Introduction The Reverse sural artery flap can be used to cover soft tissue defects of the distal leg, ankle and proximal foot. The flap has rarely been evaluated in the paediatric age group. Method A Retrospective study was undertaken including four children, with soft tissue defects of the distal leg and foot covered using a distally based Reverse sural artery flap. Results All flaps survived (100%). Venous congestion did not occur in any patient. Marginal flap necrosis occurred in one patient (25%). Re–insetting of the flap was done in one patient (25%). There was no donor site morbidity. Conclusions The reverse sural artery flap can be easily raised, while sparing the major blood vessels and without any major loss of function. As such it can be reliably used to cover defects of the distal leg and foot in the paediatric age group.