Functional Amputee Clinic

Our functional amputee program focuses on patients facing amputation and patients experiencing complications of an amputation. Our mission is to give our patients a leg that allows them to function at the level that they desire. Existing complications include bone, soft tissue, and or signs of phantom or residual limb pain and neuroma pain.

Bone problems include heterotopic (misplaced) bone formation or misalignment. Soft tissue problems can include excessive tissue, unstable soft tissue, and poorly healed incisions.  If the underlying muscles have not been myodesed (stabilized) and the tendons have not been tenodesed (sutured to a bone) to the distal tibia at the time of the original amputation, muscle wasting can occur and could lead to a prominent bone at the distal end of the stump. Not only this, but poor fittings of a prosthetic limb can also lead to an extensive breakdown of skin and tissues creating overall decreased functionality.

A poorly tapered amputation that does not fit easily in a prosthesis is a continual source of problems. The skin envelope must be smooth, free moving, without depressions and tapered. A misplaced bone or formation of an extra bone can create pressure points within the distal stump and if the skin is adherent to the underlying bone, this will always be a source of friction leading to a potential breakdown of the skin and tissue. Nerve problems are primarily associated with phantom limb or neuroma pain.

Phantom limb is a sensation or pain that is felt in a body part that no longer exists. This is due to a complex connection between the nerves, spinal cord, and brain. These sensations are different for every patient and can include shooting pain, cramping or squeezing, numbness, itchiness, or extremes of temperature. Some of these symptoms can present mildly, but often they can be debilitating and interfere with activities of daily living.

Neuroma pain is due to the nerves to the leg or foot being cut during the amputation. The cut nerve ends attempt to regenerate by sprouting new nerve fibers, but this disorganized regeneration results in a painful growth at the end of the nerve. Neuromas can be a cause of phantom pain. They can also cause significant pain when wearing a prosthetic leg, which can put pressure on the nerve ends. Neuroma pain is typically burning, tingling, or electrical in quality and radiates down the leg, even to the phantom foot.

Our patient population includes any patient facing amputation or with an amputation. Whether you have lost a limb to diabetes or a devastating trauma, our specialists are here for you. We strive to help our patients transition into a pain-free, functional lifestyle, and to become comfortable in their own skin by treating the whole patient. We use a multidisciplinary team approach to provide our patients with optimal treatment through our high-quality and innovative care techniques.

Our amputee services include our very own Plastic and Reconstructive surgeons, Christopher Attinger, MD, Grant Kleiber, MD, Derek Masden, MD, podiatric surgeon, Tammer Elmarsafi, DPM, and the Medical Director for the Amputee Rehabilitation Program at MedStar NRH, Howard Gilmer, DO.

Learn more about MedStar Health’s amputee services from our MedStar National Rehabilitation Network.

Visit our Amputee Support Group!

Our core philosophy is to include the patient in every part of medical and surgical management and to periodically monitor impacts on quality of life. We strive to provide knowledge and a supportive environment for patients who have undergone an amputation(s), as well as room to discuss their needs and concerns. We welcome you to join us!

Nerve pain can be treated with non-narcotic medications, such as gabapentin or Lyrica (pregabalin). If these treatments are ineffective, many patients respond well to surgical treatment.

Nerve decompression:

When nerves are cut for amputation, the remaining nerve may swell in size as a response to this injury. This can cause the nerve to become entrapped or pinched in the normal anatomic tunnels as it enlarges. Surgery to open the space around the nerve and relieve these compression points is often effective for pinched nerves.

Neuroma excision:

If nerve pain is caused by a neuroma, it is often helpful to surgically remove the neuroma. The end of the nerve may be buried higher up away from the contact surface of the stump, or better yet connected to a motor nerve to give it a path for regeneration. This is known as targeted muscle reinnervation.

Targeted Muscle Reinnervation (TMR):

In a TMR procedure, the sensory nerves that connect motor nerves to muscles that are no longer in use are transferred. The most common example of this is transferring sensory nerves that used to supply the foot, and connecting these to motor nerves to muscles that used to flex and extend the toes. These muscles are no longer in use after an amputation. This nerve transfer allows the sensory nerve a path for regeneration into the muscle and prevents neuroma formation. Patients who undergo TMR procedures have approximately 50% reduction in phantom pain and residual limb pain compared to patients who do not have TMR procedures. MedStar Georgetown is one of the highest volume TMR centers in the world, performing over 100 TMR procedures per year.