Stump pain
The stump itself hurts: from pressure and rubbing of the socket, damaged nerves, scars.
CONDITION / ARMS AND LEGS
Lower limb amputation.
Lower limb amputation is the loss of part of the leg: foot, shin, or thigh—after injury, trauma, or vascular disease. After this, a person learns to walk with a prosthesis, and the surgeon can help when the stump hurts, the socket rubs, or it doesn’t fit.
CONCEPTUAL VISUALIZATION- What it is
- Loss of part of the leg—foot, shin, or thigh—after injury, trauma, infection, or vascular disease.
- Causes
- According to a 2005 estimate for the USA, 38% of people living without a limb lost it due to vascular diseases related to diabetes.
- pain
- According to a meta-analysis of 51 studies, 51% of people experience stump pain after leg amputation, and 55% experience back pain.
- Who helps
- A surgeon, prosthetist, rehabilitation specialist, and, if needed, a vascular surgeon, endocrinologist, and psychologist.
01 / WHAT IS ITWhat does it mean?
What does it mean?
Leg amputation.
The leg can be amputated at the level of the toes or part of the foot, the lower leg (below the knee), the thigh (above the knee), or the hip joint. The level determines which joints are preserved, which prosthesis will fit, and which operations on the stump are possible.
Walking with a prosthesis requires significantly more effort because the lost muscles and bone need to be compensated for. Therefore, a prosthesis is not suitable for everyone, and rehabilitation takes a long time. The updated 2024 clinical guideline of the U.S. Departments of Veterans Affairs and Defense contains 26 recommendations and emphasizes multidisciplinary collaboration at all stages.
This page is about life after leg amputation and about how a surgeon can help: reduce pain, restore the stump, secure the prosthesis to the bone if the socket does not fit. The prosthesis itself is made by prosthetists. Both military personnel and civilians consult — after the hospital, years later, or even before a planned amputation.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWhat people come with
What people come with
after leg amputation.
Most often, pain and the socket make walking difficult. One affects the other: a painful or chafed stump prevents wearing a prosthesis.
Painful point
Sharp pain in a certain spot of the stump when touched or pressed with a sheath — this is often how a neuroma manifests.
Stump neuromaPhantom pain
The foot or leg that is no longer there hurts: burning, shooting pain, cramps. These sensations are real.
Phantom painStump skin
Chafing, blisters, irritation. In a Canadian analysis of 745 people with a leg prosthesis, at least one skin problem was present in 40.7% of stumps.
The sheath does not stay in place
The stump is short or changes in volume, skin sweats — the prosthesis slips off, walking is difficult.
Problematic stump
Ulcers, unstable scars, bone under thin skin — wearing a prosthesis is painful or impossible.
Problematic stump03 / REASONSWhy do they lose?
Why do they lose?
leg.
The condition of the stump tissue, general health, and the course of recovery depend on the cause.
Vascular diseases and diabetes
Gangrene due to narrowing of the arteries in the legs, a complication of diabetes. In the U.S. assessment for 2005, 38% of people living without a limb lost it due to vascular disease associated with diabetes.
Trauma and injury
Crushing, explosion, severe leg injuries where the limb cannot be saved.
Fire woundSevere infection
Severe limb infection that cannot be cured while saving the leg.
What increases the risk of phantom pain
According to a meta-analysis: prolonged preoperative pain, higher level of amputation, pain in the stump, phantom sensations, as well as the amputation itself.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Old amputation, stump pain, or an uncomfortable prosthesis — a planned situation, usually does not require emergency care. But after a recent surgery and in the presence of signs of infection or clot, do not delay.
103 immediately if:
- bleeding from the stump or wound does not stop despite pressure;
- the blood is gushing, bright red;
- it suddenly became difficult to breathe;
- breathing is very frequent;
- chest pain or pain in the upper back;
- the heart beats very often;
- the person fainted;
- confusion or slurred speech;
- blue, pale, or mottled skin or lips;
- very high or very low temperature, the person is shivering;
- rash that does not blanch when pressed.
Do not delay a visit to the doctor:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after a recent surgery the stump is increasingly painful or swollen; the skin of the stump is warm, red, and painful; fluid or pus is coming from the wound. On the same day: pulsating pain or swelling in the other leg, the skin around it has turned red or darkened (possible clot); coughing up blood; depressed mood or thoughts of suicide — tell your doctor, and if there is a danger that the person might harm themselves right now, call 103. Planned: pain in the stump, in the back, or phantom pain that does not go away; the socket rubs or does not stay in place; amputation is only planned — consult a surgeon together with a prosthetist.
05 / DIAGNOSTICSHow to evaluate
How to evaluate
stump.
- Conversation and documents
When, at what level, and why the amputation was done, what surgeries have already been performed, whether there is diabetes and vascular diseases, what hurts, how you walk with the prosthesis. Take discharge summaries and imaging.
- Stump examination
The surgeon assesses the skin and scars, painful spots, whether there is enough soft tissue over the bone, and movements in the knee or hip joint.
