Gait training after delayed prosthetic fitting: a case report

Background and Purpose: Prosthetic training after below-knee amputation (BKA) is a long, collaborative process that generally begins within six months of surgery. For some patients, this process involves the use of temporary weight-bearing devices to prepare the patient for the mental and physical aspects of ambulating with a prosthesis. This case report discusses the treatment of a patient who had a prolonged period between a BKA and initialization of gait training with any prosthesis. Case Description: A 61-year-old male referred to physical therapy for prosthetic training over a year and a half after undergoing a BKA due to a gangrenous ulcer. Initial evaluation revealed strength, mobility, balance, and gait deficits that put him at a high fall risk. The patient underwent ten weeks of physical therapy with an emphasis on restoring balance, functional mobility, and optimal gait with a prosthesis. Outcomes: The patient initially progressed and then plateaued after the first month of therapy citing a fear of falling and increased pain with weight-bearing. After addressing underlying psychosocial concerns and following up with the prosthetist, the patient showed significant improvement in strength, function, and gait ability with the prosthesis. Discussion: Although this patient ultimately made progress towards his goals and improved his gait ability, a lack of trust in his prosthesis has notably prolonged his return to prior functioning. This case indicates a need for further investigation into the timing of prosthetic training and the use of temporary prostheses in patients who intend to return to ambulating following a BKA.