Amputations are all too common, accounting for 11% of all agricultural related injuries. On the farm, injuries resulting in an amputation are typically caused by entanglement, entrapment, crushing injuries, or infection from a traumatic injury. Lower extremity amputations can include toe amputations, foot amputations, and leg amputations either below-knee or above-knee. Other limitations due to traumatic injury to the lower extremities include decreased strength or function due to tendon, muscle, nerve, or joint damage. A lower extremity injury presents a higher risk for secondary injuries to occur because decreased padding or scar tissue around the injury site may not tolerate usual bumping or minor impacts with objects such as farm machinery or tools. Overcompensating with one extremity because of limited use of the injured extremity can cause secondary injuries such as sprain/strains to muscles or damage to the joints. Individuals are more susceptible to frostbite because of nerve damage or decreased circulation to the injured extremity.
Extent of recovery
The extent of your recovery depends largely on your physical condition prior to amputation. Many amputees who are in good physical condition continue to work and do most of the other activities their peers do. Extent and speed of recovery depends mostly on these factors:
- Your age and the length of the healing process. People heal more slowly as they get older. The more complex the amputation and its wound, the slower healing is likely to be.
- The extent of other medical problems associated with the amputation such as burns or diseases causing general debilitation such as diabetes or not enough blood supply to the limb (vascular insufficiency) all of which tend to lengthen the recovery process.
- Learning to use a prosthesis is hard work, so your overall physical condition and health will play an important role in how quickly you can progress.
- How closely you follow the instructions of your physiotherapist. This is especially true of how much you do. It is easier to prevent problems than to cure them, so don't overdo!
- How much you want to recover and learn to use a prosthesis. Determination has no substitute.
- Psychological factors can speed up or slow down your recovery. Support from family and friends, and various social and economic factors can play an important role in either speeding up or virtually stopping your recovery.
Working with an amputation
You can do almost anything you want to regardless of the type of amputation. Individuals with an amputation will have to learn a new way to perform simple tasks by utilizing other body parts. With some prostheses, it takes slightly more energy to complete simple tasks than with normal limbs. This increased energy expenditure, along with pain and irritation, can limit how much you can do. This is especially true of the amount of activity you can do without causing problems in the residual limb. A real limit is how much irritation your skin can take from the pressure, sweat, and twisting of the socket.
Tips for farming with lower extremity limitations are:
- To prevent falls, increased fatigue, or further degeneration, outdoor mobility aids should be considered when maneuvering around rough rural terrain. These aids include: manual, electric, electric/gasoline-powered wheelchairs, all-terrain vehicles, golf carts, and riding lawn mowers. Foot guards and modifications to controls for all-terrain vehicles and lawn mowers should be considered if you lack sensation and/or control in your legs or feet. Headgear should be worn when operating ATVs.
- Use special cane tips for snow, ice, and loose gravel.
- When mounting and dismounting from a tractor, start out with the stronger leg.
- To accommodate lost abilities in mounting and dismounting, farm machinery can be adapted by adding a man lift, non-slip steps, wider steps, additional steps, and handholds.
- To accommodate for lost strength or function of a leg or foot when operating foot controls on a tractor, hand controls can be installed.
- Direct access to livestock should be avoided if possible (or approached with extreme caution) due to the unpredictable nature of livestock. Worksite accommodations to eliminate direct access include: fence line feeders; automated feed systems; using round bales; raised decks for hogs; or having another person perform the potentially dangerous tasks.
- If you use a prosthetic device, jumping off a tractor is not recommended. It will break the prosthesis or cause an additional injury to the legs or feet.
- Labor-saving devices such as automatic gate openers and automatic hitching devices will help in reducing further degeneration of an impaired extremity.
- Modifications to tractor seats such as better cushions or installation of an independent suspension seat might be considered for an above-knee amputation or hip replacement to help provide more protection and shock absorption for the stump or hip joint.
- If you have a hip replacement, tasks that require bending 90 degrees or more from the hip should be avoided. An all-terrain vehicle with a bench seat may be more appropriate than one that requires you to swing your leg over the top of the engine when mounting or dismounting.
- Walking through fields with weeds and knee-high vegetation can lead to potential falls or entanglements that could cause twisting of a joint. When walking out to the fields to check on crops, it is recommended to follow the wheel tread marks that have been made by farm equipment or create a smoother path for safer ambulation.
- For climbing over fences or walking on very unstable ground, it is sometimes recommended to lock the knee on the prosthesis to provide better stability.
- Several improvements have been made to lower extremity prosthetic devices to enhance comfort, reduce skin breakdown, save energy, and improve safety. These improvements include a "NSNA" (Normal Shape, Normal Alignment) socket for above-knee amputees; Flex-foot (an energy storing prosthesis); and a hydraulic knee. Consult a doctor to determine if any of these technologies would be appropriate.
- To reduce fatigue or further degeneration of an affected extremity when performing tasks that require standing for long periods of time, a sitstand chair or stool might be useful to relieve pressure without interfering with completing a task.
- Any adaptations or modifications intended specifically for an individual with a disability should be used by that individual only. Use of a modification or adaptation by another individual could result in an injury.
This fact sheet was reviewed by Karen Mancl, PhD, Professor, Food, Agricultural and Biological Engineering, The Ohio State University; and Pat Luchkowsky, Director of Public Affairs, Easter Seals of Ohio.
The Easter Seal Society. Safety Tips for Farming with Lower Extremity (Leg or Foot) Limitations.
Reed, Deborah, and Pamela Kidd. University of Kentucky. National Ag Safety Database. AgDare-Agricultural Disability Awareness and Risk Education Amputation—Teacher Fact Sheet. March 2009. nasdonline.org/document/206/amp8/d000153/agdare-agricultural-disabilityawareness-and-risk-education.html.
About AgrAbility Based Fact Sheets
These fact sheets were developed to promote success in agriculture for Ohio's farmers and farm families coping with a disability or long-term health condition. AgrAbility offers information and referral materials such as this fact sheet, along with on-site assessment, technical assistance, and awareness in preventing secondary injuries. Fact sheets were developed with funding from NIFA, project number OHON0006.