The Syme amputation is an ankle disarticulation procedure that creates an end-bearing stump. Weight bearing is accomplished through the articular surface of the distal tibia. The prosthetic socket acts as a suspension for the attached prosthetic foot, which allows direct neurologic proprioceptive feedback during gait. This differs from transtibial or transfemoral amputations, in which weight bearing is distributed over the entire surface of the residual amputated limb. The function-sparing Syme ankle disarticulation has potential application for the infected foot in patients with diabetes, as well as for peripheral vascular disease, trauma, congenital anomaly, and tumor. This chapter reviews the surgical steps and surrounding knowledge for performing a Syme ankle disarticulation.