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The original operative plan was for coverage with a medial plantar flap based distally on retrograde flow through the lateral plantar artery; however, this had to be revised intraoperatively as his vascular anatomy was not adequate to support a flap of this type. Thus, advancement with rotation modification of the conventional medial plantar flap was performed with good results. At 2\u2010month follow\u2010up, the patient's flap had fully healed, he returned to full weight\u2010bearing status, and he had gross sensation in the sole of his foot. This case illustrates the use of the well\u2010described medial plantar flap by rotating and advancing the flap for reconstruction of defects of the foot. \u00a9 2012 Wiley Periodicals, Inc. 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