By Jordana Bieze Foster
Patients who have had a partial foot amputation followed by a transtibial amputation on the same limb feel that they were inadequately educated about what the first procedure would involve, according to detailed interviews conducted by researchers at La Trobe University in Melbourne, Australia.
“When we look at conditions like cancer or end-stage renal disease, there’s quite good evidence that education and managing expectations has a positive effect on things like anxiety and depression. But there doesn’t seem to be much specific to partial foot amputation, which is surprising given how common it is,” said Michael Dillon, BP&O(Hons), PhD, a senior lecturer in prosthetics and orthotics at the university, who presented the findings in June at the 2015 ISPO Congress.
Interviews with three patients at least six months following their transtibial surgery were synthesized for the presentation; the researchers plan to continue the interviews until no new themes emerge, Dillon said.
The researchers were surprised by patients’ lack of awareness about complications associated with partial foot amputation, Dillon said, particularly since they typically make multiple clinic visits in the months preceding the procedure. Patients also said they had been unprepared for the extent of tissue removed during the surgery.
“The first point of discussion is often about will they walk again. Issues like mortality and complications are often not even on the patient’s radar,” he said.
All patients expressed disappointment in the lack of information about treatment alternatives, in particular transtibial amputation, which is typically associated with fewer complications than partial foot amputation.
“Patients said they would have liked to use their time differently in retrospect, given the complications associated with the partial foot amputation, especially since many don’t have a lot of years left,” Dillon said.
Some patients said they were able to obtain knowledge about their treatment options through unconventional channels, including chance encounters with allied health professionals and with other patients. That knowledge, they said, helped them advocate for the type of healthcare they wanted, which in some cases involved transtibial amputation rather than partial foot amputation.
Patients also told the researchers they would have liked to have had supplementary written information in addition to verbal discussion. Although this finding surprised the researchers, it does make sense, Dillon said, given that patients may be distracted or under the influence of strong medications when conversations about surgical procedures take place.
“Often at the time they are not in a good position to make decisions,” he said. “Many of these people you could have given the best information in the world, and they wouldn’t have been in a position to process that information.”
Ozturk H, Dillon M, Duke E, Kennedy-Jones M. Experience of sequential partial foot and transtibial amputation: A narrative enquiry. Presented at the International Society of Prosthetics & Orthotics World Congress, Lyon, France, June 2015.