Management of soft-tissue loss on the plantar aspect of the foot.

Restoration of the plantar surface of the foot demands an appreciation of the unique requirements of this area. Local tissues should be used when available. Otherwise, if recipient vessels are adequate, free-tissue transfer is the treatment of choice. Durable tissues include cutaneous flaps with thicker skin, such as the scapular flap, and muscle flaps covered with split-thickness skin graft. Each method has advantages and deficiencies. Tailoring of the flap can decrease the need for later modifications. Adjunctive procedures, to increase sensibility, and pedorthic devices, to accommodate and moderate imperfect surgical methods, complement the efforts of the reconstructive surgeon to restore maximum function to this critical area.