In the absence of reliable evidence, it is the consensus of the work group that all patients with lower extremity amputation be fitted with an appropriate prosthesis.

Likewise, all lower extremity limb salvage patients with residual deficits should be evaluated for and/or fitted with an appropriate orthosis.

These conditions are lifelong and require periodic reevaluation and device adjustments and/or replacement.
Limb Salvage or Early Amputation
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: AOFAS, OTA



The complexity of psychosocial and medical variables relevant to lower limb amputation and lower limb salvage patients inhibit the ability to provide the direct impact of orthotics/prosthetics. However, appropriately crafted and fitted Orthotics/prosthetics are intertwined with the patient's quality of life, return to work, physical functioning, residual limb skin health, and pain. The holistic approach to treating, managing, and supporting the patient's desired level of function after a lower limb amputation or salvage procedure requires regular adjusting or replacing of orthotics/prosthetics for the patient to maintain optimal physical function and health.


Patients' with comfortably fitting orthotics/prosthesis trend towards longer periods of orthotic/prosthesis use and higher rates of return to work. Residual limb skin health is an omnipresent challenge; appropriately fitted and maintained prosthesis are essential to preserving the residual limb skin health and potentially preserving future limb length.


Evidence indicates increased lifelong cost with lower limb amputation primarily as a result of prosthesis maintenance and replacements. There is no indication that poorly fitting or maintained prosthesis/orthotics are cost effective, improve compliance, reduce residual limb skin health complications, or improve the patient's function and quality of life; appropriately fitted, maintained, and regular orthotic/prosthesis replacement is more likely to support the holistic treatment and improve the physical function of lower limb amputee and lower limb salvage patients.


The Future of OrthoGuidelines


The OrthoGuidelines Process