Syme's amputation was initially described during the pre-antisepsis and pre-antibiotic era and was found useful in many situations. Over time, this amputation technique lost favor due to associated complications and a cosmetically unacceptable prosthesis. The original technique was modified over the years, with reduced complications and improved outcomes and gait. We discuss here the evolution of Syme's amputation, its modifications, the importance of preoperative evaluation, and critical intraoperative steps for the success of the procedure.