A Syme amputation is an amputation done through the ankle joint. The foot is removed but the heel pad is saved so the patient can put weight on the leg without a prosthesis (artificial limb). The goals of a Syme amputation are to remove diseased tissue or a non-usable foot and create a functional, painless limb.
This type of amputation is indicated for foot trauma, infection, or tumors as well as certain types of limb deformities when the foot cannot be saved. A Syme amputation is not appropriate in the following situations:
Foot and ankle orthopaedic surgeons perform this surgery with the patient asleep under general anesthesia. For patients with risk factors that make general anesthesia dangerous, the surgery can be done with spinal anesthesia or a leg nerve block with sedating medication. A tourniquet can be used to help minimize blood loss.
Your surgeon will make an incision where the foot and ankle meet. The heel pad is protected. The surgeon cuts the ligaments and tendons attaching the foot to the ankle are cut and removes the soft tissues from the foot bones. Arteries are tied off and then cut as well. Your surgeon then removes the bony prominences at the ankle so that the end of the leg has a flat surface after wound closure. A drain sometimes is used to help prevent a pool of blood from developing deep in the tissue that might cause the procedure to be unsuccessful. Lastly, a bulky soft dressing and a cast are applied.
After the surgery, patients are monitored in the recovery unit for a short time. Patients may start walking once the wound is healed. Length of stay in a hospital can vary. Patients who can get around safely on one leg with crutches or a front-wheeled walker and have help at home can go home after surgery. Patients who need more assistance or daily physical therapy may go to a rehabilitation center, transitional care unit, or skilled nursing facility before going home.
Skin staples or sutures are removed when the wound is healed. Swelling can be managed with a compression stocking, but it is normal to have swelling for up to a year after surgery.
After the wound is healed and the majority of the leg swelling is gone, an experienced prosthetist makes a prosthesis (artificial limb) for the lower leg and stump. The prosthesis may need multiple adjustments so it fits properly. When the prosthesis is ready, the patient will undergo additional therapy to learn how to walk well with the prosthesis.
A patient's leg after a Syme amputation (left) and with the fitted prosthesis (right).
The most significant complication is failure to heal the wound. This can lead to infection, death of tissue, and the need for an amputation at a higher level. Another potential problem after this procedure is too much motion of the heel pad stump, which can cause areas of increased pressure at the bottom of the amputation and lead to ulcers. These ulcers sometimes can be treated with local wound care and prosthesis modification. If there is a bony prominence causing the ulcer, additional surgery should be done to remove the bony prominence and allow healing.
Many patients start out with a sensation the foot is still there (phantom limb sensation). This is normal and not painful. However, some patients may develop nerve pain where major nerves were cut (phantom limb pain).
In many cases, either a Syme amputation or a below-knee amputation is a reasonable treatment. Both have advantages and disadvantages. Patients with Syme amputations have the ability to walk on the limb without a prosthesis. This may be beneficial in situations like getting up in the middle of the night to go to the bathroom. Prosthesis training is easier with a Syme amputation than with a BKA because it feels more functionally normal. The increased energy demands on the body are also less with a Syme amputation than with a BKA.
Because of potential complications of Syme amputations discussed above, sometimes a Syme amputation has to be revised to a below-knee amputation. If the risk of developing complications is high after a Syme amputation, it may be better to choose a BKA from the beginning. Multiple surgeries can be emotionally and physically stressful. A below-knee prosthesis can be more cosmetically appealing. The ankle portion of a Syme amputation prosthesis has to be wider to fit the end of the stump.
There are multiple aspects to consider in the decision-making process for an amputation. Your foot and ankle orthopaedic surgeon will work with you to decide what is best for you.
If there are no other physical or cognitive impairments, Syme amputation patients should not have problems with driving after getting used to the prosthesis.
Original article by Pamela Luk, MD
Last reviewed by Jeffrey Feinblatt, MD; Robert Leland, MD; Raymond Walls, MD
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.
