Stump care

It's very important to keep the skin on the surface of your stump clean to reduce the risk of it becoming irritated or infected.

Gently wash your stump at least once a day (more frequently in hot weather) with mild unscented soap and warm water, and dry it carefully.

If you have a prosthetic limb, you should alsoregularly clean the socket usingsoap and warm water.

When taking a bath,avoid leaving your stump submerged in water for long periods because the water will soften the skin on your stump, making it more vulnerable to injury.

If your skin becomes dry,use a moisturising cream before bedtime or when you're not wearing your prosthesis.

Some people find wearingone or moresocks around their stump helps absorb sweat and reduces skin irritation. The size of your stump may change as the swelling goes down, sothe number of socks you need touse may vary. You should change the socks every day.

Check your stump carefully every day for signs of infection, such as:

• warm, red and tender skin
• discharge of fluid or pus
• increasing swelling

Contact your care team for advice if you think you may be developing a skin infection.

Caring for your remaining limb

After having a leg or foot amputated, it's very important to avoid injuring your remaining "good" leg and foot, particularly if your amputation was needed because of diabetes . Your remaining leg and foot may also be at risk.

Avoid wearing poorly fitting footwear and ensure that an appropriately trained healthcare professional, such as a podiatrist, is involved in the care of your remaining foot. You should also be offered a regular review of your foot by the foot care team.

It also carries a risk of additional problems directly related to the loss of a limb.

There are a number of factors that influence the risk of complications from amputation, such as your age, the type of amputation you've had, and your general health.

The risk of serious complications is lower in planned amputations than in emergency amputations.

Complications associated with having an amputation include:

• heart complications such as heart attack
• deep vein thrombosis (DVT)
• slow wound healing and wound infection
• pneumonia
• stump and "phantom limb" pain

In some cases, further surgery may be needed to correct problems that develop or to help relieve pain. For example, if neuromas (thickened nerve tissue) are thought to be causing pain, the affected cluster of nervesmay need to be removed.

Stump and "phantom limb" pain

Many people who have an amputation experience some degree of stump pain or "phantom limb" pain.

Phantom limb sensations are sensations that seem to be coming from the amputated limb. Occasionally, these can be painful (phantom limb pain).

The term "phantom" doesn't mean the painful symptoms are imaginary. Phantom limb pain is a real phenomenon, which has been confirmed using brain imaging scans to study how nerve signals are transmitted to the brain.

The symptoms of phantom limb pain can range from mild to severe. Some people have described brief "flashes" of mild pain, similar to an electric shock, that last for a few seconds. Others have described constant severe pain.

Stump pain canhave many different causes, including rubbing or sores where the stump touchesa prosthetic limb, nerve damage during surgery and the development of neuromas.

Treating stump and phantom limb pain

Stump and phantom limb pain will usually improve over time, but treatments are available to help relieve the symptoms.

Medications

Medications that may be used to helprelieve pain include:

• non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
• anticonvulsants such ascarbamazepine orgabapentin
• antidepressants such as amitriptylineor nortriptyline (these medications work directly on the nerves in your leg)
• opioids such ascodeine or morphine
• corticosteroid or local anaesthetic injections

Self-help measures and complementary therapy

There are several non-invasive techniques that may help relievepain in some people. They include:

• checking the fit of your prosthesis and making adjustments to make it feel more comfortable
• applying heat or cold to your limb, such as using heat or ice packs, rubs andcreams
• massageto increase circulation and stimulatemuscles
• acupuncture thought to stimulate the nervous system and relieve pain
• transcutaneous electrical nerve stimulation (TENS) where a small, battery-operated device is used to deliver electrical impulses to the affected area of your body, to block or reduce pain signals
• mental imagery (see below)

Researchhas shownthat people who spend 40 minutes a day imagining using their phantom limb, such as stretching out their "fingers" or bunching up their "toes", experience a reduction in pain symptoms.

This may be related to the central theory of phantom limb pain (that the brain is looking to receive feedback from the amputated limb), and these mental exercises may provide an effective substitution for this missing feedback.

Another technique, known as mirror visual feedback, involves using a mirror to create a reflection of the other limb. Some people find that exercising and moving their other limb can help relieve the pain from a phantom limb.