|The goal of rehabilitation following a traumatic foot amputation is the return of the individual to as functional a lifestyle as possible and to use pre-injury status as the ultimate goal.|
After surgical management of a traumatic foot amputation, rehabilitation may begin as soon as the individual is medically stable. Throughout the early phase, in addition to exercise, careful attention must focus on controlling stump edema, wound care and stump desensitization. There is evidence supported by randomized controlled trials for the use of semi-rigid and plaster cast sockets to promote wound healing in patients where the blood supply of the stump is uncompromised (Wong; Vigier). This also may lead to earlier prosthetic fitting (Wong).
Rehabilitation should emphasize strengthening exercises of the upper extremities, primarily the shoulder depressors to facilitate use of assistive devices for gait, the uninvolved lower extremity and the proximal joints of the involved lower extremity (Panadian). When indicated, rehabilitation should begin to focus on stretching and strengthening of the residual limb. Full range of motion of all joints on the involved limb is critical for early prosthetic fitting (Panadian). Once full range is achieved, strengthening of all muscle groups of the involved lower extremity is indicated.
Although up to 70% of individuals who suffer a traumatic amputation experience phantom limb pain, there is little evidence from randomized control trials to guide clinicians in effective treatment (Halbert). Common clinical treatment includes desensitization of the stump through the application of sensations such as pressure, massage, and vibration.
An important component of rehabilitation is assessing not only the physical status of the individual but also the mental and social health outcomes. In-patient rehabilitation may be beneficial to those requiring more support including future vocational options (Pezzin).
FREQUENCY OF REHABILITATION VISITS
|Physical Therapist||At least 24 visits within 8 weeks|
|The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.|
Source: Medical Disability Advisor