Objective: The objective of the study is to evaluate the efficacy of reverse sural artery fasciocutaneous flap for coverage of lower third leg, posterior heel, malleoli and hind foot. Patients and methods: Over a period of 4 years, a total of 31 patients with Soft tissue defect of lower third leg, heel, malleoli and hind foot were included. Preoperative data, the age and sex of each patient, cause and site of defect, dimension of flap, transposition of pedicle (through a tunnel or laid open and covered with a skin graft), postoperative results and complications were recorded. All patients were followed up in outpatient department for 12 months. Results: Over a period of 4 years during February 2008 to February 2012, a total of 31 flaps were performed in 31 patients. Sixteenth patients were males and 15 were females. Their ages ranged from 8 to 55 years with a mean age of 31 years. There were three children. Road traffic accidents was the cause of the defects in 19 (61.2%) patients, DM in 5 (15.5%) patients, bullet injuries in three (9.6%) patients, Achilles tendon injuries in two patients (6.4%) patients, Malignant melanoma in one (3.2%) patient and foot amputation stumps in one (3.2%) patient. Postoperatively 24 flaps survived completely while marginal necrosis was seen in 5patients and infection complete flap necrosis occurred in 2 patients. There was no considerable morbidity at donor site and all patients had satisfactory functional outcome. Conclusions: The distally based superficial sural artery flap is a versatile, reliable procedure, useful in reconstruction of lower third leg, heel, and malleoli and hind foot defects. The surgical technique is safe, of short duration and provides alternative to micro surgical reconstruction. Some patients were not completely satisfied with their results mainly due to bulky flap that needed revision or due to parasthesia.