It is estimated that 185,000 limbs are amputated each year in the United States. Of these, 87 percent are dysvascular amputations, often because of the abnormal blood circulation related to diabetes.

Whether the amputation is related to disease or injury, and whether the victim is civilian or military, the goal of treatment and rehabilitation is for the patient to function as close to normal as possible. And recent advances in the development of prosthetic limbs are making this goal a reality.

Failure to adapt to and use a prosthetic device is most strongly associated with amputations due to diabetes or other vascular diseases, although other factors are age, depression and pain. Another factor is the location of the amputated limb.

In a 2008 study of civilians with prosthetics, rates of employment varied depending on the cause of the amputation and whether the amputation was upper limb or lower limb. Those having had an upper-limb amputation were more likely to have full-time employment (36 percent), while those having lower-limb amputation worked full-time at a rate of 23 percent.

Having an upper-limb amputation was also less likely to result in unemployment due to disability compared to lower-limb amputations with the rates being 28 percent for those with upper-limb loss and 39 percent for those with lower-limb loss.

Comorbid pathologies may be contributing to the greater unemployment and greater disability for those with lower-limb amputations. This same study identified that 16 percent of the lower-limb amputations were due to diabetes and no upper-limb amputations were due to diabetes.

The rate of diabetic health problems is growing at such a rate that the number of amputations due to diabetes is expected to double by 2050. Currently of those with diabetes having a lower-limb amputation, 55 percent are at risk of having the other leg amputated within two to three years.

Technical advancements in prosthetic limbs have enabled those with limb loss to perform many tasks — and some at a near-normal level. The computational power in small, durable forms allows for the integration of robotic technology in prosthetics. Research is expanding the ability of robotic technology to receive signals from the user's intact nerves and translate some information into actions on the part of the robotic prosthesis.

A recent study of hand prosthetics compares the integration of such mechanics in a hydraulic-cylinder finger and a pulley-cable finger. In both cases, a signal generated by the wearer's own nerve commands controlled the fingers — meaning that the prosthetic would resemble aspects of normal hand functions.

Lower-limb prosthetics have also evolved. For patients with above-the-knee amputations, multiple options exist that have articulating, integrated and coordinated movement within joints. There are five different models that can make quick, real-time adjustments while walking. To do this, the above-the-knee prosthesis has hydraulic and pneumatic components controlled by microprocessor technology.

A person's goals and level of activity determine the type of ankle and foot that a lower-limb prosthetic would have. There is also a foot with a microprocessor-controlled ankle unit for patients. These technology advances result in improved walking ability that requires less effort.

Whether the goals are basic tasks like grasping a grocery bag and walking independently in the grocery store or playful games of catch and tag in a child's schoolyard or the aggressive stance at the start of a marathon race, the advances and variety in prosthetic devises allow the old, young and competitive to return to their lives after a limb loss.