Below the knee amputation is surgery to remove all or part of your foot or your leg below the knee cap. It is also called BKA. You may need a BKA for a health problem that causes poor blood flow, such as diabetes. You may have a severe infection or a blood clot. You may have been in an accident that injured your leg beyond repair. You may also need a BKA if you have cancer, or were born with a deformed leg. Amputations are either planned or done in an emergency. Caregivers will only remove as much of your foot or leg as is absolutely necessary. After a BKA, you may be fitted for a prosthesis (artificial leg) for your residual (remaining) limb.
You and your caregiver will work together to decide if other treatments should be included in your treatment plan. You may need hyperbaric oxygen treatment to help heal infections. You may need surgery to provide new blood vessels to your leg if you have blood flow problems. If you have cancer, you may need surgery to remove the tumor and graft a donor bone in its place.
AFTER YOU LEAVE:
Medicines:
Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.
Ask your caregiver when to return for a follow-up visit.
Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.
Activity guidelines:
You may feel like resting more after surgery. Slowly start to do more each day. Rest when you feel it is needed, but try to exercise two to three times each day. Do not put weight on the residual limb until caregivers tell you it is OK.
Change your position often to move fluids in your lungs, decreasing your chances of getting pneumonia. This also decreases the chance of pressure sores on your skin, and keeps your muscles and tendons from tightening.
Avoid lifting heavy objects.
Ask your caregiver when you can shower, bathe and swim.
Talk to your caregiver if you have questions or concerns.
Exercises to improve your balance and increase your strength:
The center of gravity in your body has changed because you suddenly weigh less after an amputation. You will have to learn your new center of gravity so that you can keep your balance.
The following exercises will help to strengthen your muscles and improve your balance. Do these exercises while holding onto a chair. Be careful not to hit your residual limb on the chair while doing these exercises.
Stand on your toes.
Do knee bends.
Hop on your foot.
Practice standing without holding on to the chair.
Constipation:
If you are constipated, you may have a hard time having a bowel movement (BM) Do not try to push the BM out if it is too hard. Walking is the best way to get your bowels moving. Eat foods high in fiber to make it easier to have a BM. Good examples are high fiber cereals, beans, vegetables, and whole grain breads. Prune juice may help make the BM softer. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular. You can also buy these medicines at a grocery or drug store.
Eat a healthy diet:
Eat healthy foods from all of the five food groups: fruits, vegetables, breads, dairy products, meat and fish. A healthy diet may help you feel better and have more energy. It may also help you heal faster.
Your caregiver may want you to eat a diet high in calcium. Foods high in calcium are milk, cheese, ice cream, fish, and dark green vegetables like spinach. Eating high calcium foods helps prevent bone loss.
Caregivers may also want you to eat high protein and high iron foods. Foods high in protein are meat, eggs, fish, beans, and nuts. Foods high in iron are dark green leafy vegetables such as spinach, broccoli, cabbage, or lettuce.
It can take time getting used to a new diet. Special cook books may help the cook in your family find new recipes.
Drinking liquids:
Men 19 years old and older should drink about 3 liters of liquid each day (about 13 eight-ounce cups). Women 19 years old and older should drink about 2 liters of liquid each day (about 9 eight-ounce cups). Good choices for most people to drink include water, juice, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Some food items, such as soup and fruit, also add liquid to your diet. Ask your caregiver how much liquid you should have each day.
Home care nurse:
You may want or need to have a home health nurse visit you after you go home. Ask your caregiver about having home visits from a health care nurse. This caregiver will look at your home to be sure it is safe for you. They can also help you solve problems that you may have after an amputation.
Occupational therapy:
Having had your leg amputated changes many things about your life. It may also affect the type of work you do or how you do it. An occupational therapist (OT) is a caregiver who helps you learn to live with a BKA. This caregiver can teach you how to use tools to make up for only having one leg.
This caregiver can also go to where you work and do a job site evaluation. An OT can make suggestions about how you may continue doing the same work. If you cannot return to your previous job, call your state’s Office of Vocational Rehabilitation. They may be able to help you learn a new job.
Managing pain:
Treating post-amputation pain can be very difficult. Many types of caregivers will work with you to try to treat it. Some people continue to feel the part of their leg that has been amputated. These feelings are called phantom (FAN-tum) feelings. These feelings are normal and may or may not be painful. It is called phantom pain when the sensation they are feeling is pain in the missing limb. You may need one or more of the following kinds of care or treatment:
Acupuncture: This treatment is based on a belief that our bodies have channels through which fluids flow. Caregivers will insert very thin needles just under your skin. This is believed to open the channels allowing fluids to flow better. This treatment may decrease pain and improve healing. Always see a caregiver for this treatment. Do not try to give this treatment to yourself.
Biofeedback: This training teaches your body to respond in a different way to stress. Teaching your body to relax can help you feel more in control. Caregivers may use a biofeedback machine so that you know right away when your body is relaxed. You can learn to do this without a machine. If you learn to take your pulse, you can make it slow down by thinking hard about it. This can work with breathing, temperature, and blood pressure too.
