Introduction: The goal of a below- knee amputation (BKA) is to have a sturdy, sensate, pain free stump, with as much length as possible to allow for prosthetic fitting. The filet of foot flap provides adequate soft tissue stump coverage for BKA. Recently the calcaneous has been included in the new calcaneal osteocutaneous filet foot flap (COFFF). This provides additional tibial length and permits salvage of a BKA that may initially have inadequate tibial stump length for traditional BKA and prosthetic fitting. Here we describe a detailed surgical approach to performing a pedicled COFFF as well as a surgical variation of incorporating the tibialis anterior vessels . We also summarize the literature published to-date discussing the COFFF and include some examples of our experience with it. Results: There are 15 published studies to-date describing use of the COFFF. All studies show a majority of COFFF are sensate with good stump coverage and successful prosthetic fitting. Our study contains 4 successful flaps in 5 patients. All were sensate, and mean time to prosthetic fitting was just under 3 months. Conclusion: The COFFF is a good alternative to traditional BKA and stump coverage. It provides sensate, soft tissue, coverage, and additional tibial stump length. This allows prosthetic fitting in patients who otherwise would be unable to do so.