Ignoring Diabetes Gets Me A New Leg.

I was supposed to write this blog from the start of my journey when I started “Ignoring My Diabetes”, but as per my usual with things I’m supposed to do, I’ve changed how I am going to do this. Instead of any clear format I am writing blog post as they come to me in no particular order whatsoever.

Makes it all the more interesting.

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Yesterday I was fitted for my first prosthetic leg by a prosthetic company. Now one would think getting a limb to replace the limb amputated would be a simple process. Fit the stump, order the prosthetic, make sure it fits properly then start physical therapy to train the mind and body to accept and use the new limb. NO.

I had to take an AMP Test. In order not to confuse you with the information contained in today’s installment about Ignoring Diabetes and what happens when you Ignore Diabetes, read along with the following information on what an AMP Test actually is and why it’s needed before a prosthesis can be given.

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Few things are as frustrating as having an insurance company refuse to cover equipment or services you know your patient needs. This is especially true for prosthetic devices, because they have such a huge impact on mobility and quality of life. One of the best things you can do to help your patients is to clearly document their current and potential functional status. And if they need a lower limb prosthetic, the best way to do that is by communicating their K level.

Medicare established K levels, also called Medicare Functional Classification Levels (MFCL), in 1995 as a means to quantify need and the potential benefit of prosthetic devices for patients after lower limb amputation. The rating system is still used today by Medicare, Medicaid and many other insurance companies to determine eligibility for payment or reimbursement.

As mobility specialists, you (PTs) are often the most qualified member of the rehab team to establish a patient’s K level. For you this means two things: 1) You need to document your patient’s K level and 2) You need to pass that information along to their referring physician and their prosthesis. Below are Medicare’s descriptions of the five (0-4) K Levels:


K Levels

Level 0

Does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.

Level 1

Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator.

Level 2

Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator.

Level 3

Has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.

Level 4

Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.


According to the American Academy of Orthotists and Prosthetists, no one method is considered the gold standard for establishing K-Levels. The rating is left up to the clinician doing the assessment, and unfortunately, many consider it over-simplified and too subjective.

According to a 2016 survey of prosthetists, published in the Archives of Physical Medicine and Rehabilitation, 67% of respondents didn’t think the K level could accurately capture a patient’s rehab potential. For this reason, many clinicians turn to more established clinical outcome measures (OMs).

Outcome measures commonly used to establish K levels include the following:

  • Amputee Mobility Predictor (AMP)
  • Patient Assessment Validation Evaluation Test (PAVET)
  • Prosthesis Evaluation Questionnaire (PEQ)
  • Timed Up and Go (TUG)
  • Timed Walk Tests
  • Distance Walk Tests

The Amputee Mobility Predictor (AMP) is the most frequently used outcome measure by far (by a factor of 2, according to the survey just mentioned). The AMP can be administered in as little as fifteen minutes on patients with (AMPPro) or without a prosthesis (AMPnoPro). A simple conversion table (DOCX) allows for a quick K level determination. The AMP’s use for assessing functional status of lower limb amputees was validated by researchers at the University of Miami School of Medicine in 2002, and you can find a copy of the test and its instructions in their paper here.

Whichever method you choose to determine K level, it is important that you take the initiative to communicate your assessment to both your patient’s doctor and their prosthetist. This will help increase the odds this information will be used to justify medical necessity. You can learn more about how to do this in this detailed guide created by the American Academy of Orthotists and Prosthetists.

You also want to make sure you educate your patients. The Amputee Coalition, a non-profit “dedicated to enhancing the quality of life for amputees and their families,” emphasizes the importance of patients knowing their K level. They offer a patient-friendly handout, Do you know Your K-Level?, as a free download.

Ottobock also offers a free download, Documentation Tips: Justifying Functional Level, to help ensure your patients get the devices they need.

My AMP test score was a 27, which falls, BY ONE POINT, short of K3. I am classified as a K2. The real purpose of this K rating system is to determine how “Good” of a prosthesis I will get. It’s a very ass backwards process because the higher the score one gets on this AMP test, the more technology advanced prosthesis you qualify to receive. In other words, normal people who have an amputation, and who need a better/best prosthesis, get the worse quality prosthetic if they get a low score. High AMP test scores are usually attained by world class athletes or people who train daily such as firemen, soldiers, athletes and so on.

Now one would think, using logic and common sense, that a person not so athletic, someone not in the best shape, one who has issues with balance and Equilibrium because of the lost limb, would be the ones inline for the top notch prosthesis. NO. Those who need the most technology advanced prosthetic limbs are not able to qualify because their K scores are lower than the people who score higher on this AMP test.

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The entire process from being tested to determine what quality prosthesis I qualify to receive, along with seeing an orthopedic surgeon/doctor so he can sign off on the new limb {that pesky insurance guy needs a “real doctor” to write the order}, to being fitted for the prosthesis, took 3 hours. I have another appointment set to see the prosthesis maker in 2 weeks to get a look/feel/tryout, for what is to be my new appendage. At this appointment I see how well the cast was made, how comfortable the limb fits and if I am able to make the leap from my leg to my bionic limb.

To be totally honest I went through this entire amputation in a breeze. I had no pain after the surgery. I took no pain killers. There was little or no swelling. Upon discharge 4 days after the surgery, I was able to transfer and ambulate on my own and had no issues with doing things like dressing myself or other activities of daily living. I had this surgery on January 31st. Went home on February 4th. Measured/cast for my prosthesis on April 17th. First fitting/wearing for the prosthetic limb is May 2nd. In 92 days I went from having a lower leg/ankle/foot the size of a tree trunk, filled with infection, a condition called Osteomyelitis which is an infection in the bone……to having a new limb and starting to walk as a “normal” human being.

WARNING………. The images below are gross and real. This was the condition on my right foot/ankle/leg from August 14th, when the swelling/infection/osteomyelitis was first diagnosed…. until January 31st, when the infection was removed along with my foot/ankle/leg in what is known as a below the knee amputation.

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Now one would think this ordeal would push me to the point of never allowing my diabetes to go un-managed, knowing this would be the end result. I can not honestly say that if I knew for certain, back in 2008 when I was diagnosed with type two diabetes, that I would end up here, where I am now, if I did not manage this disease correctly….that I would change a single thing. Do anything differently. I asked myself this very question a few nights ago.

The answer is …… I’m not 100% sure I’d change a single thing to prevent this amputation.

DO NOT BE LIKE ME. Manage your diabetes. Prevent a hard head or that “not giving a damn” mindset from doing this to you.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!bestmanpaintlive1diabetesbanner1

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