Local muscle flaps, pioneered by Ger in the late 1960's, were extensively utilized for foot and ankle reconstruction until late 1970's when, with the evolution of microsurgery, microsurgical free flaps became the reconstruction of choice. To reassess the role of pedicled vs. free flaps in foot and ankle reconstruction, we looked at the Georgetown Wound Registry and identified all patients who underwent flap reconstruction from 1990 through 2000 with a 2-10 year follow up. By protocol, flap coverage was the reconstructive choice for defects with exposed tendons, joints or bone. Local muscle flaps were always selected over free flaps if the defect was small (3 x 6 cm. or less) and within the reach of the local muscle flap. Otherwise, free flaps were utilized. The role of diabetes was likewise evaluated. Eighty consecutive patients were identified: 32 patients (19 diabetic and 13 non-diabetic) received local muscle flap reconstruction while forty-eight received 52 free flaps (21 diabetic and 30 non-diabetic) for 51 limbs. All wounds, after debridement, had exposed bone, joint or tendon at their base. Re-vascularization prior to reconstruction was required in 34% of diabetics. Subsequently, 240 procedures were required to heal the wounds of which 42% were limited to debridements only. 34 pedicled muscle flaps were utilized (19 Abductor Digiti Minimi, 9 Abductor Hallucis Brevis, 3 Extensor Digitorum Brevis, 2 Flexor Digitorum Brevis and 1 Flexor Digiti Minimi ). 52 free flaps were done (18 gracilis, 13 rectus abdominis, and 15 fasciocutaneous flaps). When comparing the success of pedicled vs. free flaps, there were no significant differences in limb salvage in (94% vs. 88%), survival (78% vs. 75%), healing rate (87% vs. 94%), days to heal (99 vs. 109 days), flap success rate (97% vs. 94%). Complication rate was higher in pedicled than free flaps (33% vs. 18%), and almost reached statistical significance (p=0.051). Diabetes did not affect any of the above parameters except long term patient survival. Local muscle flaps are as effective as free flaps for coverage of foot and ankle defects. Proper selection based on the size and location of the defect provides the reconstructive surgeon with two excellent options for soft tissue coverage. Diabetes does not appear to adversely affect their effectiveness.