- The other leg
The doctor examines the other leg too: after amputation it bears more load, and it needs to be protected.
- Bone images
X-rays or CT scans show the length and condition of the stump bone — this is important for osseointegration and reconstruction.
- Joint decision
The surgeon and the prosthetist decide what operation is needed and whether it is needed at all.
06 / TREATMENTWhat can be done
What can be done
after leg amputation.
The basis of recovery is rehabilitation and a well-fitted prosthesis. Surgery on the stump is needed when pain, skin, or the shape of the stump prevents the prosthesis from working. The plan is made for each individual.
01
Prosthesis and skin
Receiving a prosthesis is not enough — you need to learn to walk with it.
- Knee module
- A meta-analysis (704 people after thigh amputation who barely walk outside the home) showed: a microprocessor-controlled knee module reduced falls and fear of falling. The type of module is chosen by the prosthetist.
- Skin and socket
- Stump skin problems are common: in a review of records of 745 people — in 40.7% of stumps; more active people had a higher risk. The stump is washed daily with mild soap, thoroughly dried, and examined.
02
Osseointegration
When the socket does not fit.
- What it is
- The prosthesis is attached to a titanium pin in the stump bone, without a sleeve. According to a systematic review of 38 studies on thigh amputation, after surgery, people reported better quality of life, mobility, and used the prosthesis more often. Most often, the studies compared a person's condition before and after surgery, without a control group.
- Who
- For those who cannot normally use a socket. For those who do well with a socket, according to the same review, the method may not provide additional benefit.
- Risks
- After thigh amputation, superficial soft tissue infections are most common; serious complications are rare. At the shin level, data are limited, but implant infection occurred more often in studies—29%.
- Experience in Ukraine
- In a study of 49 veterans of the Russian-Ukrainian war with arm or leg amputation, a year after the second stage, 46 out of 47 implants (97.9%) remained in place; infectious complications occurred in 18% of patients. The authors emphasize that longer follow-up is needed.
03
pain
- How common
- In a meta-analysis of 51 studies (mostly young men after traumatic amputation of one leg), 51% had stump pain, 55% had back pain; these two pains are related: where there is one, the other occurs more often. Phantom pain after amputation due to vascular diseases — 69% (12 studies, 1924 patients).
- Surgery for pain
- TMR and RPNI transfer the nerve ends to muscles. In a review of 17 studies, they reduced neuroma pain in at least 75% of patients, and phantom pain in 45–80%; complications occurred in 13–31%, most often slow wound healing. In a randomized study of 28 people, TMR reduced phantom pain more than conventional neuroma excision.
- During amputation
- If TMR or RPNI was performed immediately during amputation, 45–87% of patients in various studies subsequently did not have phantom pain. A review of amputations due to vascular disease calls for more attention to preventing pain specifically during amputation.
- Without surgery
- According to a meta-analysis of 10 randomized studies, mirror therapy reduced phantom pain during the first month; long-term effects were not confirmed. Experts support it together with gradual motor imagery and using a functional prosthesis, although systematic reviews indicate that these methods are not yet more effective than placebo.
04
The second leg and mood
- The other leg
- It is important to protect it from injury, especially if the amputation was due to diabetes: comfortable shoes, podiatrist care, and regular foot check-ups.
- Psychological support
- After amputation, depression, anxiety, and feelings of grief may occur; after traumatic amputation, especially in military personnel, there is a higher risk of post-traumatic stress disorder. Talking about it with a doctor is part of the treatment.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Lower limb amputation at the Doctor Valikhnovskyi Institute of Surgery is carried out in the direction of "Bionic Limb Prosthetics." The clinic performs the surgical part — operations on the stump, nerves, and bone. The prosthesis itself is selected and made by a partner prosthetist; the plan is developed together. Diabetes and vascular diseases are treated by specialized doctors.
CLINIC SERVICE
Bionic limb prostheses
Preparing the stump for a modern prosthesis: less phantom pain, clearer signals, attachment to the bone.
View service
What we do for this condition
- Osseointegration — The prosthesis is attached to a titanium pin in the stump bone, without a socket; in one or two stages, the load is increased gradually. It is not suitable for everyone: the quality of the bone, skin condition, and daily care of the pin exit site are important.
- TMR — Targeted Muscle Reinnervation — Stump nerves are transferred to the motor branches of the muscles — to reduce pain from neuromas and phantom pain.
- RPNI — Regenerative Peripheral Nerve Interface — the end of the nerve is wrapped with a small flap of the patient's own muscle — primarily for the prevention and treatment of neuromas.
- TMR or RPNI during amputation — if the leg cannot be saved — preventively, to reduce the risk of neuromas and phantom pain.
- Excision of neuromas — a painful overgrowth of the nerve is removed, and the nerve is transferred to the muscle to reduce the risk of the neuroma forming again.
- Stump reconstruction — excision of scars, closure of the bone with full tissue, if necessary — with flaps.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of the stump, medical records, and images — the doctor will preliminarily assess the situation.
- Assessment with the prosthetistExamination of the stump, pain and walking, bone images; they decide whether surgery is needed at all.
