Skin problems
In a study of 337 leg stumps, ulcers, irritation, cysts, calluses, and warty skin growths accounted for 79.5% of all skin problems.
CONDITION / ARMS AND LEGS
Problematic stump.
Problematic stump — a stump after amputation that hurts, develops sores, or does not allow proper wearing of a prosthesis. The reasons are different: skin, bone, soft tissues, or nerves. First, solutions are sought with the prosthetist, and when this is not enough — the surgeon performs stump revision.
CONCEPTUAL VISUALIZATION- What it is
- A stump that hurts, develops sores, or does not allow wearing a prosthesis.
- The skin
- In a study of 124 people after leg amputation, 36% had skin problems of the stump.
- Bone
- In a study of 213 stumps after traumatic and combat amputations, excess bone in the soft tissues was present in 63%, and it had to be excised in 25 stumps.
- How we treat
- First — socket fitting and skin care; if it does not help — stump revision.
01 / WHAT IS ITWhen the stump
When the stump
interferes with life.
After amputation, the surgeon shortens and smooths the bone so that it is covered by a sufficient layer of soft tissues and muscles, and the muscles are sewn to the bone — this strengthens the stump. The stump then holds the prosthesis and bears the load.
A problematic stump is called such when it hurts, develops sores and rubs, the bone protrudes under the skin, extra tissue or scars remain, or the prosthetic socket rubs or does not fit. Because of this, a person wears the prosthesis less often and walks less.
Some problems are solved by a prosthetist—with a new or modified socket. When the cause is in the stump itself, a revision is needed: a surgery during which the bone, soft tissues, scars, or nerves are corrected so that the stump fits the prosthesis again.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWhat worries
What worries
most often
Problems often occur together: a bone spur presses on the skin, and a wound forms at the pressure site.
Bone spur
An extra bone in the soft tissues of the stump (heterotopic ossification) can cause pain and skin wounds and interfere with fitting a prosthesis.
Scars and excess tissues
Scars that crack and do not heal, bone under thin skin, or excess soft tissue prevent the socket from fitting tightly.
Unstable scarStump pain
The causes vary: friction or sores where the stump touches the prosthesis, nerve damage during surgery, neuroma — thickening of the end of a cut nerve.
Stump neuromaPhantom pain
The limb that is no longer there hurts. According to study reviews, from a quarter to half of people after amputation may have long-term stump pain, phantom pain, or phantom sensations.
Phantom painThe prosthesis does not stay on
After a high thigh amputation, the stump may bend and move sideways due to muscle imbalance — this interferes with fitting the prosthesis.
03 / REASONSWhy the stump
Why the stump
becomes problematic.
The reason lies in the load from the prosthesis, the injury itself, or in how the stump healed.
Pressure and friction from the socket
The prosthesis fits tightly to the stump, which increases the risk of chafing, pressure, and skin softening from sweat. A poorly fitted socket worsens this, especially with weakened immunity or vascular problems.
Severe injury
In the same study, in 213 stumps, extra bone was more often formed when the amputation was done in the injury area and after explosive injuries.
Complications after amputation
In the US trauma center database, 41.8% of 2,879 patients after traumatic leg amputation required at least one re-amputation; it was predicted, in particular, by crush injuries and compartment syndrome.
Healing
The stump wound heals better when swelling, comorbidities, and nutrition are controlled; the faster it heals, the higher the chances of getting and using a prosthesis.
04 / SEEK MEDICAL ADVICE
When to seek urgent medical care?
Chronic stump problems — chafing, calluses, bone spur, prosthesis that does not fit — are planned situations and usually do not require emergency care. But stump infection can progress to sepsis, and thrombosis is possible after surgery.
103 immediately if:
- sudden shortness of breath;
- chest pain;
- breathing is very frequent;
- Confusion, unclear speech, or a person says something incomprehensible;
- blue, pale, or mottled skin or lips;
- Purple spots appeared on the reddened stump;
- With redness of the stump, there is a very high temperature, the person alternates between feeling hot and cold or shivers;
- person has fainted or is unresponsive.
Other levels of urgency:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: After surgery, pain or swelling of the stump increases instead of decreasing. On the same day: The skin of the stump is warm, red and painful, fluid or pus is leaking from the wound, swelling is increasing — contact your doctor the same day; one leg suddenly hurts with a throbbing pain and is swollen — possible vein thrombosis; thoughts of suicide appear — contact a doctor or psychologist the same day. In the coming weeks: Depression, anxiety, nightmares, memories of trauma — tell a doctor or psychologist. Planned: chafing, blisters, recurring sores, protruding bone, pain while walking in the prosthesis, the socket does not hold — to the prosthetist and surgeon.
