Diabetic gangrene is the second most common indication (see diabetes mellitus). In contrast to arterial occlusive disease, the aim here is to carry out what’s known as a ‘border zone amputation’. This means amputating at the most distal location possible, right in the area that is only just still healthy. These are therefore often amputations of the toes, the forefoot (amputation/disarticulation in the Chopart or Lisfranc joint) or the hindfoot (Pirogoff amputation). This approach, which used to be frowned upon and called ‘salami slicing’, has become widely accepted since the 1990s because of improvements in wound management, systemic antibiotic treatment and diabetes control. Nevertheless, many transtibial (lower leg) or transfemoral (thigh) amputations still have to be performed ‘ultima ratio’ as the final option.

Amputations due to accident injuries are rare compared to the first two indications.

Malignant tumours very rarely require a limb to be amputated. Usually these are bone or soft tissue tumours (sarcomas).
There has been a significant increase in amputations in recent years due to MRSA bacteria.

• Phantom sensations
• Phantom pain
• Postoperative pain
• Residual limb pain
• Neuroma pain
• Wound healing problems, both superficial and deep
• Deep wound infection
• Residual limb necrosis
• Residual limb oedema
• Contractures
• Skin diseases on the residual limb
• Anxiety and depression

• Prosthetic fitting
• Administration of medications
• Physiotherapy
• Walking rehabilitation

• Learning the physiological gait after an amputation is much easier with the kybun shoe thanks to the soft, springy soles, as the kybun shoe does not require the typical heel impact of other shoes and enables the wearer to feel contact with the ground.
• This relieves the strain on the stump in the prosthetic.
• The prosthesis holds better, i.e. it is not pushed away from the residual limb as much.
• The soft, elastic sole compensates for surface irregularities.
• The toes rarely get caught on the ground in the kybun shoe so you stumble much less often.
• You can tread forward confidently on the prosthesis with an easy rollover.
• Balance while standing and walking is significantly improved.
• The legs no longer feel so heavy after walking.
• You can walk more confidently, more relaxed and save more energy than in conventional shoes. Your gait is also improved.
• Getting up from a chair or the toilet etc. or getting out of the car is much easier than with other shoes. We also shouldn’t forget the safety factor. The kybun shoe has a far wider stepping surface, which reduces the risk of slipping.
• The kybun shoe is extremely slip-resistant on all dry and wet surfaces, even in snowy conditions and on wet stone floors.

• Take small steps in your kybun shoes at first.
• Be sure to maintain an upright body posture without cramping up!
• Keep your gaze forward while keeping the shoulders loose.
• We recommend a kybun shoe model with a weaker trampoline effect (Comfort or SlimFit sole). These models have a somewhat wider sole in the area of the midfoot, providing added stability.
  Seek advice from your local kybun expert.
• Try to consciously perceive the feeling of the roll-off phases. Venture out onto different surfaces. You will subconsciously gain more confidence when walking.
  After a while, you will hardly pay any attention to your steps, which will allow you to relax when walking.
• If a sole with a weaker trampoline effect is too unstable for you, we recommend the kybun mat. You can choose the thickness you are comfortable with (the thicker, the less stable, the more intensive the training). You can also hold on to a fixed object.
• Precise movements are essential, especially if you suffer from joint pain or osteoarthritis. Pay attention to exact movements and be sure to take a break in case of fatigue or weakness. Lateral/medial rolling of the ankle joint on the soft, elastic material has to be corrected so that the load is applied to the leg with proper axial alignment and so that strain on the back is kept to a minimum. Read more under ‘Lateral/medial rolling of the ankle joint’.
• Take your time! The kybun shoe and the kybun mat are intensive ‘training devices’ and pose a major challenge for the body. It may take a few months before you can walk in the kybun shoe or stand on the kybun mat for several hours in a row. The duration of use is highly individual and depends on numerous factors. It also varies from day to day. Listen to your body and accept your personal limits.
• Contact a kybun dealer you trust if you have further questions, feel unstable or if there is no alleviation of pain when using the kybun shoe even though you are following the tips.