Coping with adverse events in surgery: the need for tailored support (developed with surgeons, for surgeons)

Each year, more than 2,000 below-knee amputations are performed in the UK, often as a result of diabetes and/or arterial disease. They mostly occur in patients over 50 years. This patient group is often categorised as having “limited mobility” in the community, or as K2-level prosthesis users, according to the widely used Medicare Functional Classification Levels that inform prescription of prosthetic components, including ankle-feet. Older, below-knee amputees represent the majority (>66%) of lower limb amputees1 and form the most under-researched amputee patient group.

Below-knee amputees with limited mobility almost universally receive a prosthetic limb with a rigid ankle-foot (hereafter simply referred to as foot). Usual care “rigid” feet have limited functionality, designed for level walking and standing. These feet are unable to self-adapt to sloped surfaces, stairs and uneven terrain people encounter in daily environments. Other feet are commercially available on the NHS but seldom prescribed to this patient group because they are more expensive and their clinical and cost-effectiveness have not yet been demonstrated. In 2004, a Cochrane Review found there was insufficient evidence from “high-quality comparative studies for the overall superiority of any individual type of prosthetic ankle-foot mechanism”2.

Our patient public involvement (PPI) work with amputees who have limited mobility revealed their usual care foot is not “fit for purpose” and restricts their daily movement. Consequently, they use their prosthesis less and lead more sedentary lives, exacerbating existing health conditions (including mental) putting them at risk of re-amputation3. This leads to poor quality-of-life and increased healthcare costs for the NHS.