Fig 35A-12. Syme ankle disarticulation. A, the incision starts anteriorly at the tip of medial malleolus and is carried directly across the ankle joint to the lateral side. The second half of the incision is then carried from these two points to the plantar surface of foot and describes a slight arc. B, with the foot pulled forward the posterior capsule is divided and the heel cord dissected off the superior aspect of the os calsis. C, dissection is completed, care being taken not to puncture the skin posteriorly. D, the wound is closed.