Cognitive Therapy: This therapy helps to make you aware of how you see things. You may have trouble seeing the good in things around you. Then you are more likely to feel depressed, sad or angry. Cognitive therapy teaches you how to see things in a more positive way.
Medicines:
Anticonvulsant medicine: Anticonvulsants are given to control seizures.
Antidepressants: This medicine is given to decrease or stop the symptoms of depression. It can also be used to treat other behavior problems.
Muscle relaxers: This is medicine to help your muscles relax. When your muscles relax, you may move more easily and have less pain.
Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. Nonsteroidal anti-inflammatory medicine may help decrease pain and inflammation (swelling). Some NSAIDs may also be used to decrease a high body temperature (fever). This medicine can be bought with or without a doctor’s order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait until the pain is very bad to ask for your pain medicine. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
:
Nerve blocks: This is a procedure where an anesthetic is injected through a needle. An anesthetic is a medicine that makes you lose feeling in an area. This procedure may used to help control pain after a BKA.
Nerve stimulation:
Transcutaneous electrical nerve stimulation (TENS): This is a treatment that uses a small device giving out mild electrical impulses. These impulses produce a mild tapping, tingling or massaging feeling on your skin. This treatment may improve healing and reduce muscle cramps.
Epidural narcotic pumps: In this treatment, doctors place a small pump under your skin. It is connected to a thin tube placed near your spine. The pump gives you small amounts of pain medicine.
Relaxation and stress management techniques: Relaxation is a way to focus your attention on something other than your feelings. For instance, good smells may change your mood and help you relax. Good smells may also help your brain make special chemicals called endorphins. Endorphins are a natural body chemical that can decrease bad feelings and pain. For example, you may listen to music or take a bath with aromatherapy oils. Candles, massage oils, and scented bubble baths are ways that smells can be used.
Hydrotherapy: In these treatments, you may be placed into a warm or cold water bath or pool. Caregivers may show you exercises to do in the water. Hot or cold packs may also be placed on your body in the areas where you are feeling pain.
Surgery: Surgery may be done to destroy the nerves that go to painful areas.
Physical therapy:
Caregivers will start you on physical therapy after surgery. A physical therapist (PT) will help you with special exercises. These exercises help make your bones and muscles stronger and help you learn to be independent after an amputation. You may be fitted with a prosthesis (artificial leg). Your prosthesis may need to be adjusted several times before it fits well. Physical therapists will also help you learn to walk with crutches and the prosthesis.
Residual limb care:
Bathing: Your caregiver will remove your stitches two to three weeks after surgery. When you are allowed to bathe or shower, gently wash the incision with soap and water. Carefully rinse and dry your skin.
Do not put lotion, oil, cream, or rubbing alcohol on your residual limb. Lotions, oils and creams soften your skin, and can cause problems when using your prosthesis. Rubbing alcohol dries and cracks your skin.
Look closely at the skin on your residual limb every day. Use a hand mirror in order to see all sides of the residual limb. Watch for redness, blisters or scrapes.
Caring for wounds: Preventing the wound on your residual limb from getting infected is very important. Always wash your hands before you touch any wound. Be gentle when you are cleaning the wound. Too much force can make infection or pain worse. Only use antiseptic (germ-killing) medicines if caregivers tell you to.
Helping your residual limb heal: Do the following things to help your residual limb heal faster:
Push the residual limb against a soft pillow. Slowly increase the pressure and start to push your residual limb against harder surfaces like the back of a chair.
Massage the residual limb to soften the scar. This also decreases tenderness and improves blood flow.
Woolen residual limb socks: Wear woolen residual limb socks when caregivers say you no longer need to wrap your residual limb. This keeps your residual limb clean and comfortable. Wash the woolen socks gently in cool water and soap to keep them from shrinking. Rinse the socks very well. Dry the socks flat on a towel to prevent stretching. Do not use residual limb socks if they get torn.
Wrapping your residual limb:
Caregivers will teach you or a family member how to wrap your residual limb with an elastic bandage to help control swelling. Wrapping also helps form the residual limb into a firm cone shape so it will fit a prosthesis. You may start wrapping your residual limb within one to three days after surgery, or you may wait until after the cast is removed. Start the elastic wrap low on your residual limb away from your groin (where your abdomen meets your upper leg). You may use a "figure of 8" method to wrap your residual limb. At first you will not pull the elastic bandage very tight. Caregivers will have you pull the bandage tighter as your wound heals and the stitches are removed.
"Figure of 8" method to wrap your residual limb:
Hold the bandage roll at the front of the thigh of your residual limb. Holding the end of the bandage in place, roll the bandage down the front of your limb, angling it slightly toward the outside of your limb.
Wrap the bandage around the end of your limb, and then up the back of your limb for a short distance.
Wrap the bandage toward the front of your limb. Roll the bandage up your leg, angling it toward the outside of your limb. The bandage will cross over itself.
