Winter Safety Guide for Lower-Limb Amputees

For people with lower-limb prosthetics, winter can magnify balance issues and require additional attention towards amputee fall prevention. Falling or tripping is always a hazard for amputees; in the colder months, this increases dramatically. However, it’s not all doom and gloom. As an amputee, there are specific measures you can put in place to increase your safety and confidence.

PrimeCare, New Mexico's leading prosthetics provider, is here to support you in every sense of the phrase. Our team has years of hands-on experience helping amputees with prosthetic care and fall prevention, and we've created this guide using our practical knowledge and current research to help you stay safe and active this winter.

Why Are Amputees More at Risk of Injury in Winter?  

Winter presents significant challenges for individuals with lower limb amputations and greatly increases their risk of falling and getting a fall-related injury. The cold weather affects both the prosthetic limb and the residual limb, creating a combination of risk factors that can compromise balance and mobility. Community-dwelling adults with lower extremity amputation face a higher fall incidence during these months.

Key risk factors contributing to increased fall risk in winter include:

• Poor balance resulting from muscle stiffness and reduced sensation in the residual limb.
• Difficulty maintaining walking speed on snow or ice with artificial limbs or walking aids.
• Reduced balance confidence in challenging weather conditions, leading to a greater risk of trip-related falls.

Lower limb amputees often face multiple fall risks early in their rehabilitation. A prospective cohort study showed that most falls occurred during everyday activities in free-living environments. To reduce these risks and prevent falls, be sure to engage in fall prevention programs and work with rehabilitation professionals. If you’re not sure where to start, occupational therapists and physical therapists can provide invaluable guidance on improving balance, strength, and proper use of prosthetic limbs in winter conditions.

These factors, combined with the challenges of winter conditions, put amputees at a higher risk of serious injuries. Common fall-related injuries include fractures, soft tissue damage, and skin injuries to the residual limb. Of particular concern are head injuries, as falls can result in concussions or more severe traumatic brain injury. Falls may also cause damage to the upper-limb or lower-limb prosthesis itself, potentially leading to further mobility issues and affecting the patient's standing position.

Understanding these risks underscores the importance of participating in comprehensive fall prevention training and taking proactive measures to ensure safety during winter months.

Cold Weather Challenges and Solutions for Amputees

Besides obvious safety issues for an amputee like slipping or falling, there are other mental and physical challenges that lower-limb amputees face in cold weather. These multiple fall risk factors can lead to an increased risk of falls and fall-related injuries:

• Walking with your prosthesis safely: snow, water, and ice make even the most trusted paths unpredictable, increasing fall incidence. We recommend wearing shoes or boots that have a rubber or neoprene composite sole to improve balance confidence. Both offer better traction than leather and plastic when walking.
• Painful joints: cold weather causes muscle and joint stiffness, making it harder to move. Taking prescribed supplements and medication can ease the pain of prosthetic wearers who have arthritis or vascular disease. For those who don't have arthritis but whose joints still become aggravated, we recommend doing mild exercise routines to get the blood flowing. Stretching, swimming, and walking on a treadmill are excellent options to improve balance ability.
• Depression: those who suffer from depression know it can worsen during winter as the weather limits outdoor activities. Mitigating emotional highs and lows is paramount to maintaining general well-being, which often includes having a strong support structure and seeking professional medical guidance from rehabilitation professionals.
• Seasonal Affective Disorder (SAD): also known as "winter depression," SAD is a mood disorder thought to occur due to a lack of light during the winter months, which causes serotonin levels to drop. If you experience mood changes, withdrawal from activities that are usually enjoyable, and general fatigue, then you might want to consider getting professional help, as well as exploring light therapy options.
• Social isolation and loneliness: during winter, shorter, darker days and more time spent indoors induce prolonged feelings of loneliness. Whether it's an art class, exercise session, book club, or other group activity, we'd encourage you to join a club or class. This automatically exposes you to a group of people who already share some of your interests and can help improve your balance and confidence.

11 Tips for Staying Safe in Winter for Lower-Limb Amputees  

Following these tips will help you navigate winter with greater ease, confidence, and safety.

#1 Invest in Shoes with Good Traction

As we previously mentioned, investing in high-traction prosthetic shoes that provide a good grip will get you around safely. Rubber-soled amputee shoes or a similar variation are best for your artificial limb. We recommend selecting a size that fits your prosthetic leg comfortably but still has enough room for socks and foot warmers. If you live in a particularly cold state, you can also add gel liners for additional warmth on your residual limb. For those with foot prostheses, ensure your prosthetic foot is properly fitted in your winter footwear.

#2 Stay Warm at All Times

When your body is in a cold environment, it redistributes blood to your torso to protect and maintain the heat of your vital organs. Consequently, it becomes more challenging to maintain a normal body temperature, and your limbs become colder. As a result, it's crucial to keep yourself warm and insulated and to choose the right clothing.

Wearing multiple layers of wool, fleece, thermal garments, and waterproof outer clothing is a must. Keeping your whole body warm decreases stiffness and potential joint pain and makes it easier to go about your daily activities. For those with hand or arm prostheses, consider winter gloves designed to fit over your prosthetic hand to improve grip on icy surfaces.

