Soft-tissue reconstruction of the foot frequently requires flap coverage to preserve exposed tissues such as bones, joints, tendons, and weight bearing areas. Recently, reconstruction of skin defects in the heel has been greatly improved by use of the medial plantar sensory flap. However, forefoot coverage remains a challenge, since the alternatives for flap coverage are very limited. A case report is presented of a 52-year-old man with a chronic forefoot ulcer, successfully covered with a plantar marginal septum cutaneous island flap. This recently reported technique, which utilizes a reversed-flow flap based on the superficial branch of the medial division of the medial plantar artery, is relatively easy and disadvantages to the donor site are minimal.