Amputee rehabilitation: a patient journey through recovery and care

Double diabetic. The one time where having something twice, isn’t nice.

Kevin Hansbury was diagnosed with Type 1 diabetes at the age of 28. Approximately 18 years later, he was also diagnosed with Type 2 diabetes. Double diabetes presents a clinical challenge because, unlike typical Type 1 which is characterized by a lack of insulin production, double diabetes also features insulin resistance making blood sugar levels even harder to control.

For Kevin, his roller-coaster experience with medical complications, which ultimately led to a leg amputation, stemmed directly from his double diabetes diagnosis.

New lease on life followed by health changes

Kevin’s Type 1 diabetes diagnosis gave him access to gastric bypass surgery in 2009, followed by GLP-1 support in 2024. Bariatric surgery helped him drop from 465 pounds to just over 200. This renewed sense of health fueled the confidence to train for and run several half-marathonsand complete his first, and only, full marathon in Washington, D.C., in 2012.

When reflecting on that accomplishment, Kevin said, “It was the best shape I was ever in physically, and especially, mentally.”

All of that would change in 2023 when he faced an entirely different challenge, a left-leg, below-knee amputation — a journey that started in 2015 with a big toe blister on the bottom of his left foot.

A closer look at amputation

According to the Amputee Coalition, roughly 2.3 million people in the U.S. have limb loss, while another 3.4 million live with congenital limb differences.

Limb loss can come from a variety of circumstances. Common reasons for amputation include:

• Vascular disease: peripheral artery disease and diabetes are leading causes, restricting blood flow and causing tissue death
• Trauma: severe accidents, crushes or injuries that cannot be repaired
• Infection: gangrene or severe bone infections
• Tumors: canceroustumors in the bone or muscle

Of those causes, over 75% of amputations are due to peripheral artery disease, diabetes and trauma.

Amputations are classified by the area removed:

• Leg (lower extremity): including toe, foot, below-knee and above-knee amputations
• Arm (upper extremity): including finger, hand, forearm, below-elbow and above-elbow amputations

Lower limb amputations are more common than upper limb with an incidence of four-to-one.

Kevin’s high to low – life changed by medical complications

Kevin knew about diabetes complications. “I know neuropathy and amputation are risks,” he said.

Living in Los Angeles, he tried to manage the blister on his foot himself, but it wouldn’t heal. While visiting South Jersey for Christmas, he ended up in urgent care with a swollen, infected ankle. Back in California, months of podiatry care followed, including repeated stretches in hard casts. Each time the wound healed, it returned when he resumed normal activity.

Doctors eventually diagnosed Charcot foot in his left foot, a rare diabetes complication that weakens bones and can lead to fractures and deformity. If an ulcer develops, the risk of amputation rises sharply.

In late 2018, setbacks multiplied. While wearing a boot on his left foot, Kevin fell three times, fracturing his right knee each time. He decided to move back to the East Coast to be closer to family but needed six months of rehabilitation before he was strong enough to fly.

The challenges continued after the move. He later broke his right ankle while walking his dog and required an ankle fusion. As he became more active, his left Charcot foot returned with a severe infection that required a wound vacuum. In January 2023, his ankle collapsed as he got out of bed, forcing difficult decisions about his future.

Loss identity, independence and mental health decline

Moving home and living with his father at age 40 was a big blow to Kevin’s independence and ego. His mental health took a hit as well. With each complication he became more limited in movement and the ability to be social. He was discouraged by what his future might look like.

A strong advocate for mental health therapy, Kevin has had psychological support since 2008, which got him through his bariatric surgery, the ups and downs of ankle fusion and gave him an outlet to work through the fears and anxieties associated with losing a limb.

Once proclaiming amputation would be something he would never do, years of pain helped Kevin arrive at the decision point of losing the left leg.

“I told the doctor, ‘Amputate it. I’ve had years to think about this, I’m ready.’” That same day the orthotist on staff said something that changed his philosophy for the future.

“He said to me, ‘You’ve been living for your foot. You just made the decision to start living your life for you.’ I couldn’t have put it better myself and have let that guide me to where I am today.”

Post-surgical journey

Following his amputation and after an initial post-surgical healing time at the hospital, Kevin learned how to care for his residual limb and began to adapt to the idea of living without his lower left leg. He was then referred to Kessler Institute for Rehabilitation for approximately two weeks of continued recovery. His initial stay at Kessler focused on pre-prosthetic training where he learned how to transfer, shape his residual limb and perform activities of daily living until he received his prosthesis.

Many weeks later, once healed enough to be provided a temporary prosthetic leg, Kevin returned to Kessler for outpatient therapy.

Physical and occupational therapy: benefits of amputee rehabilitation

More than 85% of limb amputees in the U.S. seek some type of prosthetic solution. For those individuals, they find expert assistance through orthotics, prosthetics, physical therapyand occupational therapy, ideally complemented by psychological support.

Physical Therapist Farris Fakhoury often meets patients during their inpatient stay, but completes the circle of recovery in the outpatient center setting.

