The purpose of the present study was to analyze our long-term results of lateral calcaneal artery flap transfer for hindfoot reconstruction. A total of four patients (average age, 48 years) underwent lateral calcaneal artery flap transfer. The etiologies were heat injury of the lateral malleolus in one patient and skin necrosis over the Achilles tendon attachment site in three patients due to displaced calcaneal fracture, pyogenic tendinitis of the Achilles tendon, and vascular insufficiency of the wound after Achilles tendon surgery in a patient with Werner syndrome, respectively. The defect sizes ranged from 2 x 2 cm to 4 x 4 cm, and all of the patients had bone or tendon exposure. All of the flaps survived completely without any problems. The donor sites were closed by full-thickness skin grafts. Postoperative complications included delayed wound healing in one patient and transient restriction of ankle motion in another patient. No painful neuroma of the sural nerve was recorded. No recurrence of ulcers at the shoe-contacting area of the flaps was noted. Therefore, lateral calcaneal artery flap transfer is useful for reconstruction of skin and soft tissue defects with bone or tendon exposure over the calcaneus or lateral malleolus.