Of 57 patients who underwent microvascular free flap reconstruction of the plantar surface, 21 developed recurrent trophic ulcerations. Clinical and roentgenographic examination demonstrated that the recurrences were primarily traumatic in origin, resulting either from exogenous factors such as footwear or from endogenous factors such as osteophytes. A new method of surgically reconstructing the plantar aponeurosis was found to be effective in reducing the rate of recurrence.