After a major amputation, clinical attention concentrates on the stump — wound healing, prosthetic fitting, rehabilitation. The contralateral foot is the one that is now bearing more load, is usually equally neuropathic, and is frequently unexamined for months.
Make it a rule that every post-amputation review includes shoes and socks off on the remaining foot. Look, press for pulses, test sensation with a monofilament, and check between the toes and under the heel where offloading pressure has moved. A patient who is transferring more weight through one limb and cannot feel it has no warning system at all.
The same applies at the pre-operative visit. The best time to book surveillance for the second foot is before the first one has been removed.
- Socks off, both feet, at every review — including the visit that is nominally about the prosthesis.
- Reassess footwear and offloading after the gait changes, not at the routine annual check.
- Check between the toes and under the heel where the new load falls.
- Book the second foot's surveillance before discharge, with a named clinic.
Why it matters
The limb most likely to be lost next is the one nobody is currently treating.
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