There are over 2 million Americans living with limb loss. Approximately 65% are living with lower limb (leg, foot, or toes) amputations, while the remaining 35% have lost from an upper limb (arm, hand or fingers).
Of course, such losses are not limited to the U.S.: about 12 million people worldwide are living with at least one limb missing.
Who is impacted?
Traumatic amputations are seen across all ages, and account for 25-45% of all amputation causes. At least 600 children undergo lawnmower-related amputations each year in the U.S., and men are twice as likely to be affected as women.
What are the main causes?
Limb loss is generally split into three main categories: vascular disease is most common, making up more than half of all amputations annually. Traumatic amputation is a close second at 45%, while cancer-related amputations make up about 2%.
Vascular disease is most commonly caused by diabetes and/or a history of consuming cigarettes and other tobacco products, with both risk factors being preventable or treatable.
Early signs of vascular disease can include painful muscle cramps; skin color changes; loss of hair or nail changes, especially on the feet; and foot or toe wounds that won't heal or heal very slowly. Traumatic amputations can result from:
- Traffic accidents (including bicycles, trains, motorcycles)
- Workplace/factory/construction accidents
- Agricultural accidents (including lawnmowers)
- Firearm/explosives/fireworks accidents (including military casualties)
- Electrocution accidents
- Ring traction accidents (a sudden force pulling a ring from a finger)
- Building and car door accidents
Also worth noting is “limb difference,” where an arm or leg is not shaped in the usual way. This can be a congenital condition, meaning that someone can be born that way.
The road back
When an amputation surgery is planned, pre-operative exercise and counseling – including peer support – will help improve physical and emotional healing. At White Plains Hospital, we start physical therapy, residual limb protection and shaping on day one.
Patients are typically discharged from the hospital to a rehabilitation facility for anywhere from two to six weeks of therapy before returning home. Most patients receive their first prosthesis two to four months after amputation. Most patients will require a new prosthesis from regular wear and tear every three to five years. In younger children, this is likely to be more often as they grow.
I see my post-amputee patients in the office each month for an assessment following their surgery. It’s important to be evaluated for wound healing, post-operative and phantom pain control, muscle strength and joint range of motion, and readiness for a prosthesis. As you become more comfortable with your prosthesis, visits are spaced out to every 3 to 6 months. If there are any new issues with pain, skin changes or wounds, it’s important to come in right away and not wait for a regularly scheduled visit.
Living with limb loss can be complicated, but it needn’t be a cause for anger or depression. Reaching out to your rehab team, joining a support group, or even speaking with friends and family can help you adjust to your new circumstances.
Additional information can be found here and here.
Dr. Stephanie Rand is Associate Program Director, Physical Medicine and Rehabilitation (PM&R) residency at Montefiore. She practices general rehabilitation medicine, with a focus on prosthetics, bracing, and musculoskeletal medicine. To make an appointment for her WPH Somers office, call 914-849-7075.