Syme's amputation

21 January 2022

Life after amputation brings new challenges for both you and your family. Many everyday tasks will need to be approached in a different way. If you undergo a Syme amputation of the foot, the impact might not be as profound as a more extensive amputation, such as an above knee amputation, but that does not mean you should be expected to carry on without the necessary advice and support.

We appreciate just how much a Syme’s amputation can affect a person and their loved ones, not just physically, but emotionally as well. Find out more about what a Syme’s amputation can mean for you and your family – and how Shoosmiths can help.

What is Syme’s amputation?

A Syme amputation is the removal of your foot through the ankle joint. This means the whole foot is removed – but the lower leg is left intact and the heel pad is preserved for weight bearing. This procedure removes the need for an artificial limb (prosthesis).

The name ‘Syme amputation’ comes from the pioneering Scottish surgeon James Syme’s, who first published a paper in 1842 describing the procedure. Syme was unhappy at the number of limbs lost when a different procedure may have saved them. This applied particularly to patients who had suffered crushing injuries caused by trauma, non-healing ulcers, Charcot Foot or osteomyelitis.

Boyd v Syme’s amputation: What is the difference?

Like a Syme amputation, the Boyd procedure also takes place at the level of the ankle. Technically, this is a more complex surgical procedure to perform than a Syme amputation, but it offers certain advantages over a Syme amputation. The main difference is that it retains the heel bone (calcaneus) and preserves the function of the heel pad. As part of the heel bone is left and joined to the tibia, it can offer a much more solid weight-bearing surface.

Are there different types of Syme’s amputation?

In a conventional Syme amputation, it is common for the forefoot and midfoot to be removed. It is also possible, however, that someone might undergo a different type of procedure. This can depend on the specific reason for the amputation – and the likely outcome or benefit:

Distal Syme’s amputation - If you suffer from an infection such as osteomyelitis in the toe, a distal Syme’s amputation may be the best option. It can be the result of toe ulcers or wounds caused by diabetes. It often involves the removal of the wound, toenail and tissue underneath the nail, as well as the distal phalanx.

Terminal Syme’s amputation - is the partial removal of the end of a toe. The amputation will usually take place at the joint nearest the end of the affected toe. It is one surgical option where there is a deformity of the toe, which then leads to pain at the tip of the affected toe.

What injuries would lead to Syme’s amputation?

An amputation is a last resort. No doctor or surgeon will decide to remove a limb if it could otherwise be saved. However, there are a number of situations in which a Syme foot amputation might become the preferred surgical option.

In some cases, it could be the result of a wound, ulcer, infection or other complication caused by another condition. For people with diabetes, there is a higher risk of foot issues.

This is a factor that is contributing to a rising number of diabetes-related amputations in England.

A Syme amputation may also be needed following an accident. Accidents can lead to immediate (traumatic) amputation, but sometimes the amputation may have to be undertaken later if the injury does not respond to treatment, or something goes wrong with the treatment. The subsequent loss of a limb can be difficult to come to terms with if after a traumatic injury the treatment fails. 

How is a Syme amputation undertaken?

In the 1950s, surgeons would perform a Syme’s amputation in two stages. The first stage involved the removal of the foot. About six to eight weeks later, a second operation would take place to firmly attach the fat pad of the heel to the stump of the tibia and fibula. This created a platform on which to stand.

Now, however, advances in this amputation surgical technique mean the operation is undertaken in one procedure. A section of the lower end of the tibia and fibula is cut around half an inch from the distal ends. Next, the fat and skin of the heel are drawn forward and attached to the stump. To finish, a soft dressing and cast are applied to help with recovery.

What is the impact of a Syme’s foot amputation?

Our feet are such an important part of the body, maybe more so than we sometimes appreciate until something goes wrong. Feet are what connect us to the ground and are essential for balance and movement. Removing a foot (or even just part of it) can have a huge impact on how you do things. It can be difficult for you and your loved ones to adjust to life after a Syme foot amputation because the loss of a foot can affect all aspects of everyday life including your ability to work and enjoy sport and exercise. 

It is still possible to enjoy a high quality of life after Syme foot amputation, but there will be a period of adjustment and rehabilitation.

Shoosmiths partner with world-leading specialists in prosthetics, care, physiotherapy, rehabilitation and accommodation. This places us in a good position to help you during this period of adjustment by ensuring you are aware of the latest medical and technological advances so that you can make choices to improve all aspects of your new life.  We will also put you in touch with the right people so that we can build a support network tailored to your exact needs.

We can also provide guidance when it comes to deciding whether to engage the services of a Case Manager to help with care and assistance and to understand what you need in the way of aids and equipment and your entitlement to state benefits.

What are the risks involved?

No operation is without risk. If your amputated foot is the result of surgery that is elective or the last-resort solution, there may be pain or bleeding after the operation that will soon recover. You could also experience “phantom limb” – a condition where sensation can still be present. You may also need to deal with ongoing emotional distress and feelings of loss; pain and soreness in the residual ‘stump’ and the possible need for revision surgery. 

Shoosmiths can put you in touch with experts and support groups to help you understand, prepare and overcome these risks – and longer-term concerns such as slow healing, infection or even conditions like deep vein thrombosis.

What help can Shoosmiths provide?

Our team of amputation claims specialists have many years of experience dealing with amputation claims. If your amputation was caused by either an accident that was not your fault, or the negligent treatment you received from a health professional, we can investigate your circumstances to establish whether you can make a claim for compensation. We can also assist with your recovery and rehabilitation.  Any compensation you receive will help to cover the cost of your care, ongoing treatment, lost income or even a replacement prosthetic.

Talk to us for free and in confidence. Call 0808 301 7915 today or send us a message.



This information is for educational purposes only and does not constitute legal advice. It is recommended that specific professional advice is sought before acting on any of the information given. © Shoosmiths LLP 2024

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