We shall not fail or falter; we shall not weaken or tire. Neither the sudden shock of battle nor the long-drawn trials of vigilance and exertion will wear us down. Give us the tools and we will finish the job.
Sir Winston Churchill
Colleen Coulter-O’Berry PT, DPT, MS, PCS
Team Leader, Limb Deficiency Program
Children’s Healthcare of Atlanta
As with all of the surgical options, the rotationplasty patient will require physical therapy to regain function and strength. Not only are children weak from the surgery, they are weak from the effects of chemo therapy and limited activity and exercises for months at a time.
Physical and occupational therapy are required to teach the child and family how to walk and regain function. Due to the 180 degree rotation of the lower limb the physical therapist will identify function(s) of muscle groups that will move the hip, foot, ankle and toes. Stretching and strengthening exercises will be taught immediately after rotationplasty surgery to the patient and family to gain active and passive range of motion followed by strength.
Depending on the surgical procedure, involvement of surrounding structures and condition of the child, the child may not be allowed to bear weight on the leg. The orthopedic surgeon will determine when weight bearing and standing on the leg is safe. Typically, weight bearing is limited to toe touch for moving from the chair to the bed, toilet, and wheelchair. It may take longer for the bone to be strong enough to bear weight due to the effects chemotherapy on the body’s ability to heal.
Initially stretching exercises of the hip, ankle, foot and toes are instructed to the child and family. During this time, the child usually resumes chemotherapy within the first month after surgery and often is too sick for physical therapy and exercises. Crutches and wheelchair are used for mobility and transportation. As with limb sparing surgery, there is a large incision. The nurses or therapists will teach the child and family how to take care of the incision and re-apply the bandages if needed. Once the incision is healed, it is very important to keep the scar loose by massaging the scar with non-alcohol based lotions. Swelling will occur following surgery. The surgeon and therapist will also teach the patient and family how to wrap the limb with a compression dressing (wrap) to help minimize the swelling.
As soon as the bones are healed form the rotationplasty surgery, the surgeon will prescribe prosthetic fitting. Directed by the surgeon, the physical therapist and prosthetist will work together to progress the child from standing and walking in parallel bars to walking with a walker or crutches followed by walking without crutches. Stretching and strengthening exercises are continued in and out of the prosthesis. The muscles of the calf, ankle, foot and toes all play a role in controlling the prosthetic knee which is the child’s foot while in the prosthesis. The importance of stretching and strengthening the muscles in and out of the prosthesis cannot be stressed enough.
The goals of physical therapy for the first year after surgery and chemotherapy are for the child to be independent in activates of daily living, mobility and ambulation with and without crutches and/or a wheelchair and to improve cardiovascular endurance and overall strength for everyday activities. Once the child is walking without crutches and chemotherapy completed, the physical therapist’s role is to guide the patient and family in pursuit of athletic interests respecting the limitations and restrictions caused by the rotationplasty.