Below knee amputation and its Rehabilitation.pptx

Below knee amputation different levels describing each levels prosthetic and the rehabilitation

1. Below Knee amputation and its Rehabilitation By Jehan Fayed

2. Partial foot amputation Transmalleolar ( syme ankle disarticulation) amputation Transtibial (Below knee) amputation Transfemoral (Above knee) amputation Levels of Lower limb amputations

3. The level of amputation and residual limb length determination is done according to: Circulation (ischemic conditions) Cause (traumatic conditions) S kin blood supply and proper healing Lever arm to reduce energy expenditure the lower the level of amputation allows better prosthetic fitting & reduces energy expenditure

4. Proper surgical procedure: Cone shaped residual limb construction Proper wound closure Adequate soft tissue cover of the bone Good muscle balance

5. Hip flexors and extensors Hip abductors and adductors Knee flexors and extensors Muscle Strength

6. Ankle- foot assembly Shank Socket Suspension system Components of trans- tibial prosthesis

7. Ankle-foot Assembly Non-Articulated Articulated SACH foot (Solid Ankle Cushioned Heel) SAFE foot (Stationary Attachment flexible endoskeleton) Single Axis Multi-axis

8. No ankle joint Advantage: More stability Light weight Easy maintenance Disadvantage: Can not walk on uneven ground Not suitable for active individuals Non-Articulated

9. Consists of rigid wood or aluminum keel that cannot dorsiflex & Compressible heel Shock absorbent at heel strike Simulated planter flexion for a smooth gait SACH foot

10. Similar to SACH foot but with a flexible keel Allows better walking on uneven ground Prescribed for moderate activity patients SAFE foot

11. Advantage: Ability to ascend and descend inclination Used for active individuals Disadvantage: Heavy High maintenance Less cosmetic Articulated Foot

12. Solid wood internal keel + metal single axis joint + rubber planter flexion bumper + dorsiflexion stop Allows movement in one plane Advantage: Increased knee stability at heel strike Disadvantage: Noisy Single A xis Foot

13. Similar to single axis foot Allows movement in all planes Reduced stability Better movement Multiple Axis Foot

14. Can be articulated or non-articulated Single or multiple axis Elastic keel deforms under pressure (storing energy)  returns to original shape when the load is removed  release energy Examples: Seattle foot, Flex foot, Energizer foot Dynamic Response (Energy Storing) Foot

15. Dynamic Foot

16. Total Contact (Patellar Tendon Bearing) Total Surface Bearing Sockets

17. Commonly used socket Custom molded Distributes weights on pressure tolerant areas through build up (bulges) Removes weight off pressure sensitive areas through concavities (reliefs) Advantage: Prevent edema, good support Patellar tendon Bearing

18. Distributes weight evenly all over the residual limb to reduce pressure Not frequently used since the residual limb can change in shape and size Total Surface Bearing

19. Used to retain the prosthesis on the residual limb during swing phase Types: Supracondylar Brim Sleeve Suction Joint and thigh corset Suspension

20. Without fork strap or waist belt Strap goes around the thigh above the femoral condyles Indication: new amputee, limited movement Contra-indication : limited vision medio -lateral instability short and fleshy stump Supracondylar suspension

21. With fork strap or waist belt A fork strap is attached to the leather strap distally and to waist belt proximally Used for active amputee who needs extra support Supracondylar suspension

22. Supracondylar (SC ) Medial & lateral wall extend above femoral epicondyles Anterior wall cut out to accommodate patella Advantage: high medio -lateral knee stability Disadvantage: cannot be used in short stump Supracondylar/ Suprapatellar (SC/SP) Medial & lateral wall extend above femoral epicondyles Anterior wall above patella Advantage: more effective suspension, short stump, control genu recurvatum Disadvantage: limited flexion Brim Suspension

23. Brim Suspension

24. Neoprene or latex rolled over the socket and thigh Used as 1ry suspension system with PTB or as 2ry suspension in highly active amputee Contraindication: Low medio -lateral stability Genu recurvatum Short residual limb Perspire excessively Lack hand strength Sleeve Suspension

25. Leather thigh corset+ metal joints + side bars connected to the socket Metal side bars give max medio -lateral stability The corset shifts 50% of weight bearing from the stump to the thigh Joint and Thigh Corset Suspension

26. Indications: Patellar tendon cannot tolerate weight bearing Painful knee joint Moderate-Sever medio -lateral instability Moderate-Sever genu recurvatum Disadvantage: Atrophy of thigh muscles Bad cosmosis Difficult to don / doff Joint and Thigh Corset Suspension