Free muscle flap transfer with skin graft coverage for extensive foot defects can be a successful form of foot reconstruction in well-selected patients who have overall normal foot innervation and deep pressure sensibility. Cutaneous sensibility does not appear to be necessary to maintain a functional or well-healed foot. The major reconstructive goal in plantar foot reconstruction is the restoration of weight-bearing during normal ambulation using regular foot apparel. Based on this reconstructive goal, the authors present their current approach in the reconstruction of extensive defects of the foot using free microvascular muscle flaps with skin grafts.