Letts M: Surgical cases and amputations: amputation at the ankle-joint. .Clin Orthop 256::3. ,1990. .
Harris RI: Syme’s amputation: the technical details essential for success. .J Bone Joint Surg Br 38::614. ,1956. .
Catterall RC: Syme’s amputation by Joseph Lister after sixty-six years. .J Bone Joint Surg Br 49::144. ,1967. .
Ratliff AHC: Syme’s amputation: result after forty-four years. .J Bone Joint Surg Br 49::142. ,1967. .
Baker GCW, Stableforth PG: Syme’s amputation: a review of sixty-seven cases. .J Bone Joint Surg Br 51::482. ,1969. .
Bowker JH, San Giovanni TP: “Amputation and Disarticulations,” in Foot and Ankle Disorders, Vol 2, ed by MS Myerson, p 466, WB Saunders, Philadelphia, 2000..
Bowker JH, San Giovanni TP: “Minor and Major Lower Limb Amputations in Persons with Diabetes Mellitus,” in Levin and O’Neal’s The Diabetic Foot, 6th Ed, ed by JH Bowker and MA Pfeifer, p 627, CV Mosby, St Louis, 2001..
Malone JW: “Lower Extremity Amputation,” in Vascular Surgery: A Comprehensive Review, 4th Ed, ed by WS Moore, p 822, WB Saunders, Philadelphia, 1993..
Wagner FW: A classification and treatment program for diabetic, neurotrophic and dysvascular foot problems. .Instr Course Lect 28::143. ,1979. .
Dickhaut SC, DeLee JC, Page CP: Nutritional status: importance in predicting wound-healing after amputation. .J Bone Joint Surg Am 66::71. ,1984. .
Pinzur MS, Sage R, Stuck R, et al: Transcutaneous oxygen as a predictor of wound healing in amputations of the foot and ankle. .Foot Ankle Int 13::271. ,1992. .
Pinzur MS, Stuck R, Sage R, et al: Transcutaneous oxygen tension in the dysvascular foot with infection. .Foot Ankle Int 14::254. ,1993. .
Spittler AW, Brennan JJ, Payne JW: Syme amputation performed in two stages. .J Bone Joint Surg Am 36::37. ,1954. .
Pinzur MS, Morrison C, Sage R, et al: Syme’s two-stage amputation in insulin-requiring diabetics with gangrene of the forefoot. .Foot Ankle Int 11::394. ,1991. .
Pinzur MS, Smith D, Osterman H: Syme ankle disarticulation in peripheral vascular disease and diabetic foot infection: the one-stage versus the two-stage procedure. .Foot Ankle Int 16::124. ,1995. .
Jahss MH, Michelson JD, Desai P, et al: Investigations into the fat pads of the sole of the foot: anatomy and histology. .Foot Ankle Int 13::233. ,1992. .
Robinson KP: Disarticulation at the ankle using an anterior flap. .J Bone Joint Surg Br 81::617. ,1999. .
Smith DG, Sangeorzan BJ, Hansen ST, et al: Achilles tendon tenodesis to prevent heel pad migration in the Syme’s amputation. .Foot Ankle Int 15::14. ,1994. .
Pinzur MS: Restoration of walking ability with Syme’s ankle disarticulation. .Clin Orthop 361::71. ,1999. .
Cottrell-Ikerd V, Ikerd F, Jenkins DW: The Syme’s amputation: a correlation of surgical technique and prosthetic management with an historical perspective. .J Foot Ankle Surg 33::355. ,1994. .
Radcliffe CW: The biomechanics of the Syme prosthesis. .Artif Limbs 6::76. ,1961. .
The Canadian Association of Prosthetists and Orthotists: “Socket Designs for the Syme’s Amputee,” in Clinical Aspects of Lower Extremity Prosthetics, ed by D Weber, p 169, Elgan Enterprises, Oakville, Ontario, 1991..
Northwestern University Medical School Prosthetic-Orthotic Center: Prosthetic Manual, p 227A, Northwestern University Medical School Prosthetic-Orthotic Center, Chicago, 1993..
Sarmiento A: A modified surgical-prosthetic approach to the Syme’s amputation: a follow-up report. .Clin Orthop 85::11. ,1972. .
Waters RL, Perry J, Antonelli D, et al: Energy cost of walking amputees: the influence of level of amputation. .J Bone Joint Surg Am 58::43. ,1976. .
Sinclair WF: Below the knee and Syme’s amputation prostheses. .Orthop Clin North Am 3::349. ,1972. .
Wagner FW: Amputations of the foot and ankle: current status. .Clin Orthop 122::62. ,1977. .
Pinzur MS: Amputation level selection in the diabetic foot. .Clin Orthop 296::68. ,1993. .
Pinzur MS, Wolf B, Havey RM: Walking pattern of midfoot and ankle disarticulation amputees. .Foot Ankle Int 18::635. ,1997. .
Amputation at the level of the ankle joint is a valuable but underused procedure for a variety of conditions affecting the foot and ankle. The procedure provides a comfortable and durable stump that allows the lower-extremity amputee to function with minimal disability. This article reviews the indications for Syme’s amputation, provides a detailed surgical description of the procedure, and discusses postoperative prosthetic considerations. In addition, three case reports are presented in which Syme’s procedure was successfully used as an alternative to higher-level amputation. (J Am Podiatr Med Assoc 92(4): 232-246, 2002)