Synovial sarcoma of the foot and ankle frequently is misdiagnosed, which leads to delays in treatment. The clinical records of 14 patients with synovial sarcoma of the foot and ankle were reviewed. Common findings at presentation were an enlarging mass with a variable incidence of pain, tenderness, and edema. The patients tended to be younger than patients with other soft tissue sarcomas (30 years) and had a median duration of symptoms of 14 months. Of the 14 patients, 12 underwent an attempted curative surgical procedure. Ten patients had partial foot amputations or below knee amputations, whereas two had an attempted limb salvage by wide resection. Of the 14 patients, one experienced regionally recurrent disease and eight had pulmonary metastasis developed. All patients who had metastasis develop died of their disease. Tumor size was not observed to be a prognostic variable in this group of patients. Patients with biphasic histologic features had a better outcome than did those with a monophasic subtype. Patients with a prolonged duration of symptoms before diagnosis had a better outcome, presumably because these tumors biologically were less aggressive. Wide resection can be considered in a select group of patients.