Amputation

08/18/2009

Question:

my left leg was amputated below the knee in january of 2008 from P.A.D and diabetes i was fitted with a leg when i first got my new leg i didn`t really have any problems now i can`t walk that far without having constant pain in the leg i have to stop and rest all the time and when i walk too far my right hip hurts am i just walking on it wrong and another thing after i got my leg it was everyone forgot about physical therapy so everything i learned i learned on my own why would it hurt so much after all this time i have had my new leg for almost a year

Answer:

Although it is less difficult for a person to learn, on their own, how to walk with a prosthesis following amputation below the knee compared to above the knee, what the amputee may feel is a functional gait may not be optimal. That is, an amputee isn't the best judge of whether their walking pattern is smooth, symmetric, and the most efficient it can be. Although the amputee's prosthetist observes that person's prosthetic gait, once proper fit and function of the prosthesis have been achieved, if the prosthetist and/or patient don't feel a need to see each other for a while, the amputee may develop "bad habits" - with respect to their gait pattern - which are difficult to correct the longer they occur.

If you haven't seen your prosthetist recently, you should do so ASAP, to determine whether your left leg pain:

has a "prosthetic cause" - which can be addressed by your prosthetist - or

if the prosthesis is fitting and functioning correctly, but the way you are walking with it may be less than ideal - which can be addressed by referral to a Physical Therapist - or

if there is a "medical" cause for your pain including, for example, poor circulation to your left leg which can cause leg pain which becomes worse with exertion, or a pinched nerve in your lower back which can "refer" pain into your leg, or nerve irritation in your residual limb (called a "neuroma") - all of which can be addressed by your physician.

If you are wearing stump socks, usually the number/thickness of stump socks needs to be increased as the residual limb decreases in volume and changes shape over time. Alternatively or in addition, socket modifications (certain areas may need to be built-up or relieved) may be necessary to re-achieve an intimate fit - that is, total contact between the inside surface of the socket and your residual limb.

Your right hip pain could result from "favoring" (placing less weight on, or "off-loading") - your left leg, which then "overloads" your right hip and leg, placing more force upon the joints in your right hip, sacroiliac and lumbar spine regions, but also, causing the muscles in your right leg to increase their "demand" for circulation, which may already be deficient.

If you've not been using a cane, you may benefit from doing so for now (holding it in your right hand, so cane tip and prosthetic left foot move together), but ideally a cane isn't necessary for ambulation by a below knee amputee wearing a prosthesis.

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Response by:

Brian L. Bowyer, MD
Associate Professor of Clinical PM&R
The OSU Sports Medicine Center
Department of Physical Medicine and Rehabilitation
College of Medicine
The Ohio State University