Use of Mirror Therapy for Phantom Limb Pain in Lower Limb Amputees: A Narrative Review

Abstract

Phantom Limb Pain (PLP) remains a pervasive and debilitating consequence of amputation, affecting up to 80% of lower limb amputees. Pathophysiological theories suggest that PLP arises from maladaptive neuroplasticity, specifically between the motor cortex’s output and the lack of sensory feedback from the missing limb. Mirror Therapy (MT) addresses this by providing a visual surrogate for the absent limb, theoretically resolving the sensorimotor conflict in the primary somatosensory and motor cortices. This narrative review evaluates the current state of clinical evidence regarding the use of MT for managing PLP in lower limb amputees. A comprehensive qualitative synthesis was performed by searching major medical databases (PubMed, CINAHL, Scopus, and PEDro) for studies published between 2010 and 2026. Selection criteria included Randomized Controlled Trials (RCTs), case-control studies, and systematic reviews involving adult lower limb amputees experiencing chronic or acute PLP. Key findings suggests that MT facilitates the “re-mapping” of the cortical representation of the limb, reducing the invasion of adjacent cortical areas into the deafferented zone. Active, bilateral synchronous movements (e.g., ankle dorsiflexion/plantarflexion) under the mirror illusion yield higher pain reduction scores compared to static viewing. Mirror therapy is a highly effective, low-cost adjunct for lower limb phantom limb pain, though it currently lacks standardized dosage guidelines.