Life Post-Symes Amputation – Outcomes and Adaptations

Symes amputation, a surgical technique that amputates the foot while saving the heel pad for weight bearing, will significantly impact one’s lifestyle. This article goes into the essentials of the procedure, its potential to facilitate mobility, and what patients can anticipate during recovery and beyond.

Key Takeaways

  • Syme amputation is a foot removal procedure that preserves the heel pad for weight-bearing capabilities, providing functional advantages over other amputations such as below-knee while requiring careful post-operative rehabilitation and management of complications.
  • Maintaining optimal functionality and quality of life after Syme amputation relies on well-fitted custom prostheses, tailored patient care, and attention to environmental factors impacting the amputee’s ability to ambulate without a prosthesis.
  • Comprehensive care for Syme amputees includes preventing and managing residual limb ulcers, addressing complications such as phantom limb pain and poor blood circulation, and the support from community networks and psychological counseling.

Exploring the Syme Amputation Procedure

Syme amputation, also known as syme ankle disarticulation or syme’s amputation, is named after its pioneer Dr. James Syme. It is an ankle level amputation that involves the removal of the foot while preserving the heel pad. This technique is performed to remove diseased tissue or a non-usable foot, resulting in a functional and painless limb. With the syme amputation performed, patients can experience improved mobility and quality of life.

By preserving the heel pad, the patient retains weight-bearing capabilities, which is a significant advantage over other major amputation types like below knee amputation or transtibial amputation. This is a crucial aspect to consider.

The Role of the Heel Pad in Syme Amputation

Maintaining the intact heel pad in Syme amputation is of utmost significance. The heel pad’s excellent weight-bearing characteristics allow the patient to bear weight on the leg without a prosthesis, a significant functional benefit. However, the heel pad must be free from ulcers, wounds, or dead tissue, as these conditions may necessitate a higher-level amputation.

Surgical Insights: How Syme Amputation is Performed

Performing Syme amputation involves the following steps:

  1. Start with a cut at the malleoli’s tips, extending across the ankle joint and straight down across the sole.
  2. This superior incision results in slightly longer skin flaps that provide coverage over the malleoli.
  3. Make a careful incision to enable the heel flap to fold up.
  4. Take measurements to ensure that bone ends are palpable and pressure points are addressed.

The procedure also includes:

  • a subperiosteal dissection of the os calcis to protect the posterior tibial neurovascular bundle, which includes the posterior tibial nerve and posterior tibial artery
  • securing the heel flap by suturing it to the tibia and fibula through drill holes, incorporating the plantar aponeurosis and deep fascia
  • performing the surgery under various types of anesthesia, with the use of a tourniquet to control bleeding.

Post-Operative Care and Recovery

After surgery, Syme amputees are given care that encompasses recovery unit supervision and methods to control swelling and avert infection at the operation site. However, complications such as edema, infection, wound dehiscence, and tissue necrosis can occur, requiring interventions like rigid dressings, exercises, and potentially surgical intervention.

Syme amputees, who might have experienced limb deformities, may also experience phantom limb sensation and pain, which can be addressed through multidisciplinary approaches like mirror therapy, desensitization techniques, and medications.

The recovery timeline typically allows for the first prosthetic fitting at around 6 to 8 weeks post-surgery, provided wound healing is secure.

The Advantages of Syme Over Below Knee Amputation

Technician adjusting an socket for an symes amputation patient
Technician adjusting an socket for an symes amputation patient

The selection of the amputation level is a vital decision, considering factors like successful recovery, maintaining function, and preparing the remaining limb for the best interaction with a prosthesis. Syme amputation often trumps below-knee amputation due to its functional benefits, including the preservation of the ability to walk without a prosthesis and easier prosthesis training.

However, the benefits of Syme amputation should be weighed against factors such as the physical and emotional stress of potential multiple surgeries and the likelihood of successful prosthetic use. Although Syme amputations may sometimes require revision to below-knee amputations due to complications, careful patient selection and consideration of bone joint surg can avoid the stress of multiple surgeries.

Functional Optimization with Syme Amputation

Functionality is a crucial aspect of post-amputation life, and Syme amputation allows for superior function at major lower limb amputation levels, such as weight bearing without a prosthesis. Research suggests that a balance in limb length discrepancy (LLD) may be integral to optimal functionality, with moderate LLD associated with the least activity restriction.

Optimal patient care post-Syme amputation should be tailored to achieve functional optimization, considering the individual’s daily activities and relevant prosthetic options.

Quality of Life Considerations

Syme amputation can markedly affect patient contentment because it requires less energy than a below-knee amputation. However, the ability to walk without a prosthesis varies by age and is generally lower in individuals over 11 years old, impacting engagement in daily activities.

Environmental factors, such as flooring type, also affect the ability of Syme amputees to ambulate without prosthesis, playing a role in their daily life engagement.

Prosthetic Solutions for Syme Amputees

Custom-designed prostheses, made from laminated plastic material and the creation of a custom prosthesis involves:

  1. Taking a plaster mold of the amputation stump
  2. Forming a trial socket from this mold
  3. Carefully adjusting the socket for optimum comfort during various activities such as standing, walking, and sitting.

Enhancing Mobility: Prosthetic Options

Prostheses for Syme amputees can be custom-designed to closely follow the contour of the natural leg, providing an improved cosmetic effect. The design features include:

  • A leather lacer
  • A specially tailored cavity to snugly fit the unique bulbous shape of the Syme amputee’s stump
  • A focus on achieving good cosmetic appearance and proper alignment

In the prosthetic socket, appropriate padding and liners are essential to minimize the friction and shear forces that can lead to skin ulceration. Additionally, incorporating emollients and moisture-wicking fabrics in prosthetic sock and liner designs contributes to maintaining skin integrity and preventing the development of ulcers.

