Amputation

The weeks between the operation and a fitted prosthesis are not waiting time. They decide whether the prosthesis will work: whether the residual limb is the right shape, whether the hip and knee still straighten, and whether the person has the cardiovascular fitness to walk on it.

Walking on a prosthesis costs considerably more energy than walking on two legs, and the cost rises the higher the amputation. A person who spent three months in a chair before their first fitting has usually lost the fitness required, and that loss is harder to reverse than it was to prevent.

So this phase is compression and shaping of the residual limb, stretching to prevent the hip and knee contractures that make a prosthesis unusable, strengthening the remaining limb, balance work, and general conditioning.

A definitive prosthesis is usually fitted between six and eighteen months after surgery, once the wound has healed and the swelling has settled into a stable shape 4. Some people receive a temporary prosthesis earlier, within weeks, specifically to keep them upright and conditioned.

This matters more for someone travelling than for someone local. If you fly in three weeks after an amputation expecting to leave walking on a definitive limb, the timeline is against you — not because of the programme but because of wound healing and limb volume.

What an early block can do is prepare: shaping, contractures, fitness, and the assessment that determines the right components. What it cannot do is compress biology. We would rather say that before you book than explain it on arrival.

Prosthetic prescription is graded by expected function — internationally by levels running from no realistic prospect of walking, through walking on level surfaces at a fixed speed, up to unlimited community walking and higher-demand activity. The level determines which knee, foot and ankle components are appropriate.

That grading is not a judgement of effort. It reflects the other things going on: cardiac and respiratory capacity, the state of the other limb, vision, cognition, and how much of the leg remains. A component prescribed above someone's realistic level is heavier, harder and often ends up in a cupboard.

For people who are not prosthetic candidates, the programme is not smaller — it is different: transfers, wheelchair skills, the other limb, skin protection and independence at home. Those goals are worth travelling for too.

A well-made prosthesis fitted to an untrained person produces a limp, a sore residual limb and a device that gets abandoned. Learning to walk on it is a training process — loading, balance, stepping, then stairs, slopes and uneven ground.

Gait analysis is used to see what is actually happening rather than what it looks like, and the alignment is adjusted from that. The anti-gravity treadmill allows loading to be introduced gradually where the limb is not yet ready for full weight.

Sensation from the missing limb is normal and near-universal. Pain in it is common and can be severe. It is real pain generated by the nervous system, not imagination, and saying so matters because many people are told the opposite.

Treatment combines desensitisation, early prosthetic use, medication where indicated, and graded motor imagery — of which mirror therapy is one part. Mirror therapy is cheap, safe and easy to do at home, and the evidence for it is weaker than its popularity suggests: it does not appear to give more immediate relief than motor imagery alone, though a daily programme within a wider graded approach may help.

We include it on that basis, and we describe it that way rather than presenting it as a solved problem.

Where the amputation was caused by vascular disease or diabetes, the remaining limb is under the same threat, and it now carries more load. Protecting it — skin checks, footwear, glycaemic control, circulation — is not an add-on to the programme; over a ten-year horizon it may be the most valuable part of it.

For traumatic amputation in a younger person the long-term issues are different: overuse of the sound side, back pain, and socket fit changing as the limb continues to remodel for six to eighteen months 4.

Four to eight weeks, three to five hours a day. Residual limb care and shaping, contracture prevention, strengthening and conditioning, balance, transfers and wheelchair skills where relevant, gait training with the prosthesis, gait analysis, and management of phantom pain.

Prosthetic and orthotic provision is part of the wider service; what is appropriate and when is determined by the assessment rather than promised in advance. Where a device is recommended, it is quoted separately before anything is made.