Abstract
The details in technique which are most essential to ensure a perfect Syme's stump are the provision of a broad area of support for the heel flap by transecting the tibia and fibula as low as possible; the maintaining intact of the specialised weight-bearing qualities of the heel flap; and the proper placement of the heel flap under the cut ends of the tibia and fibula. If these aims are achieved a good and useful stump is assured; if they are neglected the stump will be imperfect and may be unsatisfactory and no further operation can restore the qualities of the heel flap which are lacking.
It must be recorded, however, that Syme's stumps which are not technically perfect often function so well that there has been no need to consider re-amputation. A loose heel pad can be held beneath the end of the bone by firm lacing of the corset of the prosthesis.If its area of bony support is reasonably large it may serve well, though not perfectly, as an end-bearing stump. Syme's stumps so completely unsatisfactory as to necessitate re-amputation have been those in which the plane of transection of the tibia is so high that the area supporting the heel flap is too small; or the weight-bearing qualities of the heel flap have been damaged; or there is instability of the heel flap which cannot be controlled; or there is impairment of nutrition of the heel flap.
