What to expect during recovery from a foot or leg amputation depends on how much of the limb was removed. Recovery for the different types of amputation includes:

• Toes or forefoot. Unlike the more involved amputations, this type may not require an overnight hospital stay. Outpatient physical therapy can begin a day or two after discharge. The splint may be removed within the first week. The physician may allow the patient to bear weight on the involved leg after four to six weeks, or when the wound heals. During healing the wound granulates, forming small bumps of tissue. The wound requires sterile dressings until healing is complete. A custom shoe may be the only prosthetic device required.
  
  
• Below the knee. A temporary splint may be used to protect the sutured incision. It will also help keep the knee from bending. A flexion contracture (muscle disuse causes the knee to be stuck in a bent position) is a risk of a below-knee amputation (BKA). One focus of therapy will be on avoiding this complication, which would prevent use of a prosthetic limb.
  
  
• Above the knee. The incision is closed with sutures or staples. The stump is wrapped in an elastic bandage or stocking to reduce swelling (edema). An above-knee amputation may require a longer hospital stay than a BKA, perhaps several days in an acute-care hospital, inpatient rehabilitation center or both. Weeks of outpatient rehab may follow. The wound must be kept dry for several weeks until the stitches or staples are removed. Sponge baths may be necessary to prevent moisture from reaching the wound.

Recovery from leg or foot amputation focuses on several areas. These issues may vary depending on the type of amputation as described above. Concerns include:

• Wound care and stump care. Wound care begins right after surgery, and routine stump hygiene and care needs are continual. Skin grafting may be used to help close the wound. The physician or other health professional will give specific instructions on caring for the incision site and residual limb. Typical aspects involved include:
  
  
• • Guarding against infection. The incision site should be kept sterile, clean and dry. Symptoms of infection, such as fever or nausea, should be reported.
    
    
  • Shaping a leg stump and controlling swelling. A conical shape is desired to fit an artificial limb. Elastic bandages are wrapped more tightly at the bottom, more loosely at the top to help form this shape. Elastic wrap may be worn continually at first, with rewrapping several times a day, to control swelling until the prosthesis can be worn. Keeping the stump wrapped and elevated enhances circulation and healing.
    
    
  • Hygiene. Typically, the site should be washed nightly with antibacterial soap after the removal of stitches. A prescription cleanser may be used. Bathing at night instead of in the morning helps prevent moisture and risk of infection in the socket of an artificial leg. Other aspects of hygiene include:
    
    
  • • Drying well after washing
    • Letting scabs and dead skin fall off on their own
    • Leaving pimples alone to prevent infection
      
      
  • Prevention of contractures. A physician, physical therapist, nurse or other health professional will advise how to keep the joints moving so they do not get stuck in one position. The most common contracture after amputation is flexion (bending) of the knee. Stretching exercises to extend (straighten) the joint are used, while avoiding damage to stitches.
    
    
  • Desensitization. Gently and carefully rubbing and massaging the stump, including the end after removal of stitches, reduces skin hypersensitivity.
    
    
• Physical rehabilitation. Physical therapy usually begins a day or two after the surgery, before a prosthetic is used. It intensifies after the artificial limb is introduced. Outpatient treatments may continue for weeks after discharge. The physician might order occupational therapy in the hospital to offer instruction in self-care such as bathing and toileting with assistive devices such as a shower bench or commode chair. Physical therapy involves:
  
  
• • Transfer training (e.g., from bed to chair, chair to standing)
    
    
  • Standing tolerance, increasing the length of time the patient can stand up
    
    
  • Gait training (walking), including:
    
    
  • • Progression from parallel bars to walker to crutches to cane to ambulation with no assistive device, if possible
      
      
    • Progression from smooth surfaces to irregular terrain and obstacles such as thresholds and curbs
      
      
  • Stair climbing
    
    
  • Balance training, to adjust for the change in the body’s center of gravity
    
    
  • Learning how to land safely in case of a fall, and how to get back up
    
    
  • Range-of-motion exercises to keep joints from contracting
    
    
  • Strengthening to enhance recovery and the ability to use crutches
    
    
  • Desensitization
    
    
  • Instruction in wound care and stump care
    
    
  • Instruction in daily foot care and skin care to help avoid another amputation
    
    
  • Prosthetic fitting and training. A medical specialist called a prosthetist supplies and fits the artificial limb, custom shoe or other orthotic device needed. Sometimes a temporary prosthetic limb is used shortly after the amputation, with the permanent prosthesis introduced later. Artificial limbs are not appropriate for some amputees. Someone with a toe amputation, for example, will not need one. Sometimes there is not enough of a stump to accommodate one. Other complications including infection, mental confusion or physical frailty can rule out this option.
    
    
• Avoidance of further amputation. Many amputees with diabetes undergo further amputation of the involved leg or an amputation of the other leg. Prevention is crucial and includes:
  
  
• • Patient and family education on diabetes care and management
    
    
  • Foot and skin care
    
    
  • Protection of the stump
    
    
  • Control of the risk factors of diabetes such as high glucose (blood sugar), high blood pressure and abnormal levels of cholesterol

• Psychosocial issues. A foot or leg amputation involves a profound psychological and social adjustment. The following resources can help:
  
  
• • Counseling addresses common reactions such as depression, grief, mourning, fear, altered body image, impaired self-esteem and family stress.
    
    
  • Support groups such as the Amputee Coalition of America supply solidarity and advice.
    
    
  • A social worker can provide details about financial assistance and other resources.