transtibial (below-knee) amputation

A transtibial amputation removes the leg below the knee, cutting through the two shin bones (the tibia and fibula) partway down the calf and keeping the knee joint intact. Of all the major leg amputations, this is the one rehabilitation teams hope for, because keeping a person's own knee transforms how easily they will walk again. The knee bends, takes weight, and powers each step in a way no artificial knee fully matches.

The surgeon removes the foot and the lower leg and creates a residual limb a hand's-breadth or so below the knee. A key detail is the soft-tissue covering: the calf muscle at the back is brought forward and stitched over the cut end of the bone, giving the stump a well-padded, weight-tolerant cushion (a long posterior flap). The bony front edge of the tibia is bevelled smooth so it does not press painfully into the socket. The result, when it heals well, is a sturdy, slightly conical limb that a prosthetic socket can grip and load.

Below-knee amputees do well as a group. Because they keep the knee, the energy cost of walking rises only modestly — roughly a tenth to a quarter more than normal — and most can walk with a prosthesis, often without a cane, returning to work and daily life. The catch is the residual limb's skin: it now does a job it was never designed for, bearing body weight against a socket all day, so skin breakdown, a poor socket fit, and changes in limb shape as swelling settles are the everyday concerns of follow-up care.