Adaptation and Adjustment Periods

Syme amputees frequently need several modifications to the prosthesis for a right fit, complemented by extra therapy for learning efficient walking with the prosthesis. Swelling management, including the use of compression stockings, is a part of adapting to a Syme prosthesis and can persist for up to a year following surgery.

Prosthesis-related residual limb ulcers can be managed with continued use in compliant patients, and minor adjustments may help redistribute pressure to alleviate ulcers or pressure sores. In cases of severe acute ulcerations, prosthetic discontinuance may be necessary, followed by a staged plan for re-introduction.

Prosthesis training for Syme amputees is generally easier when compared to below-knee amputees due to the more natural feeling of function.

Managing Complications and Secondary Conditions

Making a new trial socket for an amputee patient
Making a new trial socket for an amputee patient

Poor blood circulation through the artery to the heel pad can hinder recovery after Syme amputation, potentially causing a delay in wound healing. Complications such as sinuses and osteomyelitis may develop post-Syme amputation, potentially necessitating further surgery and impacting rehabilitation.

Phantom limb pain is a nerve pain that can occur after a Syme amputation due to the cutting of major nerves during the procedure. In cases of diffuse osteomyelitis and infected Charcot’s arthropathy, early amputation may be preferable to prolong treatment.

Preventing and Treating Ulcers in Residual Limbs

For Syme amputees, skincare should concentrate on keeping the remaining limb clean and hydrated to avoid breakdown and ulcers. However, excessive motion of the heel pad stump can cause areas of increased pressure at the bottom of the amputation, leading to ulcers.

Daily inspection of the residual limb for signs of irritation, redness, or breakdown can help in early detection and prevention of skin ulcers. Skin ulcers develop in nearly 27% of diagnosed skin problems in prosthetic users, with prevention and management shared between the prosthetist and the patient.

Diabetic Foot Considerations in Syme Amputees

A high percentage (92.3%) of patients who undergo Syme amputation have diabetes mellitus, necessitating specialized post-operative care. These patients often have had diabetes for an average duration of more than 10 years, indicating a heightened risk for diabetic complications that can affect amputation outcomes.

Modified prosthetic use combined with patient education, including the option of elevated vacuum suspension systems, has proven safe for diabetic Syme amputees and effective in ulcer size reduction while maintaining limb function during healing.

Real Stories: Life After Syme Amputation

Community and Support Networks

Organizations like Limbs 4 Life underscores the importance and positive impact of support networks. In helping Syme amputees to connect, share experiences, and receive emotional support, support groups, resources, and communities have a pivotal role.

Regional groups, online platforms, and specialized programs offer community, volunteerism, and aid in leading active lives, while initiatives cater to the unique needs of the youth experiencing limb differences. Psychological counseling and support groups can significantly aid Syme amputees in overcoming emotional and mental challenges, such as chronic pain and adjustment to life post-amputation.


Syme amputation, while a significant life-altering event, does not define the individual or limit their potential. Rather, it paves the way for a new journey filled with resilience, determination, and adaptability. Through understanding the procedure, its benefits, the role of prosthetics, and how to manage complications, Syme amputees can lead fulfilling lives, buoyed by the support of their communities and the triumphs of their peers.

Life after Syme amputation is a testament to human adaptability and resilience. It’s a journey of determination, perseverance, and an inspiring narrative of overcoming adversity to lead an enriching life. So, to those facing this journey, remember: It’s not about the destination, but the journey itself, and every journey begins with a single step.

Frequently Asked Questions

What are the advantages of Symes?

The advantages of Syme’s amputation include a lower energy cost of walking, an end-bearing and durable residual limb, and possibly better proprioception in the prosthesis. These benefits make it a preferred choice for many individuals.

What is the terminal Syme procedure?

The terminal Syme procedure involves the complete removal of the nail bed and matrix, along with the amputation of a portion of the distal phalanx of the great toe just distal to the interphalangeal joint. This procedure aims to preserve the function and cosmesis of the great toe.

What are the two types of amputations?

The two types of amputations are above-knee amputation, which involves removing part of the thigh, knee, shin, foot, and toes, and below-knee amputation, which involves removing the lower leg, foot, and toes.

How many hours does it take to amputate a leg?

It can be difficult to predict how long the amputation will take as there are several factors that will affect this type of surgery, but you should expect it to be between one to three hours. Your surgeon will be able to advise you on your specific circumstances.

What is the function of Symes prosthesis?

The function of Symes prosthesis is to provide comfortable support for body weight on the stump and firm support against the leg during push-off.


The article provides an overview of Symes amputation, a surgical procedure that removes the foot while preserving the heel pad for weight-bearing purposes. This technique offers significant functional advantages, including the ability to bear weight and potentially walk without a prosthesis, compared to other amputation types like below-knee amputation. Key aspects of the procedure, post-operative care, and the importance of custom-fitted prosthetics for maintaining optimal functionality and quality of life are discussed. The article emphasizes the importance of comprehensive care, including prevention and management of complications such as residual limb ulcers and phantom limb pain, as well as the support from community networks and psychological counseling. Syme amputation, while life-altering, is portrayed as a journey of resilience and adaptability, enabling individuals to lead fulfilling lives with the right support and care.

About The Author