05 / DIAGNOSTICSHow they search
How they search
the reason
- History
When and at what level the amputation was, which surgeries have already been done, what is happening with the prosthesis, and exactly when it hurts or rubs.
- Stump examination
The surgeon examines the skin, scars, and soft tissues, looks for painful points; preferably — together with the prosthetist and with the prosthesis.
- Bone images
X-ray shows the end of the bone and any excess bone in the soft tissues.
- Nerves and pain
The doctor determines where the pain comes from: from socket friction, neuroma, or phantom pain.
- General condition
Blood circulation, comorbidities, and nutrition affect healing, so they are taken into account in the plan.
06 / TREATMENTHow we treat
How we treat
problematic stump.
Treatment depends on the cause. First, they try adjusting the prosthesis and skin care; surgery is considered when this is not enough or the cause is in the bone, tissues, or nerves. The stump is managed jointly by a surgeon, prosthetist, and rehabilitation specialist, and if necessary — a dermatologist and psychologist.
01
Without surgery
- Socket
- A reworked or new socket reduces pressure on painful areas. With a bone spur, many people find changing the prosthesis is enough.
- Skin care
- Wash the stump at least once a day with mild fragrance-free soap, dry it thoroughly, and do not keep it in water for long: softened skin is more easily injured. Change socket liners daily.
- Skin diseases
- Irritation, cysts, warty overgrowths, and other skin problems are treated by a dermatologist so that the person can continue wearing the prosthesis.
- Swelling
- Swelling of the stump after surgery is common; a compression liner reduces it and helps shape the stump.
02
Stump revision
When the cause is in the stump itself.
- Bone spur
- If prosthesis adjustments do not help, the excess bone is excised. In a study of 24 patients (25 stumps) who had a spur excised, on average after 12 months all were wearing a prosthesis; in 23 stumps the spur did not recur, in 2 a minimal spur appeared without symptoms; 6 patients had wound complications requiring reoperation.
- Scars and soft tissues
- Unstable scars are excised, and the bone is covered with full-thickness tissue, if necessary — with a flap.
- Muscles
- Suturing muscles to the bone (myodesis) makes the stump stronger and more balanced; after a thigh amputation it facilitates prosthesis fitting.
03
Nerves and pain
- Neuroma
- If pain is caused by a neuroma, it is removed. The end of the nerve can be sutured to a motor branch of a muscle (TMR).
- TMR
- In the first randomized trial of surgery for post-amputation pain (28 patients), TMR reduced phantom pain, and stump pain tended to decrease compared to conventional neuroma excision.
- Medications and support
- Stump pain and phantom pain usually lessen over time; analgesics, medications for nerve pain, prosthesis adjustment, mental exercises, and mirror therapy may help.
04
Osseointegration
- Prosthesis without a socket
- The prosthesis is attached to a titanium pin in the bone. According to a systematic review of 17 studies, clinical outcomes improved compared to preoperative levels, but infections occurred in 32%, and there were many postoperative complications.
- Who suits?
- Not for everyone: the decision is made together with the prosthetist after assessing the bone, skin, and readiness to care for the pin site daily.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
The problematic stump at the Doctor Valikhnovskyi Institute of Surgery is treated in the direction of "Bionic Limb Prostheses." The clinic performs the surgical part; the prosthesis is selected and manufactured by a partner prosthetist, and the plan is made together. Skin diseases are treated by a dermatologist, and psychological help is provided by a psychologist.
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
- Stump reconstruction — scars are excised, the bone is covered with full-fledged tissues, if necessary — with flaps.
- Stump neuroma — a neuroma is excised, and the nerve is transferred to a muscle (TMR or RPNI) to reduce the risk of it forming again.
- Phantom pain — if medicines and rehabilitation do not help — TMR or RPNI.
- Osseointegration — the prosthesis is attached to a titanium pin in the bone, without a socket; the method is not suitable for everyone.
- Assessment with the prosthetist — examination of the stump, pain and muscle signals, bone images; it is decided whether surgery is needed at all.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos of the stump, images, and medical records, describe what is wrong with the prosthesis — the doctor will preliminarily assess the situation.
- ConsultationExamination of the stump together with the prosthetist, painful points, X-ray; list of necessary investigations.
- PlanIs it possible to manage with socket fitting, or is stump revision, nerve surgery, or osseointegration needed.
- SurgeryStump revision, if necessary — together with nerve surgery.
