Background: Plantar foot reconstruction in children is uncommon but uniquely challenging, particularly when tissue loss follows systemic illness like neonatal sepsis. In weight-bearing areas, skin grafts are often insufficient. The medial plantar artery flap offers a glabrous, sensate, and durable alternative.

Case Report: We present the case of a 10-year-old boy with a history of neonatal sepsis complicated by unilateral lower limb gangrene. He underwent a left transmetatarsal amputation in infancy, which was managed with a skin graft. Years later, recurrent ulceration and blistering prompted definitive reconstruction.

Intervention: A free sensate medial plantar artery flap (MPAF) was harvested from the contralateral foot. Postoperative recovery was uneventful.

Outcome: The child returned to pain-free ambulation, with preserved function at both donor and recipient sites.

Conclusion: This case demonstrates the successful use of a free sensate MPAF in a paediatric patient with a rare sequela of neonatal sepsis. It highlights the potential of this flap in long-term limb salvage and encourages further reporting of similar cases in children.