 Avoiding Injury:
Safety Tips for Seniors With Amputations
As you age, simply being an amputee may increase your risk for various types of injuries. You are more likely to fall and hurt yourself. You also may not be able to stay fit because of a more sedentary lifestyle. Other injuries may occur because:
- Your prosthesis fits poorly
- Your prosthesis does not provide proper shock absorption
- Your prosthesis prevents you from achieving a proper gait.
The injuries that can occur include:
- Broken bones
- Undue stress on the heart
- Back and hip problems
- Skin breakdown
- Additional stress on the sound limb, which might lead to
ulcers, infection and, in extreme cases, the amputation of
your sound limb.
Broken Bones
Our bones generally decrease in density, mass and strength as we age, especially beyond age 50. They become thinner, more brittle, more porous and easier to break. This disorder is known as osteoporosis.
Amputees who use lower-extremity prostheses need to be especially careful to protect your bones because of the importance of your residual limb for support.
Participating in activities that put weight on your bones is one of the most important ways to keep your bones strong. Unfortunately, it may be difficult to bear weight on your residual limb. This may become
even more difficult as you lose more and more bone density. To prevent this problem, it is important to become active again as soon as possible after your amputation. Then you must stay active. Activities that are especially good for strengthening your bones include aerobics, walking, running, weightlifting,
skating, dancing, basketball and tennis.
Many amputees participate in able-bodied exercise and sports programs, and there are many programs that are for amputees only. (For information on such programs, please contact the Amputee Coalition.)
Before beginning any new exercise program, it’s a good idea to talk with a doctor. If desired, a physical therapist (PT) who has experience with amputees can help you design an exercise program that fits your needs.
Exercise will also help protect your bones by developing
the muscles around them. Even if you can’t participate in a full exercise program, it’s a good idea to contract and release the muscles of your residual limb a few minutes every day to develop them.
Including foods that are rich in calcium like milk, yogurt, dark green vegetables, and fish in your diet is also important for your bones. A physician can tell you how much calcium you need on a daily basis and prescribe calcium, vitamin D, estrogen or fluoride supplements.
Undue Stress on the Heart
Because amputees who use a prosthesis generally use more energy to walk than able-bodied people do, good overall physical health is essential.
For some older amputees, the problem is even more severe, explains Terrence P. Sheehan, MD, a physiatrist and the medical director of Kessler-Adventist Rehabilitation Hospital. “For many amputees, loss of a limb is part of a larger problem with the blood vessels, including the blood vessels to the other major structures such as the heart. If the heart is not functioning well, all efforts will take more energy and the stress of ambulating with a limb deficiency can exacerbate the heart problems.”
The primary care physician, the cardiologist, the physiatrist and the PT can help with these issues. A thorough assessment followed by proper medication
and physical training can help the amputee develop the stamina needed to handle the added strain of walking with a prosthesis. Eating a heart-healthy diet is also important.
 Back and Hip Problems
Back and hip problems caused by the stress and strain of walking with an improper gait, using prostheses, or using crutches are sometimes a major problem for amputees.
“Lower-extremity amputation causes a change in the center of gravity, disrupting the biomechanical
symmetry of the back and hips,” explains Dr. Sheehan. “The joints of the lower back and sound limb are stressed and muscles are used abnormally. This often leads to chronic pain, a propensity to repeated
acute spasm and strain, and acute inflammatory
processes such as bursitis.”
Although some of the back problems you have might not be caused by your gait or prosthesis, it is important that PTs and prosthetists know about them. They may be able to deal with the problems through proper prosthetic fit, more appropriate components, or gait training. In addition, you should learn about good body mechanics to avoid as many problems as possible. A physiatrist and a chiropractor can help.
“Many patients don’t understand why their backs hurt,” explains Bill Sheppard, DC, a chiropractor and below-knee amputee. X-rays sometimes show misalignment of their back, he explains, and usually one side is rather high or rather low because of the improper fit of the prosthesis.
Skin Breakdown
As you age, your skin is likely to become thinner, more fragile,
and less elastic. This can be especially dangerous for your residual limb, which is often in contact with your prosthesis and is pulled, stretched and rubbed by the socket. Friction, heat, pressure, shear and moisture within the socket combine to bring about damage to the skin. As with shoes, a properly fitting prosthesis
is essential to preventing this painful problem.
Swelling, weight fluctuations and muscle changes caused by atrophy,
disease, and loss of soft tissue can all affect the size of your limb and the fit of your prosthesis. The volume of your limb can even change throughout the day as you walk around. Although they will not solve the problem completely, a proper diet, regular exercise, and the maintenance of muscle tone and weight can help minimize these fluctuations. In addition, gel-type liners, which are more cushioning than socks, may help.
Skin damage can also result from the use of certain detergents to clean the residual limb and the use of some topical medications inside the socket.
Ultimately, attention to hygiene and skin care is essential for protecting your skin from damage. “There are a few basic rules for skin care, the first of which is cleanliness,” says Paddy Rossbach,
RN and Amputee Coalition president and CEO. “If you wear a prosthesis, your residual limb is encased in a completely or partially airtight socket that does not breathe or allow sweat to evaporate. Sweat is acidic and salty, and when it is allowed to dry, it forms tiny crystals
(like sandpaper) on your skin. If this sweat is left on the skin and socket, bacteria can grow. If the skin is broken, infections may occur and can become severe if left untreated.”
She warns: “Always consult your physician or prosthetist if sores or blisters erupt because they could lead to ulcers and serious infections. If you have diabetes or circulatory disease and have anything more than a mild rash, consult your physician immediately.”
Although cleanliness is essential, the details of how it is achieved may vary depending on your specific condition and the type of prosthesis you use. (For more detailed information on basic skin care, see the article Tips for Skin and Socket Care in this publication).
One thing is essential: You should pay attention to any pain in your residual limb, and if any kind of problem is detected, do not ignore it.
Injury to the Sound Limb
Many senior amputees have lost a limb as a result of diabetes, vascular problems, or the lack of sensation in their limb (neuropathy).
It may be that the sound limb, or remaining limb, is affected by the same problem that caused the amputation.
When you wear a prosthesis on your residual limb, however, your sound limb may receive additional stress during walking. Diabetic
amputees with neuropathy often avoid putting full weight on their prosthesis and instead put more weight on their sound limb. They may try to get off the prosthesis as quickly as possible and will therefore swing the sound limb faster. As a result, their sound limb hits the ground harder, which may cause damage to the heel. In addition, they may hold their weight on the front of their sound foot longer as they walk because they are hesitant to put weight on their prosthesis. This additional time on the front of their foot may then cause calluses on that area, which can lead to foot ulcers and, ultimately, amputation. To avoid such problems, amputees should wear appropriate shoes that fit correctly, inspect their sound foot daily, and report changes to their physician.
According to statistics, about half of diabetic amputees will develop infections in their sound foot and possible amputation within two years of their first amputation. With proper caution, this might be prevented.
Note: This article is partly based on Prosthetics and Aging: Mobility for the Long Run, by Kevin Carroll, MS, CP, FAAOP (First Step –2001) and Keeping the Sound Limb Sound: Foot Issues for Amputees With Diabetes, by Robert Gailey, PhD, PT (inMotion, March/April 2003).
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