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What You Need to Know About Below Knee Amputation in Southern California

Dr. Daniel Silver - Silver Orthopedics November 15, 2017

In this week's blog I'm going to discuss what many people know nothing about unless you're an amputee, know an amputee, live with an amputee, or take care of an amputee such as a prosthetist, orthopedic surgeon, or vascular surgeon. It turns out as of July 1, 2016, I am both a below knee amputee and an orthopedic surgeon. This gives me a lot of insight into what an amputee goes through physically and psychologically. I also understand the changes in life style and adaptations someone has to go through living with an amputation. Please note that I have a below knee amputation (BKA) which is through the mid-tibia. There are other lower extremity amputations through the foot, ankle, knee, femur, and even through the hip joint. The higher the level of amputation, the trickier it is to fit a good prosthesis and to achieve a relatively normal gait.

For all levels of amputation there have been major achievements in prosthetics. The materials are stronger and lighter than they were even 10 years ago. Also electronics with sensors, transducers, and minicomputers in the knee joint prosthetic components have improved walking ease for the above knee amputees. There are mini-processors for ankles as well. There are a variety of suspension systems (methods to keep the prosthesis on). These include two commonly used methods…a suction system and a locking pin system. The one I have for my BKA is the locking pin system. This system depends on a snug fitting silicon liner with the pin attached. The silicon ¼” liner fits inside a hard plastic shell. Once the liner is on the leg (stump), the pin which is attached to the liner is inserted into a locking mechanism near where the lower leg and ankle were previously. See Illustration. For improved walking the artificial ankle and foot are adjusted to improve the tilt and balance. Even the spring and push-off of the foot which is part of our natural gait can be adjusted.

There definitely are differences that have to be addressed in fitting a prosthetic for different levels of amputation, but there are a lot of commonalities as well. One of the trickiest things to deal with is the skin. Wearing a silicon line on your leg all day retains motion and this can encourage a skin breakdown. Whether simply due to abrasion or frequent fungal infection, the skin must be checked and treated at least daily. Sometimes it should be addressed twice daily. There several things available to protect the skin from these problems. There is a product called Liner-Liner by Knit-rite that is a very thing cotton liner worn directly on the skin under the silicon sleeve. This thin Liner-Liner wicks away moister and thereby protects the skin.

Even with this cotton line r system bacteria and fungi can accumulate on the skin and create a problem of breakdown, itch, etc. A good way to deal with the prevention of these problems is to shower daily and use a gentle skin brush on the leg, dry thoroughly use a good skin conditioner. If red spots and itching appear a thin layer of Tinactin cream should be applied for a day or two to stop the spread of the fungus. This medicine is sold over the counter primarily for athletes' foot, but works well for this.

In the beginning of this blog I mentioned there are psychological factors affecting below knee amputees. These concerns affect all amputees as well. There is an element in some individuals of depression due to the loss of a body part. They don't feel whole. Usually there is a period of mourning the loss, but as the therapy and retraining begin, there is usually a rapid improvement in mood. No matter what age young and old will grieve to different degrees. However, most lower extremity amputees quickly get motivated to walk and get as independent and back to normal as soon as possible.

Nowadays due war injuries it is a common occurrence that young soldiers are dealing with amputations. Most of these young men and women will adapt to their disability, but many still need help through generous donations by all of us through organizations such as Wounded Warriors, Gary Senise Foundation, and many others.

If you have questions or need some advice contact Dan Silver, M.D. at 818 784-9593 or