In order to perform a Syme's amputation, the heel fat pad must be intact. In addition, patients who are concerned about the cosmetic result of their surgery often find a below-knee amputation more cosmetically acceptable than a Syme's amputation because the ankle thickness in a below-knee prosthesis can resemble that of a normal ankle and the foot will often fit into regular shoe wear. The prosthesis for a Syme's amputation has a large, broad ankle portion that extends distally as a continuation of the brace rather than the shoe, and is often cosmetically unacceptable to patients. Laughlin RT, Chambers RB: Syme amputation revisited: A review of 46 cases. J Bone Joint Surg 1996;78B:461-467.