Limb amputation

Rehabilitation after amputation
- Aims of rehabilitation
  - Teach the patient how to use prosthesis
  - Improve balance, endurance and strength
    - After amputation the amount of energy necessary for walking increases a lot, so endurance and strength are important
  - Prevents secondary disabilities
    - Contractures, especially flexion contracture
  - Reduces phantom pain
  - Hasten stump conditioning
    - After amputation the stump is oedematous
    - The oedema gradually and naturally shrinks, a process called stump conditioning
    - Stump conditioning must finish before a permanent prosthesis can be designed, otherwise the prosthesis may not fit perfectly, causing problems
- Components of rehabilitation
  - Strength exercises
  - Balancing exercises
  - Stretching
  - Patient education
    - The patient must learn to take care of the stump and the prosthesis
  - Patient counselling

Orthoses

Orthoses (orthosis in singular) are externally fitted devices which support the musculoskeletal system
- They’re often used temporarily, but in some conditions permanent orthoses are necessary
- Uses
  - After operation or injury, to promote recovery until full recovery is achieved
  - Reduce weight-bearing forces on the limb
  - Restrict movement in a certain direction
  - Immobilize an extremity or joint
  - Correct abnormal shape or function of an extremity or joint
  - Offloading of a region of a pressure ulcer
- Naming
  - Orthoses are named after the joints they contain or their function
  - An ankle-foot orthosis (AFO) is applied to the foot and ankle
  - An ulcer-healing orthosis offloads the region of a foot ulcer, allowing for healing
- Foot orthoses – see orthopaedic shoes
- Ankle-foot orthoses
  - For temporary fixation of the ankle
  - Used after trauma and operations
- Knee orthoses
  - For temporary fixation of the knee
  - Used to prevent lateral instability or hyperextension
- Knee-ankle-foot orthoses
  - Used in muscle weakness, knee instability, genu valgum or genu varum
- Hip orthoses
  - Used in DDH (Pavlik harness)
  - Also used in infantine cerebral palsy and after trauma
- Hip-knee-ankle-foot orthoses
  - Transfer weight-bearing to the sciatic tuber
  - Used in Perthes disease
- Spinal orthoses
  - Used in degenerative spinal disorders, vertebral fractures, scoliosis, etc.
- Wrist orthoses
  - Used in carpal tunnel syndrome
Orthopaedic shoes and insoles
- Custom-made shoes or insoles used to compensate for orthopaedic conditions
- Uses
  - To equalize limb length discrepancies
  - To remove pressure from some parts of the foot
    - In metatarsalgia, RA
  - To distribute pressure across the whole foot
    - In diabetes, other neuropathies
  - To prevent deformities of the foot
  - To soften the impact of the heel-strike
  - To compensate for valgus or varus of the ankle