REHABILITATION FACTORS FOLLOWING TRANSMETATARSAL AMPUTATION

Despite the occurrence of approximately 10,000 transmetatarsal amputat ions (TMAs) a year in the United States, there are few reports describ ing rehabilitation for this patient group. The purposes of this clinic al perspective are (1) to identify common problems encountered during rehabilitation of patients with TMA, (2) to identify factors that may contribute to these problems, and (3) to propose methods to manage the se problems. A review of the literature and biomechanical models of th e residuum, footwear, and orthotic devices are provided to help accomp lish these purposes. Common problems encountered during rehabilitation of patients with TMA are skin breakdown and instability during functi onal activities. Decreased foot length and peripheral neuropathies app ear to contribute to these problems. Solutions focus on attempting to provide a substitute for the plantar-flexor lever arm and protection o f the insensitive residual foot. Suggestions for additional research a re presented.