Stroke hemiplegia and subsequent lower extremity amputation: which side is at risk?

The purpose of this study was to see 1) if there is a relationship between side of hemiparesis and subsequent lower extremity amputation and 2) if time from onset of cerebrovascular accident (CVA) to onset of amputation is less in patients with diabetes mellitus than in those without that disease. Twenty-two subjects with a mean age of 63.9 +/- 11.4 years met the criterion of having a CVA followed by a lower extremity amputation. Date and side of hemiparesis and amputation were noted and a relationship was determined using the two-tailed chi-square test. Twenty-one of 22 subjects had the amputation on the same side as their hemiparesis which represents a significant relationship (chi 2 = 18.16, p less than 0.001). Mean time from CVA to amputation was 32.5 +/- 26.12 mo for diabetics and 55.0 +/- 33.1 mo for nondiabetics which also represents a significant difference (t = 1.74, p less than 0.05). It is concluded there is a strong relationship between side of hemiparesis and subsequent lower extremity amputation with the amputation occurring most often on the hemiparetic side and earlier in patients with diabetes mellitus. The causal relationship between side of CVA and subsequent same sided amputation may be due to altered autonomic nervous system control, altered sensation with increased incidence of local unobserved trauma or decreased/altered muscle fiber use on the affected side. Implications for clinical rehabilitation include education for skin protection and attempting to increase muscle fiber activity.