Background: Lower limb amputations should be evaluated carefully, especially with regard to the possibility of preserving the knee joint to enable a more physiological gait and lower energy consumption. Below-knee amputations were performed immediately below the tibial tuberosity with maintenance of the insertion of the patellar tendon, resulting in very short, but functional stumps. This case study examined whether very short below-knee stumps allow a more functional gait, as compared to more proximal amputations. Case Description and Methods: Between June 2010 and June 2011, four patients had extremely short below-knee amputations, with resection of the head of the fibula at the junction and reinsertion of the collateral ligaments and structures attached to the tibia. This was followed by placement of a prosthesis with a vacuum-assisted suspension socket. Findings and Outcome: At the end of treatment, patients that underwent transtibial amputations with an extremely short stump were considered well adapted to their prosthesis and were satisfied in relation to the acquired gait patterns. Conclusion: The extremely short below-knee amputation, despite having a short lever arm should be considered as another option for lower-limb amputations, although we cannot yet assure that other patient groups undergoing this level of amputation may have the same results of the study.362236238