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The Symes amputation describes the amputation procedure in which the ankle joint is removed from the lower extremity and the heel pad of the foot is placed on the bottom of the residual limb to allow for weight bearing. The full length of the lower extremity limb is maintained without disrupting the growth plates, and is still a common procedure for children with clubfeet and other foot and ankle deformities.
Unlike transtibial amputees, many patients with symes amputations are able to fully bear weight on the bottom of the residual limb. Therefore, the socket design for a symes amputation is slightly different than the transtibial socket. While pressure must be still redistributed throughout the limb, more emphasis placed on the distal end or very bottom of the prosthesis, as tolerated. The carbon fiber frame is then connected directly to the prosthetic foot.
Many symes sockets incorporate a removable window to allow the limb to pass through the narrow region, which then locks into place, usually by a Velcro strap.
Since there is no pylon or connection tube between the bottom of the socket and the prosthetic foot, the symes socket is usually bulky on either side of the ankle.
Many Symes prostheses are attached to the body using anatomical suspension, meaning that the prosthesis grips onto the sides of the knee joints for suspension. Due to the bony nature of the symes residual limb, additional padding is usually provided by a gel liner.
Sometimes a custom liner is necessary because an off the shelf, or premade, gel liner does not fit the contours of the “hourglass” limb shape. Custom liners enable practitioners to indicate regions on the limb where more padding is needed in the liner.
The length of the Symes residual limb reduces the prosthetic foot options because the build height, or space between the end of the limb and the floor, is less than with a transtibial amputation. This type of foot may also sometimes be referred to as a “low profile foot” or LP, because it is lower to the ground. Several manufacturers have prosthetic feet specifically for Symes prostheses.
The partial foot amputation is the most common type of amputation in the United States, occurring twice as frequently as transfemoral or transtibial amputations. Proper care of the partial foot amputation prevents further complications and higher level amputations. P&O Care practitioners treat all levels of partial foot amputation and want you to return to the life you love.
Prosthetic intervention is usually recommended if the great toe or more has been removed.
While there many levels of partial foot amputations, partial foot management typically involves some type a custom designed foot orthosis or insert with a “toe filler” to fill out the remainder of the shoe. A carbon footplate may also be used to restore the push off lost from the removal of the front of the foot. Generally, the shorter the residual limb, the higher device extends above the ankle to re-distribute the forces. Many partial foot prostheses can fit directly into the patient’s existing shoe.
1. Increase the weight bearing area
2. Provide Cushioning to transected bone, prevent skin breakdown
3. Assist in rollover