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This article was written by Christopher Attinger, MD, Karen Kim Evans, MD, and Christopher Ply, BS, Georgetown University School of Medicine Medical Student Class of 2027.
A pilot study presented at the MedStar Health – Georgetown University Research & Education Symposium suggests mental health care could improve patients’ functional recovery after amputation. Now we’re taking action for patients.
The loss of a lower limb can be emotionally devastating. Our research identified a relationship between mental health, how well a person recovers from below-the-knee amputation, and how they experience symptoms of limb loss, such as pain. This suggests that patients could benefit from mental health care as a part of limb loss recovery, so we’re taking steps to add these services to our care teams.
Each year in the U.S., about 150,000 people have a lower limb amputated, and many of these are below the knee. The most common reasons someone might need this kind of amputation include diabetes, peripheral vascular disease, and trauma.
Amputating the lower leg can significantly impact someone’s ability to carry out daily life tasks, including balancing and walking. More than 80% of patients fitted with a prosthetic leg after lower limb amputation, and depend upon devices such as crutches or a wheelchair to get around.
Our study identified a relationship between the challenges of recovering from amputation and mental health. This highlights an opportunity to support recovery for these patients by
improving access to mental health care services.
Surveying patients about function, symptoms, and more.
Our study was a cross-sectional survey of 13 patients, mostly men with an average age of about 65, who had below-the-knee amputation for reasons other than trauma. When patients came to the clinic for follow-up, we asked those who had undergone surgery at least six months before to complete a survey called LIMB-Q.
LIMB-Q is a patient-reported outcomes tool designed for patients who have lost a lower limb. It enables us to collect data on a wide range of patient experiences. We were particularly interested in questions about:
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How patients function day-to-day
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How satisfied patients are with their prosthetic
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Limitations to patients’ ability to work
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Patients’ psychological well-being
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Patients’ financial burdens
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Their experience of symptoms such as pain
Our study showed that almost half of the participants (46.2%) had a documented mental health diagnosis, most often depression and/or anxiety. These patients had much worse functional scores than patients without a mental health diagnosis. We also found that patients with a diagnosis of depression or anxiety were more likely to report more symptoms, primarily pain.
Related reading: How Team Care Helps Patients Treat, Prevent, and Recover From Non-healing Wounds.
Mental health is associated with recovery success.
Our pilot study is cross-sectional, so our results can show associations rather than causes. For instance, we know that chicken is related to the egg, but we do not know which came first.
Now that we have shown an association between mental health conditions and recovery, we can say more confidently that patients who have had below-the-knee amputations could benefit from mental health care.
Further study involving a larger group of patients over a longer period could help us gain a deeper understanding.
In the meantime, dedicated psychiatric services for patients recovering from limb loss could help more patients recover with less pain, help them adapt to their prosthetics, and enhance their quality of life.
Putting research into action for patients.
This study and others highlight the association between mental health and recovery outcomes following lower limb amputation, so we’re taking steps to ensure this new knowledge benefits patients.
In August 2025, we’ll welcome a full-time psychiatrist to our clinical team at the Wound Healing Institute. This represents a significant advancement in our multidisciplinary wound care model, reflecting our commitment to caring for the whole person.
This new step builds upon our longstanding model of collaborative care, in which experts in surgery, rehabilitation, nursing, and behavioral health work together to provide our patients with the best care.
In addition to clinical care, we are also planning to focus our research on the psychosocial burden of chronic wounds and limb loss. We hope that this model, which embeds mental health in the core of surgical and rehabilitative care to improve patient-centered outcomes, can help other centers enhance their patient outcomes as well.
