55. Rehabilitation following limb amputation, orthoses, orthopaedic shoes

From greek.doctor

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