A distally based posterior tibial artery adipofascial flap with skin graft was used for the reconstruction of soft tissue defects over the Achilles tendon in three cases and over the heel in three cases. Good resurfacing with protective sensation of these wounds was achieved. There was no breakdown of the graft or morbidity of donor sites, which were closed primarily. We believe there were many advantages to this adipofascial flap and that it is an ideal choice for the reconstruction of soft tissue defects in the lower third of the leg and foot, especially over the Achilles tendon.