Ideally, a rotationplasty turns the child’s foot around 180 degrees, thus enabling the ankle to function as a knee with a prosthesis. Not only does the foot allow for weight bearing, the toes are also there for balance and to aid in powering the prosthesis. With an ill-fitting prosthesis, issues ranging from cramping of the toes to overextension of the ankle can occur, along with a whole range of other issues. Proper alignment is essential to a successful fit. When aligning a rotationplasty socket, we set the weight bearing load in line with the socket (which the toes are inserted into) and prosthetic foot, not the heel of the natural foot.