Twenty-three children had proportionate growth of bone and soft tissue
between two and eleven years after a Syme ankle disarticulation. All walked
with permanent prostheses within three months after operation. Ischemic
necrosis occurred twice after inadvertent ligation of the posterior tibial
artery. Suture of the extensor tendons into the heel pad eliminated its
posterior migration. Prosthetic realignment compensated for progressive
genu valgum in ten of fourteen amputees with fibular hemimelia. On the
basis of these gratifying results, the Syme ankle disarticulation is
suggested as early treatment for certain congenital anomalies of the lower
extremity.