Abstract
Lower extremity injury and deformity can result from a number of etiologies. Regardless of the underlying cause, the decision to pursue amputation or reconstruction of a lower limb is challenging for both patients and practitioners. This decision is largely dependent on the patient’s premorbid health and function, functional goals and preferences, and characteristics and viability of the affected limb. The role of adaptive devices following surgery should never be underestimated. Advances in prostheses and orthoses have provided patients with a wider range of options to consider when deciding between limb reconstruction and amputation. The primary goals of any adaptive device are to improve function, prevent recurrence or ulceration of the defect, and allow for use of conventional footwear and/or clothing. When a lower extremity amputation is indicated, selection of the correct level is of critical importance in order to optimize healing potential and function. Each distinct level has certain inherent prosthetic and orthotic considerations. Likewise, the application of an adaptive device following reconstruction of the lower extremity also has demonstrable benefits and must be tailored to the specific defect and procedure performed. Knowledge of available prosthetic and orthotic options is of considerable importance for the reconstructive surgeon tasked with limb salvage or resurfacing an amputated extremity. This article reviews considerations of various types of lower extremity amputation and reconstruction, and provides a framework for the role of adaptive devices following surgery.
Highlights
Lower extremity injuries resulting in dysfunction and deformities can be due to a variety of conditions including congenital abnormalities, trauma, burns, vascular disease, and neuropathic disorders
We present the surgical considerations of various types of lower extremity amputation and reconstruction, and provide a framework for the role of postoperative adaptive devices including prostheses and orthoses
Determining whether to pursue amputation or reconstruction of a lower extremity is challenging for patients and practitioners alike - and is dependent on the patient’s premorbid health and function, functional goals and preferences in addition to the viability of the limb
Summary
Lower extremity injuries resulting in dysfunction and deformities can be due to a variety of conditions including congenital abnormalities, trauma, burns, vascular disease, and neuropathic disorders (including diabetes, leprosy, nutritional deficiency, axonal degeneration and demyelinating processes). A longer residual foot provides additional weight-bearing surface and less muscle imbalance, but the quality of the soft tissue coverage should be considered. After the transmetatarsal amputation has adequately healed and the patient has progressed to weight bearing, a partial foot prosthesis or orthosis may be prescribed.
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