Diabetic ulcers located in the plantar surface of the great toe resist conservative treatment modalities including skin grafts and usually require flap coverage for a stable reconstruction. Free tissue transfer is not feasible in these patients, because these defects are closely associated with peripheral vascular disease and local flap alternatives are extremely limited in this region. Reported here is the use of homodigital reverse flow island flap for reconstruction of neuropathic great toe ulcers in diabetic patients with encouraging results. (c) 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. Alt rights reserved.