Methods

This paper is based on the clinical experience of the authors in Britain and the United States, a review of the literature, and information gathered from colleagues in rehabilitation medicine throughout the world.

Amputation: causes and impact

In developed countries the main cause of lower limb amputation is circulatory dysfunction. The prime reason for this is atherosclerosis, although up to a third of patients have concomitant diabetes. These people are usually in their sixth decade (or older), and most have additional health problems that limit their walking ability. In the United Kingdom there are about 5000 new major amputations a year.1

This is in sharp contrast with developing countries, where most amputations are caused by trauma related either to conflict or to industrial or traffic injuries. Global extrapolations are problematic, but a recent US study states that the amputation rate among combatants in recent US military conflicts remains at 14-19%2 and the devastation caused by land mines continues, particularly when displaced civilians return to mined areas and resume agricultural activities.3

An amputation is a permanent disfigurement. For some, the relief from pain or disease in the affected limb may be welcome, but, for those losing a sound limb, resentment is understandable. Despite modern prosthetics, some adaptation is required, and people vary in their ability to adjust to the change in body image and, sometimes, lifestyle.

Advances in prosthetic technology

Prosthetic technology has advanced to a remarkable degree in …