Bone and soft tissue tumors of the foot are rare, accounting for 4–5% of all musculoskeletal tumors, with a quarter of them being malignant. Hence, these lesions are at a high risk for diagnostic delay and require special clinical awareness. Soft tissues around the foot and ankle are ultimately limited, and limb salvage surgery therefore may be anatomically challenging. Concise preoperative planning and diagnostic work-up of the patient including core needle biopsy are mandatory. The advanced techniques of local and free tissue transfers have facilitated wide tumor resection and limb salvage surgery. In this context, the free gracilis flap provides a safe muscle flap for the foot and ankle, resulting in excellent anatomical contour. Additional skin grafting by glabrous skin may provide better mechanical resilience. Postoperative surveillance should establish adequate antibiotic and blood pressure management as well as optimization of microcirculation and rheology. Postoperative mobilization is mainly oriented towards full healing of the soft tissue reconstruction, and immobilization in an orthosis is advisable. Successful long-term results may allow return to unrestricted function.