We reconstructed a large-sized defect at the weight-bearing plantar region by a free anterolateral thigh flap successfully. This is the first case report of using the anterolateral thigh flap for reconstruction of the plantar foot. Based on the preoperative and postoperative pedogram examinations, the pressure distribution on the weight-bearing area reconstructed by the transferred flap was obviously improved and demonstrated a nearly normal pattern. No previous report has compared the weight-bearing pattern before and after large plantar reconstruction with a free flap. The anterolateral thigh free flap, which provides adequate bulk and contour of the foot, and which withstands weight pressure and shearing force and has the ability to provide recovery of sensation, is considered a good alternative in covering a large weight-bearing plantar defect.