgeon and rehabilitation consultant feel your wound has healed enough. This is called an early walking aid trial.

You must have enough muscle strength, the ability to stand up in the parallel bars, and be able to stand for about 8 to 10 minutes to use the aid. Not everyone will be able to take part in a walking trial. Your physiotherapist will talk to you about this.

The walking aid you use will depend on the level of your amputation you have had.

The pneumatic post-amputation mobility aid (PPAM aid, or pam aid) is an inflatable leg. The PPAM aid helps to reduce the swelling to your stump, and helps you to walk again.

The Femurett is another type of walking aid. It is used by people who have had their leg amputated above the knee.

Stump shrinker compression sock

The compression sock is a tight, elastic bandage for your stump. It helps to control any swelling. Your physiotherapist will give you a sock and show you how to put it on.

It will be difficult to put it on yourself at first, as it is designed to be tight. Your physiotherapist or nurse will help you until you can do it yourself.

The sock should not be worn when you are asleep or overnight. Remove the sock if it is causing you pain, or if your wound becomes very sore. If this happens, tell your physiotherapist.

Keep your compression sock in a dry place at room temperature. Follow the washing instructions inside the sock, or in the information sheet that comes with the sock.

If your sock is damaged (for example, it has a ladder or a hole), it will no longer be helpful and you should not wear it. The sock cannot be repaired, and you will need a new one. Ask your physiotherapist for a new one. If this happens when you are at home, contact your prosthetic centre.

Days 11 to 21

If your stitches are not dissolvable, your nurse will remove them.

You might be taken to our specialist Amputee Rehabilitation Unit once your consultant is happy that your wound is healing well.

The unit provides amputee nursing, physiotherapy, occupational therapy, counselling, prosthetic provision and social care support. There is a rehabilitation gym, a practice kitchen and bathroom, and outdoor space. The unit is at the Lambeth Community Care Centre, in Kennington. It is a few minutes from St Thomas’ Hospital.

If you are able to manage safely, your doctors might be able to let you go home at this stage.

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Using a prosthesis

If you can have a prosthesis, and you have done the early walking aid trial, the prosthetist will visit you. 

The prosthetist will make a cast of your stump, and start making your prosthesis.

If you cannot use a prosthesis

Some people might not be able to have a prosthesis. You will need a lot more energy to walk with a prosthesis. Some medical conditions can also limit your return to walking.

If you are not suitable for a prosthesis at this time, you can still learn to be very independent. Your physiotherapist and occupational therapist will help you practise exercises and techniques until you are safe to move around on your own in a wheelchair.

Depending on your home environment, you might need to be set up in an area of your home so that you do not need to use the stairs. Your occupational therapist might visit your home to help you practice getting around your home and using your wheelchair.

You can always be considered for a prosthesis at a later stage. If you think you would like to be reconsidered for a prosthetic limb when you are at home, ask your GP for a referral to the local limb fitting centre.

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Stump and foot care

It is important that you look after your stump, and your remaining foot.

If your foot or stump become sore, please contact your prosthetic centre, foot clinic or GP as soon as possible.

Stump care

Your nurses can give you information on how to look after your stump.

  • Keep the skin on your stump clean and dry.
  • Wash your stump every day in warm water with soap. Wash the area gently so you do not damage delicate areas of skin. You might need to wash more than once if you sweat.
  • Use moisturising cream before bed. 
  • Clean your socks at least once a day.
  • Check your stump carefully to make sure there are no red areas. This can be harder to see on brown and black skin, but your nurse will tell you what to look for. A small mirror can be useful so you can see the whole area.

Foot care

You can get more information from the diabetic and podiatry clinics about looking after your remaining foot.

You should never ignore a minor problem because it could turn into a larger problem and need hospital care. 

  • Check your foot every day.
  • Wash your foot every day. Test the water temperature with your elbow first to avoid burns.
  • Dry your foot carefully, especially between your toes.
  • Cut and file your toe nails straight across. A podiatrist can help you cut your toenails.
  • Put a non-perfumed moisturiser around the heel and sole of your foot, but not between your toes.
  • If you have any breaks in the skin, cover these with a dry sterile dressing.
  • Do not burst blisters, as this can cause an infection.
  • Never use anything sharp on your foot.
  • Do not use corn plasters, as they contain acid.
  • Avoid direct heat.
  • Make sure your shoe fits well.
  • Keep in touch with a podiatrist.

Smoking

If you smoke, we strongly advise you to stop, especially if your amputation was as a result of poor blood supply. If you smoke, you are at risk of the disease becoming more severe and needing further amputations.

Our Stop Smoking Service can help you to give up smoking during your stay in hospital, and arrange continuing support once you leave hospital. Any member of staff can refer you to this service.

You can also contact the NHS Smoking Helpline, phone 0800 0224 332

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Leaving hospital

We will carefully plan for when you leave hospital, and make sure all services you need are in place.

A social worker can arrange any help you need at home. It might not be appropriate for you to return to your own home, and the social worker will make any arrangements for you. 

You might have your care transferred to your local hospital, so that you can continue your rehabilitation before going home.

Before you leave hospital, you will be given the names and telephone numbers of the people to contact if you have any problems.

It is important that you continue with your exercises after you leave hospital. If you need more physiotherapy or occupational therapy this will be arranged before you leave.

You will stay under the care of a prosthetic centre in your local area. We will make this referral before you leave hospital. 

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Useful sources of information

The Limbless Association has information and support for anyone who has had an amputation, phone 0800 644 0185 Monday to Friday, 9am to 5pm.

BLESMA, support limbless veterans who have lost a limb in or out of service, phone 020 8590 1124 Monday to Friday, 9am to 5pm.

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Ref number: 0243/VER4

Date published: December 2018 | Review date: December 2021

© 2018 Guy’s and St Thomas’ NHS Foundation Trust

A list of sources is available on request

 


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