#3 Take Care When Walking

Fall prevention for an amputee starts with environmental awareness. Some of the most dangerous surfaces in winter are stairways, wheelchair ramps, balconies, porches, parking lots, and sidewalks. Try not to walk on or rush through slippery areas without stabilizing yourself.

On that note, you also want to make sure your prosthetic limb is working properly. If something feels wrong, or you begin experiencing sudden pain or complications, make an appointment with your prosthetist rather than try to fix it yourself. It's also important to learn how to get up after a fall. Amputees do occasionally fall. If you do, don't panic. Check your residual stump and seek appropriate medical attention.

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#4 Don’t Shy Away from Support

Another amputee fall prevention strategy is to use a walker, a cane, or a pair of crutches as walking aids for slippery surfaces. What you choose depends on particular conditions, like knowing whether you need rubber or spiked tips. Some cane and crutch tips are interchangeable, so it's good to shop around. As always, the best option is to avoid potentially dangerous walkways, although this isn't always possible.

#5 Search for Specialized Prosthetic Technology

Today's cutting-edge prosthetic technology offers greater safety and comfort for those with a lower limb amputation. From heat regulation to bionic ankles that bend, there are many prosthetic leg options designed to make life easier and reduce fall incidence. The more clued-up you are about what's out there, the better you can plan for all winter conditions. Remember to keep your prosthesis well-maintained and check it regularly for any cold weather-related issues.

Consult your physical therapist or occupational therapist for recommendations based on your personal needs.

#6 Charge the Phone

Keep a charged phone on you at all times. That way, if you do fall and can’t get back up, you can easily call for help.

#7 Wear Comfortable Clothes

Don’t wear restrictive clothing that inhibits movement or garments that can get caught on things. Moreover, make sure your pants are the right length, so you don’t trip over them.

#8 Keep Your Hands Free

Another part of fall safety for lower limb amputees is keeping their hands as free as possible when walking. If you do slip, your hands will break your fall. Use a bag to store and carry valuable belongings like keys etc.

#9 Keep the Areas Around Your House Clear of Snow and Ice

A great fall safety tip for lower limb amputees is to keep your yard and driveway free of snow and ice. If you can’t do it yourself, then hire a snow control company to de-ice surfaces outside your home.

#10 Inspect Steps, Hills, and Ramps

Another tip for fall prevention for patients with below-knee amputations includes inspecting steps, hills, and ramps. Rather use alternative routes or ask for help if they look unsafe.

#11 Plan Your Getting Out

Colder seasons entail a little more planning. Allow enough time to get to where you are going, so you don’t rush. If possible, plan routes with the least amount of risk. For example, if you usually walk somewhere, but there’s a lot of snow, it might be safer to drive, even if it's a short distance away.

What Activities Should Amputees Avoid in Winter?

As a rule of thumb, you should always pay attention to surfaces before walking on them. Additionally, try to avoid the following:

• Walking on slippery surfaces without something to stabilize yourself, such as a walking aid or handrail.
• Running errands alone, like grocery shopping or going to the doctor.
• Proceed with caution on wheelchair ramps or sloped paths — only do so if there are handrails.
• Fixing your prosthetic device yourself if something feels wrong or broken.
• Taking shortcuts to get somewhere quicker can be dangerous. Stick to designated walkways as much as possible.

If your profession or lifestyle requires you to spend extended time walking outside, you should speak with your prosthetic team about the best options for fall prevention. Amputees can do a lot to improve their safety with the right prosthetic devices and by participating in fall prevention programs tailored to their needs.

How to Get Up After a Fall: Amputee Dos and Don’ts

When we fall, our natural reaction is to tense up. Ironically, this makes us more susceptible to injury. It seems counterintuitive, but you should try to relax your body completely. This allows different body parts to move independently in reaction to the collision and distributes the force of impact across more of your body. Bend your joints to remain flexible and try to protect the vulnerable parts of your body.

How to get up after a fall as an amputee:

• When you have a fall, you will most likely get a fright. Instead of rushing up, stay calm and first get your breath back. Take a moment to determine if you are injured and plan how you will get back up safely before trying to do it.
• If someone is waiting to help you, ask them to check for wounds or bleeding.
• When you are ready, roll onto your side, using your hands as support, and assume a side-sitting position. Then, rise with support from a person nearby.
• If you do not have help, crawl to the nearest sturdy surface (either on your stomach or shuffle on your bottom) and hoist yourself up into a standing or sitting position.
• Rest and alert your doctor if you have serious injuries.

Please note:

• Improper help may worsen the situation if you think you have a dislocated joint. In this case, call for medical help.
• If necessary, contact your prosthetist, so your artificial limb can be checked.
• If you notice damage to your skin or pain in your joints, make an appointment to see your general practitioner.
• Contact your physiotherapist if your fall affects your walking in any way.

Conclusion

Lower-limb amputees don’t need to dread winter. As long as you’re prepared, you can avoid many season-related issues and go about daily life with minimal stress. With the right orthotic equipment and shoes, you’ll feel better and be more active.

If you’re looking for winter prosthetic solutions, we can help. As a leading prosthetics provider in New Mexico, PrimeCare has a wide range of options to suit varied needs. Contact us today for a free consultation!