[Two stage Syme amputation]

In 1843 James Syme described the amputation which bears his name. It is done in two stages and can be accomplished in the presence of wounds and infections or gangrene of the feet. The operation is of great value especially in the elderly. Patients with a Syme stump can be fitted with a strong, light, plastic prosthesis, they develop an excellent gait and the entire body weight can be borne without pain. The advantages of the Syme amputation are that the knee joint is retained and the long lever allows an almost normal gait with an energy cost only 10% above normal. The stump has a large interface for proprioceptive feed-back and the prosthesis is easy to put on.