A Syme amputation is an amputation which is done through the ankle joint. The foot is removed but the heel pad is saved so that the patient can put weight on the leg without prosthesis (artificial limb).

What are the goals of a Syme amputation?

The goals of a Syme amputation are to remove diseased tissue or a non-usable foot and create a functional, painless limb.

What signs indicate that Syme amputation may be needed?

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.

When should anyone avoid Syme amputation?

A Syme amputation is not appropriate in the following situations:

• In those with medical conditions where the risks of surgery outweigh the benefits. If the medical conditions can be improved, surgery can be reconsidered.
• Poor blood flow through the artery that supplies the heel pad. Without good blood flow, the surgical wound will not heal.
• Lack of an intact heel pad. If there is any ulcer, wound or dead tissue at the heel, a Syme amputation should not be performed and a higher-level amputation is recommended.
• Infection, tumor or trauma that involves the ankle. A Syme amputation will not adequately treat the problem so a higher level of amputation is needed.

General details of Syme amputation

The surgery is usually performed 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.

Specific Technique

The incision is made where the foot and ankle meet. The heel pad is protected. The ligaments and tendons attaching the foot to the ankle are cut and the soft tissues are removed from the foot bones.

Arteries are tied off and then cut as well. The bony prominences at the ankle are removed so that the end of the leg has a flat surface after wound closure.

A drain is sometimes used to help prevent a pool of blood from developing deep in the tissue that might cause failure of the procedure. Lastly, a bulky soft dressing and a cast are applied.

What happens after Syme amputation surgery?

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 temporarily before going home.

Skin staples or sutures are removed in the clinic 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 the prosthesis (artificial limb) for the lower leg and stump.

The prosthesis may need multiple adjustments, so it fits properly. When the prosthesis is ready, additional therapy is done to learn how to walk well with the prosthesis.

Potential Complications

The most significant complication is the failure to heal the wound. This can lead to infection, the 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 can sometimes 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).