Purpose: To evaluate the results of anterolateral thigh perforator free flap for reconstruction of foot and ankle in old diabetic patients. Materials and Methods: Fifteen diabetic foot ulcer patients over the age of 55 were operated with anterolateral thigh perforator free flap. Hematological, hemodynamic, diabetic, bacteriologic and radiologic tests were checked with examination of blood vessel state in both the donor site and the recipient site. After surgery, serial check-up was performed at 6 week, 6 month, and 1 year postoperatively on the survival of transplantation tissue, condition of foot, and condition of walking. Results: There are one case of transplantation failure and four cases of partial tissue-necrosis. Delayed wound-healing was observed both recipient and donor tissue sites. At the final follow up, three cases of small ulcer were found at junction of flap and recipient tissue in plantar area. Fourteen out of fifteen patients could walk without any brace or walking aids. Conclusion: Reconstruction of foot and ankle region in old diabetic patients with the anterolateral thigh perforator free flap is a useful method which can prevent the amputation of foot and ankle.