A transtibial amputation is the surgical removal of the lower leg below the knee. It is one of the most common types of limb amputation, and is performed for a variety of reasons. While losing a limb is always a difficult adjustment, people who have had a transtibial amputation usually recover well and can do most of the things that they did before the amputation. There are prosthetic limbs, helpful exercises, and personal support methods available for people who have lost a lower leg.
Disease and trauma are the most common reasons for transtibial amputation. The most common medication conditions are peripheral vascular diseases such as diabetes mellitus, in which poor circulation leads to tissue damage. Cancer is another disease that may necessitate amputation in order to remove all cancerous tissue. Serious trauma, such as traffic or industrial accidents, may lead to amputation, particularly if the leg is so damaged that many surgeries would be required to reconstruct it or if the wound becomes seriously infected.
Amputation is often thought of as a last resort, but may be a better option than trying to preserve the limb for some cases. Sometimes after trauma the lower limb can be reconstructed to some degree but the result would actually be less functional than an artificial limb. In other cases, treatment and surgery that attempts to save the limb would cause significant and long-lasting pain, as well as require the patient to spend a great deal of time in treatment that may not even be successful.
Surgeons will usually choose transtibial amputation over transfemoral, or above-knee, amputation whenever feasible. This is because walking with a prosthetic leg is much easier and requires much less energy when the knee is preserved. Lifting and lowering the leg and maintaining balance is easier for patients who retain the knee. Recovery and resumption of activity is less difficult for most patients with transtibial amputation versus transfemoral amputation.
Recovering from a transtibial amputation often involves a multidisciplinary team including doctors, physical therapists, prosthetists, and counsellors. Feelings of depression and grief are very common, and can vary widely in severity and duration. Most patients come out of depression with renewed commitment to become active again, but some struggle for a long time and a few never seem to recover. Professionals must be sensitive and flexible to the different needs of patients who have had lower leg amputation.
Healing amputation sites are prone to infection, particularly if poor circulation contributed to the need for the surgery. Pain and sensitivity is often a problem, including 'phantom' pain in the amputated limb. All pain should be brought to the attention of physicians in order to determine the cause of the pain, and to a patient's prosthetist if a prosthetic is causing discomfort. Physical therapists experienced at helping people recover from transtibial amputation can provide patients with many different exercises that maintain muscle strength and prevent tightening of the scar tissue and muscle.
