Below-Knee vs Forefoot Amputation: Which Is Better For Mobility

Recovering from amputation surgery is a long journey, unfolding one day at a time. While regaining amputation mobility may take months of healing, prosthetic rehabilitation, and practice, many people thrive after limb loss.

Like an earthquake rattling the foundations beneath your feet, traumatic injury or degenerative disease can throw life into upheaval in mere moments. Decisions loom like aftershocks - to amputate or not, and if so, how much? Below-knee vs forefoot only? The uncertain path forks ahead. 

But informed steps bring confidence. Seek wisdom and facts, not just opinions and fears. Define priorities like mobility and independence. Weigh options collaboratively, then commit fully to healing. With today's prosthetics, an active life persists post-amputation if you equip yourself with knowledge and support. 

Take a deep breath and trust the process, one insightful choice at a time.

Comparison Between Below-Knee Vs Forefoot Amputations

When amputating the lower limb, the usual options are a below-knee vs forefoot amputation. Both surgically remove damaged areas but have major differences. Choosing the right procedure requires understanding how each compares in terms of:

Surgical Procedures

Below-knee amputation is the complete surgical removal of the lower leg from just under the knee joint down to the ankle. It leaves an optimal residual limb length for fitting a prosthetic leg.

Forefoot amputation involves the surgical removal of only the front portion of the foot. It includes all the toes and metatarsal bones leading to the base of the toes. The heel is left fully intact.  

Count of Limb Removed

Forefoot amputation preserves more of the original biological limb by only removing the damaged forefoot area. In contrast, below-knee amputation takes more of the leg — everything below the knee joint.

Reasons for Each Surgery

Below-knee amputation is often done for severe non-healing wounds, infections, trauma, or unmanageable pain isolated to the foot and lower leg. Conversely, forefoot amputation may be considered first for localized problems like non-healing diabetic foot ulcers confined to the toes and ball of the foot.

Post-Surgery Healing and Complications

After surgery, one primary consideration is whether the patient will experience smooth, swift healing or complications.

Healing Rates

Based on studies, below-knee amputations have a higher success rate for initial healing, around 95%. Forefoot amputations have proven less reliable, with one study showing only a 50% chance of proper healing.

Risk of Repeat Amputation  

If forefoot amputation fails to heal properly, repeat amputation becomes inevitable. Approximately nearly 50% of forefoot amputations went on to require additional amputation revision. In contrast, below-knee amputation more often heals fully the first time.

Recovery Weight Bearing

After initial healing, some protected weight bearing may be possible on the preserved heel following forefoot amputation. But below-knee amputees cannot put weight on their residual limb until fully healed.

Impact on Mobility and Function

Mobility is often a top concern when choosing between below-knee and forefoot amputations.

Prosthetic Options

A major benefit of below-knee amputation is the wide range of available prosthetic knees and feet, allowing customization of the prosthesis. But forefoot amputation’s limited residual space makes fitting a prosthetic foot extremely challenging.

Prosthetic Mobility 

Regarding function with a prosthetic limb, below-knee amputees ultimately tend to have better prosthetic mobility and independence. Their full-sized residual limb and diverse prosthetic options are optimized for movement.

Daily Tasks

Routine tasks like self-care, transferring positions, home and vehicle access, and walking ability are typically easier for below-knee amputees using their customized prostheses.

Athletic Activity

Avid athletes may have some advantage in retaining a partial foot, allowing activities like swimming. But for most sports, properly fitted below-knee prosthetics with specialty feet provide greater function.


Recovering from amputation surgery is a long journey, unfolding one day at a time. While regaining amputation mobility may take months of healing, prosthetic rehabilitation, and practice, many people thrive after limb loss.

There is no universal best option between below-knee and forefoot amputation. Each has pros and cons for healing, function, and emotion. Your medical team considers your specific needs in recommending a surgical plan. Gather information, seek support, and take it step-by-step. How you live your life matters more than what you wear on your feet.