transtibial

Transtibial refers to an amputation performed through the tibia below the knee, preserving the knee joint. It is commonly called a below-knee amputation (BKA) and is contrasted with transfemoral (above-knee) amputation. The preserved knee joint can aid in mobility and balance and influences rehabilitation and prosthetic design.

Indications for a transtibial amputation include severe traumatic injury, limb-saving infection or nonviable tissue, advanced peripheral vascular disease, tumor, or congenital deformity where preservation of the knee improves function or where limb salvage is not feasible. Decisions aim to maximize remaining limb length when possible to enhance prosthetic control and energy efficiency, while ensuring durable soft-tissue coverage.

Surgical considerations focus on residual-limb shaping and tissue stability. Techniques may include primary closure, myodesis or myoplasty to stabilize muscle groups to bone, and careful management of soft tissue to reduce pain and pressure sites. Postoperative care emphasizes edema control, prevention of skin breakdown, and avoidance of knee flexion contractures to optimize prosthetic fit and function.

Rehabilitation and prosthetics involve fitting a transtibial prosthesis after healing, comprising a socket, a pylon or frame, and a foot-ankle assembly. Rehabilitation topics include stump desensitization, strengthening, gait training, and adaptation to ambulation with the prosthesis. Regular follow-up ensures socket fit, alignment, and maintenance of skin and residual-limb health.

Outcomes and complications vary with residual-limb length, overall health, and access to rehabilitation. Common issues include wound problems, infection, neuromas, phantom limb sensations, and residual-limb pain. When well managed, transtibial amputation can enable functional mobility and a good-quality life with proper prosthetic support.