“I’m in a unique spot where we are the last stop in their care. I have patients who are all about therapy and patients who are still trying to process everything,” said Farris.

For outpatient therapy and prosthetic training, there are several key steps:

• Evaluation
  • Physical – look at the residual limb (shape, skin integrity, phantom pain), joint range of motion, strength of remaining limbs and core stability
  • Functional mobility – review of bed mobility, transfers including from sitting to standing, assistive device (cane, walker, wheelchair) management and balance
  • Gait training – ability to walk safely with proper weight distribution with the prosthesis
  • Prosthetic check – assessment of socket fit and alignment and ability to put on and remove the device
• Objective tests – baseline numbers used to monitor function and progress are documented through tests like timed walks, the Amputee Mobility Predictor, Timed Up and Go and others
• Goal identification – through collaboration, develop goals tailored to each individual patient’s lifestyle (walking, returning to work, driving, etc.)
• Interventions – physical therapists and occupational therapists use techniques and treatments as needed to improve:
  • Agility
  • Balance and fall prevention
  • Coordination
  • Everyday functional activities
  • Flexibility
  • Mobility and walking
  • Strengthening
• Patient education – provide instructions on limb hygiene, scar tissue management, positioning to prevent permanent tightening of muscles, tendons, skin and tissues and home exercise plans

Farris recommends taking the time to find a good prosthetist (the expert who designs, fabricates and fits artificial limbs) and therapists who are specially trained or regularly treat amputees.

“Prosthetist selection is very important,” said Farris. “It’s a lifelong journey for these patients, so having a good relationship with the prosthetist is paramount. And then our communication with the prosthetist is super important. It has to be a team effort.”

Just as patients have their own personal goals for living with their new limbs, outpatient therapy programs have goals of:

• Creating independence
• Supporting emotional and psychosocial health
• Helping to regain mobility
• Improving everyday function
• Preventing injury
• Managing pain
• Returning to work and activities

Those goals are addressed during the initial rehabilitation period, during regular check-ins and/or when the patient has any change that affects the way they are living with the prosthetic.

Rehabilitation as partnership

Lower extremity amputee patients have a few main focuses in outpatient therapy. Farris relays the top three are:

• They have to be able to put the prosthesis on and take it off.
• They have to be comfortable putting weight on the prosthesis, including shifting with and understanding what muscles to fire to stabilize themselves.
• They must mentally understand the mechanics of movement and progressing safely to move in the real world with confidence. This starts on the parallel bars using both hands, progressing to one hand to using no hands and relying fully on posture, balance, strength and weight.

For Kevin, working with Farris in the outpatient center was essential in reclaiming his life.

“I knew it was the next step in my journey,” said Kevin. “I just wanted to learn how to get better, to get around better and to continue to just be better. I wanted my life back.”

Farris identified quickly that Kevin was well-versed in putting his new leg on and off. It was also clear that Kevin’s main objective was to live on his own again and to get back to his work in higher education administration and use his degrees in psychology and clinical psychology.

“For Kevin, the biggest thing he needed initially was endurance with the prosthesis,” relayed Farris. “One of the things he enjoyed or wanted to get back to doing was more hiking and walking on uneven surfaces.” Kevin also needed to be able to walk large campuses and stand for prolonged periods of time if teaching.

Farris worked with him on muscular endurance and the residual limb through strengthening, higher repetitions and lower-weight exercises. He also honed in on cardiovascular endurance for walking long distances with fewer rests or breaks without compromising safety.

“Someone can be super strong when I’m doing my testing with them, but it doesn’t necessarily translate well into using the prosthesis,” said Farris.

“They have to continuously be able to not only time the contractions of the muscles when they’re supposed to contracting and firing, but also be able to do it consistently for longer intervals until they are able to be up on their legs for a full day.”

Flip the script – gaining life through amputation

Kevin’s lost years are behind him now. The small victories are coming daily and having a big impact. And he’s grateful. He’s fully able to appreciate the new positives in a way that one does when succeeding in overcoming challenges.

The self-proclaimed “beach rat” visited the beach for the first time in eight years in 2025. A milestone that is the first in many things he hopes to return to including hiking, going to concerts, traveling and watching his Phillies and Eagles play live.

He’s the proud owner of a home in New Jersey and able to independently move through life still using the techniques he learned in occupational therapy.

He’s found a new job overseeing student conduct as a director at Montgomery Community College in Pennsylvania, where he navigates the campus with no issue.

And it doesn’t stop there. He’s focused on his future.

He has grand plans to renovate his house with his long-term movement goals in mind, including stairs with two sturdy railings. He’s meeting new people and was recently elected to the board of trustees of the housing corporation to which he belongs. He rescued a nearly 8-year-old English bulldog in January and wants to start walking more.

For Kevin, amputation may have been the last thing he wanted, but it’s also been a driving force in returning his purpose for living and he’s not looking back.

April is Limb Loss and Limb Difference Awareness Month, a dedicated time to support Americans living with limb loss or difference while focusing on advocacy, education and community.

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