Bypass to the dorsalis pedis, tarsal, or plantar artery is often required in efforts to salvage the ischemic lower extremity in diabetic patients. The objective of this review was to summarize the current indications, techniques, and outcomes associated with such distal revascularization procedures. A review of the literature and our own institutional experience with dorsalis pedis (n=1 032), tarsal (n=21), and plantar (n=77) bypass was performed. Bypass to the dorsalis pedis, tarsal, or plantar artery is essential in efforts for limb salvage in the ischemic limb in the absence of a more proximal bypass target option. Inframalleolar bypass can be performed with an acceptable perioperative mortality rate (<1%). Limb salvage and patency rates achieved warrant the consideration of these distal bypass procedures as an alternative to limb amputation. Careful patient selection, detailed preoperative work-up and meticulous operative technique play a crucial role in the success of these arterial reconstructions.