- PlanWhat surgery, when, and how to link it with the creation of a prosthesis.
- SurgeryOsteointegration, TMR or RPNI, or stump reconstruction.
- RecoveryHealing, gradual loading according to the rehabilitation program, prosthesis adjustment, and gait training.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Do you make prostheses yourselves?
No. The clinic performs surgical stump preparation, and the prosthesis is selected and made by a partner prosthetist; the plan is made together.
Who is suitable for osseointegration?
First of all, for those who cannot walk normally with a shell. Important factors are bone quality, skin condition, and willingness to care for the pin site daily. If everything is fine with the shell, the method may not provide any additional benefit.
How long does recovery after osseointegration take?
Usually several months: the bone gradually fuses with the titanium, and load on the leg is increased according to a rehabilitation program.
Will phantom pain go away after surgery?
It may decrease, but not in everyone and not always completely. In a review of 17 studies, phantom pain after TMR or RPNI decreased in 45–80% of patients. More details can be found on the page about phantom pain.
Why does the back hurt after amputation?
This is common: according to a meta-analysis, 55% of people have back pain after leg amputation, and it often occurs together with stump pain. Tell your doctor and rehabilitation specialist about it.
The amputation is only being planned. Should I consult in advance?
Yes. TMR or RPNI can be performed during the amputation itself—as a preventive measure to reduce the risk of neuromas and phantom pain.
Do you treat civilians, not only military?
Yes, both military personnel and civilians seek help. The surgeon states the cost of the operation after an examination; the prosthesis is paid for separately to the prosthetist.
Sources
20 sources · clinical guideline, systematic reviews, meta-analyses, studies from Ukraine and NHSshowCollapse
- Clinician’s Guide to the 2024 VA/DoD Clinical Practice Guideline for the Rehabilitation of Individuals With Lower Limb AmputationAmerican Journal of Physical Medicine & Rehabilitation, 2026doi:10.1097/PHM.0000000000002995 ↗
- Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050Archives of Physical Medicine and Rehabilitation, 2008doi:10.1016/j.apmr.2007.11.005 ↗
- The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysisPLOS ONE, 2020doi:10.1371/journal.pone.0240431 ↗
- Phantom Limb Pain and Painful Neuroma After Dysvascular Lower-Extremity Amputation: A Systematic Review and Meta-AnalysisVascular and Endovascular Surgery, 2024doi:10.1177/15385744231197097 ↗
- More than half of persons with lower limb amputation suffer from chronic back pain or residual limb pain: a systematic review with meta-analysisDisability and Rehabilitation, 2022doi:10.1080/09638288.2020.1783377 ↗
- Dermatologic conditions associated with use of a lower-extremity prosthesisArchives of Physical Medicine and Rehabilitation, 2005doi:10.1016/j.apmr.2004.09.003 ↗
- Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical TrialAnnals of Surgery, 2019doi:10.1097/SLA.0000000000003088 ↗
- Pain and Functional Outcomes following Targeted Muscle Reinnervation: A Systematic ReviewPlastic and Reconstructive Surgery, 2024doi:10.1097/PRS.0000000000010598 ↗
- Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment: A systematic reviewPM&R, 2023doi:10.1002/pmrj.12972 ↗
- Bone-anchored prostheses for transfemoral amputation: a systematic review of outcomes, complications, patient experiences, and cost-effectivenessFrontiers in Rehabilitation Sciences, 2024doi:10.3389/fresc.2024.1336042 ↗
- Complications of bone-anchored prostheses for individuals with an extremity amputation: A systematic reviewPLOS ONE, 2018doi:10.1371/journal.pone.0201821 ↗
- Surgical complications and implant survival of the Osseointegrated Prostheses for the Rehabilitation of Amputees system in patients with combat-related limb loss: a retrospective cohort studyInternational Orthopaedics, 2026doi:10.1007/s00264-026-07054-0 ↗
- The effect of microprocessor controlled exo-prosthetic knees on limited community ambulators: systematic review and meta-analysisDisability and Rehabilitation, 2022doi:10.1080/09638288.2021.1989504 ↗
- Effectiveness of Mirror Therapy for Phantom Limb Pain: A Systematic Review and Meta-analysisArchives of Physical Medicine and Rehabilitation, 2022doi:10.1016/j.apmr.2021.07.810 ↗
- Treatment Recommendations for Phantom Limb Pain in People with Amputations: An Expert Consensus Delphi StudyPM&R, 2021doi:10.1002/pmrj.12556 ↗
- AmputationNHS, 2023nhs.uk/tests-and-treatments/amputation ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- Pulmonary embolismNHS, 2026nhs.uk/conditions/pulmonary-embolism ↗
- Deep vein thrombosis (DVT)NHS, 2026nhs.uk/conditions/deep-vein-thrombosis-dvt ↗
The figures on the page are from these sources.
Does the stump hurt or
is the sleeve not suitable?
Send a photo of the stump, medical records, and images. The doctor together with the prosthetist will tell whether surgery is needed and which type.