- RecoveryHealing, stump compression, rehabilitation; new socket and prosthesis training — with the prosthetist.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
The socket rubs. Is this already a reason for surgery?
Not necessarily. First, the prosthetist modifies the socket, and you take care of the skin. If sores return, the bone protrudes, or scars interfere, the surgeon will assess whether a stump revision is needed.
What is a bone spur in the stump?
It is extra bone in the soft tissues of the stump — heterotopic ossification. In one study, it was found in 63% of stumps after traumatic and combat amputations. For many, it does not bother them or a prosthesis adjustment suffices; when it hurts and injures the skin, it is excised.
The stump hurts. How to understand why?
Pain can come from rubbing or sores under the socket, from a damaged nerve, neuroma, or be phantom. The cause is determined by the doctor during an examination, with the prosthesis and imaging.
Will osseointegration help if the socket does not stay in place?
This is one option: the prosthesis is attached to a pin in the bone, without a socket. According to studies, results after surgery improve, but infections and complications are common, so the method is not suitable for everyone.
How to care for the residual limb?
Wash the residual limb daily with mild unscented soap, dry it thoroughly, do not keep it in water for a long time, change the liners daily and inspect the skin. Wash the socket regularly.
The residual limb is red and hot. What should I do?
If the skin is warm, red, and painful, and there is fluid or pus — see a doctor the same day. If there is also very high fever, chills, purple spots, rapid breathing, or confusion — call 103.
The amputation was a long time ago. Is it too late to fix anything?
Late is not always: nerve surgeries (TMR or RPNI) are performed not only during amputation but also later. Whether stump revision is needed will be determined by the surgeon after an examination together with the prosthetist.
Sources
18 sources · guidelines, systematic reviews, cohorts, RCTs, and NHSshowCollapse
- Amputation and prosthetics of the lower extremity: The 2020 Dutch evidence-based multidisciplinary guidelineProsthetics and Orthotics International, 2023doi:10.1097/PXR.0000000000000170 ↗
- Skin problems in lower limb amputees: a systematic reviewDisability and Rehabilitation, 2006doi:10.1080/09638280500277032 ↗
- Skin problems of the stump in lower limb amputees: 1. A clinical studyActa Dermato-Venereologica, 2011doi:10.2340/00015555-1040 ↗
- Skin problems of the stump in lower-limb amputees: 2. Influence on functioning in daily lifeActa Dermato-Venereologica, 2011doi:10.2340/00015555-1023 ↗
- Skin problems in an amputee clinicAmerican Journal of Physical Medicine & Rehabilitation, 2006doi:10.1097/01.phm.0000214272.01147.5a ↗
- Dermatologic Conditions Following Limb LossPhysical Medicine and Rehabilitation Clinics of North America, 2024doi:10.1016/j.pmr.2024.06.002 ↗
- Post Amputation Skin and Wound CarePhysical Medicine and Rehabilitation Clinics of North America, 2022doi:10.1016/j.pmr.2022.06.010 ↗
- Heterotopic ossification following traumatic and combat-related amputations. Prevalence, risk factors, and preliminary results of excisionThe Journal of Bone and Joint Surgery. American Volume, 2007doi:10.2106/JBJS.F.00412 ↗
- Heterotopic ossification in the residual limbs of traumatic and combat-related amputeesJournal of the American Academy of Orthopaedic Surgeons, 2006doi:10.5435/00124635-200600001-00042 ↗
- Complications and revision amputation following trauma-related lower limb lossInjury, 2017doi:10.1016/j.injury.2016.11.019 ↗
- Residual limb pain: An evidence-based reviewNeuroRehabilitation, 2020doi:10.3233/NRE-208005 ↗
- Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical TrialAnnals of Surgery, 2019doi:10.1097/SLA.0000000000003088 ↗
- Osseointegration for lower and upper-limb amputation a systematic review of clinical outcomes and complicationsJournal of Biological Regulators and Homeostatic Agents, 2020pubmed.ncbi.nlm.nih.gov/33261296 ↗
- The importance of soft tissue stabilization in trans-femoral amputationDer Orthopäde, 2016doi:10.1007/s00132-015-3098-8 ↗
- AmputationNHS, 2023nhs.uk/tests-and-treatments/amputation ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
- DVT (deep vein thrombosis)NHS, 2026nhs.uk/conditions/deep-vein-thrombosis-dvt ↗
The figures on the page are from these sources.
Does the stump interfere
with wearing the prosthesis?
Send a photo of the stump, images, and describe what is wrong with the prosthesis. The doctor will tell you whether adjusting the socket is enough or if surgery is needed.