What is the physiotherapy treatment for below knee amputation?

Physiotherapy for a below knee amputation would really depend on the age and reason of condition which lead to the amputation. First lets us look at a young patient who had the amputation due to trauma. First physiotherapy would be aimed at assisting with the healing of the incision on the stump, then the desensitasation of the stump. Also there should be treatment to give the brain new input so it is able to recognise the new end of the limb. Then treatment would be to strengthen all the main muscles in the remaining part of the leg. So the muscles around the hip and the muscles of the thigh would be strengthend . The important ones would be the knee extensors, the knee flexors, the hip extensors and flexors and the hip abductors. The treatment must ensure that the patient has full range of all movemnts and does not develop a bent knee, as pain often makes the patient hold the knee in a bent position so stretching is important. Treatment is also provided to keep swelling in the stump to a minimum. The patient would also be taught wheelchair mobility, transfers and independent activities of daily living, this would be asssited by an Occupational Therapist. The patient would also be taught trunk strengthening and core stability to help with balance, balance on one leg would also be taught. When the patient got the prosthesis ( the artificial leg) the patient would be taught how to walk and how to walk without a limp. Stump care is also very important and would be addressed by the Physio and nursing staff. Finally for good rehabilitation the patient should relearn how to go back to work or to school and continue to have hobbies.

If the patient was older with Diabetes some of this work would be too much so it would be decided if the patient wanted to walk again or live in a wheel chair. Healing of the incision would be more of an issue and maintaining the stump would also be an issue. Much more patient eduction is needed. The patient may be taught all the same things but in a less aggressive fashion. If the patient was to live in a wheelchair then pressure relief and positioning would be an important part of the rehabilitaton. Some treatment for phantom pain may also be needed. The patient will need to practise such things as getting into and out of bed, on and off toilet etc. With older patients the relatives also need teaching and sometimes have to help with putting on the leg or helpng the patient transfer get in and out of car, in and out of a bathtub and even change dressings.