A below knee amputation (often referred to as BKA), is an operation during which the lower portion of the leg is removed, whilst the surgeon saves as much of the healthy skin, bone and tissue as possible. This is often a very traumatic surgery, but with the right treatment and rehabilitation, you can get your independence back, along with a high level of functionality and mobility.
Keep reading as we break down the most common causes of BKA, explain what to expect after surgery, and give some insight on the most suitable mobility aids for below knee amputation.
What kind of injuries and illnesses could require below knee amputation?
While some people are born with a congenital amputation – which is a portion of the body missing from birth – a below knee amputation is usually the result of illness or injury. Here are the most common causes of a below knee amputation:
- Severe infection
- Inadequate blood supply to the leg
- After an injury sustained in an accident
- An ulceration of the leg, or other significant tissue damage
- To remove a malignant tumour
Below Knee Amputation Surgery & Recovery
Before you have below knee amputation surgery, a physiotherapist will visit you to discuss the recovery process, and advise you on what physiotherapy you’ll need afterwards. They could also check your current level of fitness and range of movement, as this can impact your rehabilitation.
A general anaesthetic is usually administered to anyone having this kind of surgery, which will mean you’re unconscious for the duration of the operation. If you’re on conflicting medications or there are other factors to consider, a regional anaesthetic could be used to numb the area instead – your doctor will decide on the best option for your specific circumstances.
After the operation, you’ll be given medication to help with any pain and discomfort. The remaining part of your leg (also known as a stump, or residuum) will have stitches, and is likely to be dressed in bandages, a rigid dressing or cast to protect it. You might also have a drain attached to your limb, which will collect any blood or fluid – but this is temporary and should only be necessary for the first day or so after the surgery.
If you’re struggling to eat and drink, your doctors may fit you with an IV to make sure you’re getting enough fluids, but it’s also possible that you’ll have a temporary catheter to monitor your urine output, and check your kidneys are functioning properly.
Treatment After a Below Knee Amputation
In the period following your surgery, your post-amputation stump needs to be kept clean and dry at all times, until your stitches have dissolved, or they’re ready to come out – this is to stop it from getting infected.
It’s very common to experience swelling in your limb for as long as a month after the operation, but to counter this, your doctor might prescribe the use of a stump shrinker. This a compression sock designed to prevent or limit localised swelling while your blood vessels heal, but it can also help to prepare your stump for the fitting of a prosthesis.
If you continue to experience considerable pain in the weeks following your surgery, your doctor will help you to develop a personal pain management plan, tailored to your needs. This could include exercises to prevent stiffness, pain control medications to help you heal and sleep comfortably, and a nerve blocker is sometimes prescribed for those suffering with Phantom Limb.
Rehabilitation for a Below Knee Amputation
The rehabilitation process after a below knee amputation can vary hugely in line with your age, fitness and general health, so it looks different for everyone. That said, most rehabilitation plans will involve the following steps:
As the pain recedes, your occupational therapist (OT) and nurses will encourage you to start moving around more independently. You may begin some gentle physiotherapy exercises as soon as a week after your surgery, attending the specialist gym at the hospital, where a rehabilitation therapist will discuss your long-term treatment plan with you. This is also a good opportunity to meet other amputees going through a similar process.
Day by day your strength and range of movement will improve, and around two weeks to a month after your operation, you could be discharged, as long as you have a supportive set up at home. The rest of your physiotherapy after this point will take place somewhere local to you, rather than at hospital.
Using a Prosthesis
You’ll be asked to take part in an early walking aid trial to assess whether or not your amputation is suitable for a prosthesis, and if you are, then a prosthetist will visit you at your local practice, and make a cast of your stump for an exact fit.
It’s worth noting that if your condition improves further down the line, you can do the trial again, and be fitted for a prosthesis at a later stage.
If you do have a prosthesis, it will be incorporated into your ongoing physiotherapy sessions so you can learn to get around effectively whilst wearing it, and continue to build your strength.
If you can’t have a prosthesis, you’ll keep working with your OT and physiotherapist, practising exercises and techniques so you can safely move around with crutches or a wheelchair.
Even once the stitches have healed, it’s important you take good care of your stump. You might be given specific aftercare instructions, but generally you’ll be advised to:
- Gently wash your stump every day, with warm water and mild soap
- Moisturise the skin before bed, to stop it from drying out
- Wear fresh socks every day
- Keep the area clean and dry whenever possible
- Regularly inspect your stump for any abnormalities or signs of infection
- Take your prosthesis off before you go to bed
The Best Mobility Aids for Below Knee Amputations
Whether you use a prosthesis or not, there’s a wide range of mobility aids suitable for below knee amputations, which can help you get your confidence back, as well as your freedom of movement. In addition, you will need a mobility aid to assist you in the weeks and months between your amputation and fitting of your prosthesis.
Along with wheelchairs, traditional crutches are often prescribed as the default mobility aid for leg injuries and below knee amputation. Standard-issue crutches are affordable, widely available and come with adjustable hand grips to make them suitable for a range of different heights. After BKA, it may take you a while to find your balance and get walking again; crutches can help with your stability, but consistent use can often cause secondary injuries, such as carpal tunnel, back and shoulder issues or hand blisters.
A knee scooter (or knee walker) is mounted on a foldable metal frame with four wheels, and two handlebars for additional control. There’s a padded platform which you rest your knee on, while you use your other leg to push yourself along, and many have convenient baskets where you can keep your personal belongings. While knee scooters do offer an increased level of mobility and comfort, some weight restrictions apply, and you can’t use them to get upstairs.
iWALK Hands Free Knee Crutch
An innovative mobility aid that offers unprecedented flexibility, the iWALK hands-free knee crutch is worn directly on the injured limb, tightly secured by comfortable straps for maximum support and stability. As it’s worn – rather than carried – your hands are left completely free, so you can carry on your day-to-day life unhampered and find a new normal, be it by walking your dog, cooking the dinner or holding hands with your kids.
The iWALK 3.0 offers many other patient benefits too, including improved blood flow, reduced muscle atrophy and a better level of wellbeing overall. Simply put, it can revolutionise the rehabilitation and long-term mobility of anyone learning to walk again after below knee amputation surgery.
It has also been shown to assist amputees develop the skills they need to use a prosthesis during the often lengthy transition period between amputation and eventual prosthesis fitting.
To find out more about using the iWALK hands-free knee crutch after a BKA, take a look at our product reviews from amputees, read a little more on our BKA page, or get in touch with your questions today.