Types of lower limb amputation

Lower limb amputations can occur following trauma, infection, or complications from diseases such as diabetes or peripheral vascular disease.

There are many causes of lower limb amputation and at Boyes Turner we have helped our clients investigate cases relating to delays in diagnosing and properly treating infection and sepsis, delays in diagnosing and treating foot injuries such as ulcers, lacerations and Charcot foot and also delays in diagnosing and treating vascular conditions like peripheral arterial disease. The aim of the amputation is to get the best possible outcome in terms of mobility and long term function. And depending on the illness or the site of the injury, consideration will need to be given to the most appropriate type of amputation.

We understand from our clients that regardless of the type of amputation, the impact is life changing and has an ongoing physical and psychological impact. It means learning to adapt to a new level of mobility and how to manage any remaining limb carefully. Living with an amputation can also place financial and social pressures on an individual and their family.

What are the different types of lower limb amputations?

Above and Below-Knee Amputations

A transtibial amputation is more commonly known as a below-knee amputation. A transfemoral amputation is often referred to as an above-knee amputation.

An above-knee amputation involves the surgical removal of the leg from above the knee joint. As the amputation takes place higher up the leg, it can make using a prosthetic more challenging due to the effect on a person’s balance.

A below-knee amputation involves the surgical removal of the foot, ankle, and part of the lower leg between the ankle and the knee joint.

The goal with both these types of amputations is to preserve as much healthy bone, skin, and tissue as possible, while still addressing the underlying medical issue that made amputation necessary.

Midfoot Amputations

Although above and below-knee are the types of amputations we most commonly see, we have also acted for a client who experienced midfoot amputations after a delay in diagnosis of meningitis.

There are different types of midfoot amputations and these include Lisfranc, Charcot, Chopart, and transmetatarsal amputations.

A midfoot amputation involves the surgical removal of part of the foot, typically including the toes and some of the bones of the foot's forefoot but leaving the ankle and hindfoot (heel and ankle joint) intact. This type of amputation is often carried out to manage conditions like severe foot infections, diabetic ulcers, or trauma when other treatment options are not viable.

What are the key issues when living with a lower limb amputation?

Skin Breakdown and further procedures

People with lower limb amputations often experience episodes of skin breakdown as a result of prosthetic use or sometimes underlying conditions like diabetes. Those who have undergone a midfoot amputation often experience more regular skin breakdown and ulceration than those who have undergone an above or below-knee amputation. This is largely due to the fragile nature of the skin on the foot and also occurs as a result of mobilising without specialist orthotics or appropriate support at the amputation site.

If skin breakdown happens, then there is also a risk that further procedures to remove skin or soft tissue might be needed, or infection can develop. This can in turn result in the need for skin grafting or even more extensive surgery like further amputation procedures. In some cases, a midfoot amputation will have to be extended to become a below-knee amputation.

There is also a risk of further surgery following above and below-knee amputations. Sometimes revision surgery will need to be carried out to the stump (remaining limb) as a result of skin breakdown when using prosthetics and to enable a prosthetic limb to fit more comfortably and be used effectively and safely.

Prosthetics

Prosthetics are available for all types of lower limb amputations.

People with above and below knee amputations can obtain prosthetics to replace the limb that they have lost. These prostheses involve sockets which fit around the stump and are focused on restoring mobility and enabling a person to transfer as independently as possible. Specialist prosthetics are also available for sports and water-based activities.

Above and below knee prosthetics require regular fitting and maintenance and with implementation of a good rehabilitation programme with physiotherapists and prosthetists, many amputees regain some independence.

Partial foot prostheses are available to amputees who have experienced a midfoot amputation. The prostheses help improve function and mobility. They also provide additional comfort when walking and are often chosen for aesthetic reasons too.

Is there support for people with lower limb amputations? How can compensation help?

At Boyes Turner, we have supported clients who have experienced lower limb amputations as a result of a serious accident or medical negligence.

The compensation obtained for our clients has enabled them to purchase high quality prosthetics and seek specialist prosthetic and physiotherapy input on a private basis. Our clients have been able to progress with their rehabilitation to enable them to regain some independence in adapted accommodation and with the right support and care package to enable them to adapt to their new lives following amputation.

We understand the value that peer support can offer to someone newly injured, and those supporting them. We work alongside charities that support those who have experienced limb loss including the Limbless Association. The Limbless Association offer peer support for those who have experienced and are living with limb loss and strive to ensure ‘no amputee need cope alone’.