Rehabilitation of a Diabetic Amputee:Sequelae, Impact and Effect on the Precious Limb

Background: In a patient who has undergone a major amputation of one lower limb, the role and function of the precious limb is of paramount importance. We assume that once the patient has been rehabilitated with a prosthesis, the static plantar pressure distribution is equal over both the amputated limb and the precious limb. There is not much published literature that actually compares the distribution of the static plantar pressure over the precious limb available in India. This study aimed at studying the characteristics of static plantar pressure distribution after a major amputation in the precious foot of diabetic patients with and without prosthesis once they have been rehabilitated.

Objectives:

1) To compare the relationship between static plantar pressure distribution in the precious limb with and without the prosthesis in diabetic patients who have undergone a below knee amputation and have been rehabilitated.

2) To identify areas of high pressure over the precious limb and suggest appropriate modifications in the prosthetic footwear so as to reduce the static plantar pressure in those high-pressure regions.

Results: The static plantar pressure distribution was found to be significantly higher without the advocated prosthetic device on the amputated limb over the 1st, 2nd, 3rd, 4th, and 5th metatarsal. . The ratio of the forefoot versus the hind foot pressures with and without a prosthesis was also noted to be significant (p = 0.002).

Conclusions: This variation in the pressure distribution over the precious foot disproved our hypothesis that there is an equal spatial redistribution in static plantar peak pressures in the precious limb following rehabilitation with a prosthetic device in a diabetic patient who has undergone a below knee amputation and that a prosthesis alone is not adequate to protect the precious limb.