Sometimes a foot or leg amputation is an emergency procedure with little time to prepare, such as a longtime infection that has suddenly worsened. Often, however, the patient and healthcare team will have advance notice of the need for amputation. This time will allow for several types of preparation:

• Medical. The surgeon will perform tests to determine the optimal level of amputation. An ideal site offers enough blood flow to promote healing and enough of a stump to accommodate a prosthetic limb. These tests are generally painless and noninvasive. The tests may include:
  
  
• • Monitoring of blood pressure at various sites on the leg or foot
    
    
  • Doppler ultrasound to measure blood flow in the arteries
    
    
  • Fluorescent measurement of the small blood vessels in the skin
    
    
  • Infrared measurement of skin temperature
    
    
  • Transcutaneous oxygen measurement. Use of electrodes to detect the amount of oxygen passing through the skin.
    
    
• Physical. Exercises to strengthen the upper and lower body will speed recovery from the surgery and make it easier to use assistive devices such as crutches and prosthetics. The physician may refer a patient to a physical therapist, exercise physiologist or other health professional who can devise and monitor a strengthening and endurance program. A dietitian may be consulted if recovery is at risk because of malnourishment.
  
  
• Mental and emotional. The physician will give the patient details of the procedure and receive a signed consent form. Knowing what to expect before the surgery can help prepare the patient and family. Loss of a limb often affects a person’s self-image. Counseling may be necessary (and should be planned) to restore a person's self-confidence and self-esteem.
  
  
• Environmental. The physician might order a home evaluation in advance by a physical therapist, occupational therapist or both. These professionals will note safety issues and the need for any modifications of the home, such as installation of a stair railing or removal of rugs. Alternately, a home evaluation might be ordered shortly before the amputee returns home.

Insurance may cover some of the physical, mental and environmental preparations for amputation.

Amputation ranges from removal of a toe to the entire leg. It is natural to hope for the least invasive intervention possible. The patient should understand that the extent of the surgery depends on factors the individual cannot control.

An above-the-knee amputation (AKA) may be necessary if circulation in the foot and lower leg is insufficient to promote healing. The site of amputation needs to be free of infection but ideally will have adequate limb length to accommodate a prosthetic.

In some cases, such as a below-knee amputation (BKA), a midlength stump may work better with an artificial limb than a longer stump. An AKA with a long stump may be preferable to a BKA with a stump too short to allow for a prosthesis.