9/4/2015

BELOW-KNEE (TRANSTIBIAL)
AMPUTATION
 Usually performed at the junction of the
BELOW-KNEE AMPUTATION upper and middle third of the tibia

 Nearly full use of the knee allows for a

more efficient gait

MOST COMMON REASONS FOR A MOST COMMON REASONS FOR A

LOWER EXTREMITY AMPUTATION: LOWER EXTREMITY AMPUTATION:
 Most lower extremity amputations occur in
 TRAUMA – the second most common cause of
individuals older than 60 years because of
lower extremity amputation, typically occurs
complications of medical disease.
in the young male population.
 DIABETES and PERIPHERAL VASCULAR
DISEASE – the leading complications of  TUMORS and CONGENITAL MALFORMATIONS
medical disease requiring thromboembolism – less common
and vasculitis

CHARACTERISTICS OF A GOOD RESIDUAL LIMB MANAGEMENT

STUMP
 To prevent edema, protect from trauma
 Neither too long nor too short
and decrease post-operative pain
 Should have good muscle power with full
movement in the proximal joint  Use of Postoperative Plaster of Paris or
 With a healthy non-adherent scar Fiberglass Rigid Dressing
 Should have a fleshy end with no bony
 Cotton–Elastic Bandages – least effective
spurs
shrinkage device

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THREE BASIC TYPES OF

RESIDUAL LIMB SHRINKAGE DRESSING
 Bandaging is important to prevent swelling and
1. RIGID DRESSING (cast)
ensure that the residual limb is properly shaped.
– To ensure control of swelling and to provide
 CYLINDRICAL SHAPED residual limb is desirable comfort

 Re-wrapping every 3 to 4 hours in order to allow – The end of the cast is made to take a simple
the residual limb to be exposed to fresh air and training prosthesis (usually called a
to adjust the bandage’s tension. “pylon”) so training in standing and walking
can be started immediately.

THREE BASIC TYPES OF THREE BASIC TYPES OF

DRESSING DRESSING
2. ACE WRAP (elastic bandage) 3. JOBST Compression Pump

– Still the most frequently used shrinkage – Air-filled sleeves that place constant, equal
method pressure on all sides of the residual limb to
shrink it rapidly and to shape it
– Careful patient and family instruction is
appropriately.
necessary because poor wrapping leads to
skin problems and a poorly shaped residual
limb

PRE-PROSTHETIC TRAINING PROSTHESIS

 DETERMINANTS OF A SUCCESSFUL OUTCOME WITH
 AROM exercises PROSTHETIC USE:
 Positioning  Level of motivation of the individual
 Muscle strengthening  A prosthesis must be:
 Skin care – Comfortable to wear
 Wheelchair mobility – Easy to put on and take off
 Transfers – Light weight and durable
 Ambulation with AD – Cosmetically pleasing
 Self-care  A prosthesis must function well mechanically and have
 Patient and family education reasonably low maintenance requirements

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PROSTHESIS PARTS
 CONSIDERATIONS IN CHOOSING A PROSTHESIS:
 Suspension device
 Amputation level
 Expected function of the prosthesis  Socket
 Cognitive function of the patient
 Patient’s vocation  Rigid components
 Patient’s vocational interests (i.e. hobbies)
 Cosmetic importance of the prosthesis  Terminal device (e.g. foot)
 Patient’s financial resources (e.g. medical insurance,
worker’s compensation)  Artificial joint (if needed)

RIGID COMPONENTS: PYLON AND

THE SOCKET
ANKLE
 Connection between the residual limb and the
prosthesis  PYLON

 Protects the residual limb and transmits the forces – a simple tube or shell that attaches the socket to
associated with standing and ambulation the terminal device

 PREPARATORY SOCKET (TEMPORARY) – adjusted – can be an EXOSKELETON (soft foam contoured to

several times as the volume of the residual limb match the other limb with a hard laminated shell)
stabilizes. or an ENDOSKELETON (internal metal frame with
cosmetic soft covering.
 PATELLAR-TENDON-BEARING PROSTHESIS – most
common socket used in a below-knee amputation
 ANKLE – usually incorporated into the terminal device
(BKA).

TERMINAL DEVICE TERMINAL DEVICE

(i.e. foot)
 5 BASIC FUNCTIONS:
1. Provide a stable weight-bearing surface
2. Absorb shock
3. Replace lost muscle function
4. Replicate the anatomic joint
5. Restore cosmetic appearance
CLASSIFICATION
 NON-ENERGY STORING:
1. SOLID-ANKLE/CUSHIONED HEEL (SACH)
FOOT – mimics ankle plantarflexion, allows
for a smooth gait
2. SINGLE-AXIS FOOT – adds passive plantar
flexion and dorsiflexion, with increase
stability during stance phase

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TERMINAL DEVICE GAIT TRAINING

CLASSIFICATION
 Parallel bars
 ENERGY STORING:
 Sit-to-stand transfers

1. MULTI-AXIS FOOT – adds inversion,  Balance

eversion and rotation to plantarflexion and  Knee control
dorsiflexion  Lateral weight shifting
 Forward progression
2. DYNAMIC RESPONSE FOOT – top of the
 Advance gait training
line foot