Roll the bandage around the back of your limb, and then to the front of your limb. Roll the bandage back down the front of your limb, and wrap it around the end of your limb. Partly overlap the bandage as you wrap, so that you are always covering new skin surface.
Keep bandaging, following these steps, until your limb is completely covered, from mid-thigh down. Be sure to include your knee while wrapping the bandage around your limb.
Helpful hints:
While you are unrolling and using an elastic bandage, stretch the bandage slightly while wrapping your limb.
If you need to use more than one bandage, secure each bandage with a clip or tape before applying another one. When you are finished, secure the last bandage. When securing the end of a bandage using clips, try to end the bandage in a place that is not in a skin fold, or at your knee joint.
Be sure that all of your skin is covered with the bandages. Bandages should cover your limb from the middle of your thigh to the end of your limb.
Rewrap the residual limb two to three times each day to keep the bandage smooth and tight. Rewrap the bandage if your pain is worse. This may mean the bandage is too tight.
Keep the bandage on at all times except when bathing.
Playing sports:
People often worry that they will not be able to do the things they used to do before having their leg amputated. You may worry that you cannot participate in sports any longer. Many companies supply sports equipment, like skis, so people with amputations can use them. You can also talk to caregivers about having your prosthesis made to allow you to do sports.
Support:
Having a leg amputated is life-changing for you and your family. You and those close to you may feel ashamed, angry, sad, or frightened, after your amputation. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person after an amputation.
You may also want to join a support group. This is a group of people who also had a limb amputated. Ask your caregiver for the names and numbers of support groups in your town. You can also contact one of the following national organizations for more information:
The Amputee Coalition of America (ACA)
900 E. Hill Ave, Ste 285
Knoxville, , TN 37915
Phone: 1- 888 – 267-5669
Web Address: www.amputee-coalition.org
American Pain Society
4700 W. Lake Avenue
Glenview , IL 60025
Phone: 1- 847 – 375-4715
Web Address: www.ampainsoc.org
Wellness hints:
Follow a healthy diet:
Eat a variety of healthy foods such as fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat and fish. Eating healthy foods may help you have more energy and heal faster. Ask your caregiver if you need to be on a special diet.
Men 19 years old and older should drink about 3 liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 liters of liquid each day (close to 9 eight-ounce cups). Follow your caregiver’s advice if you must change the amount of liquid you drink. For most people, good liquids to drink are water, juices, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Try to drink enough liquid each day, and not just when you feel thirsty.
Start exercising: Talk to your caregiver before you start exercising. Together you can plan the best exercise program for you. It is best to start slowly and do more as you get stronger. Exercising can help make your heart stronger, lower your blood pressure, and keep you healthy.
Quit smoking: It is never too late to quit smoking. Smoking harms your body in many ways. You are more likely to have heart disease, lung disease, cancer, and other health problems if you smoke. Quitting smoking will improve your health and the health of those around you. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.
Avoid stress: Stress may slow healing and cause illness. Since it is hard to avoid stress, learn to control it. Learn new ways to relax, such as deep breathing. Talk to your caregiver about things that upset you.
What should I do to take care of my prosthesis?
If you have a prosthesis, it is important to take good care of it. A caregiver called a prosthetist will make a prosthesis for you. Your height, weight, and other things will be considered when making the prosthesis.
When your wound has healed completely, it is important to wear the prosthesis all day. Put the prosthesis on first thing in the morning right after you get up. This will help decrease residual limb swelling.
Clean the inside of the socket every day with a damp soapy cloth to remove sweat and dirt. Remove the soap with a clean damp cloth. Dry the socket very well with a dry cloth.
Call your prosthetist if you have problems with your prosthesis. Never try to fix or adjust the prosthesis on your own.
Make an appointment with your prosthetist every year. The prosthetist will check to see if changes in your prosthesis are needed.
When can I drive?
Driving may be difficult at first after surgery. You may want to have changes made to your car so you can drive. Talk to your caregiver about how this is done.
When can I have sex?
You may have sex when you feel ready. Some patients may have problems with sex after an amputation. These problems usually do not last forever and most can be helped. Talk to your caregiver if you are worried. Your caregiver can help you find ways to handle these problems.
CONTACT A CAREGIVER IF:
You have a fever (increased body temperature).
Your stitches come apart.
Your bandage becomes soaked with blood.
The skin around your stitches is red, swollen, or has pus coming from the incision (cut). This may mean that you have an infection.
You have a sudden increase in tenderness in your residual limb.
You have chills, a cough, or feel weak and achy. These are signs that you may have an infection.
Your skin is itchy, swollen, or has a rash. Your medicine may be causing these symptoms. This may mean you are allergic to your medicine.
You have chest pain or trouble breathing that is getting worse over time.
You have questions or concerns about your BKA surgery, medicine, or recovery.
SEEK CARE IMMEDIATELY IF:
You have severe (very bad) pain in your residual limb.
You have chest pain or trouble breathing.
You suddenly feel lightheaded and have trouble breathing.
You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may also cough up blood.
Your arm or leg feels warm, tender, and painful. It may look swollen and red.
