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Background: There were very few options available for distal foot and toe defects that required a vascularized flap for coverage. As such, the use of a free flap was often justified in this region of the foot. The use of perforator flaps has created a new subset of local tissue transfer alternatives that increases the potential that the difficulties associated with microvascular tissue transfers could be avoided. The first dorsal metatarsal artery (FDMA) perforator flap was one variant of this new type of tissue transfer. The aim of this report was to describe our experience using FDMA perforator flap to cover great toe defect. Methods: A standard FDMA flap from the dorsum of the foot was raised in reversed fashion based on the distal communicating branch or “perforator” from plantar foot circulation in two patients with great toe defect. Results: Salvage of the great toe was achieved in both patients. FDMA perforator flap achieved both reconstructive goals, and the donor site closure can be successfully performed without tension. Donor site healing was achieved in both patients with no associated complications by the 1-year follow-up. Conclusions: FDMA flap can be successfully used as a local flap to cover distal foot and toe wounds. However, direct donor site closure can be problematic and may need skin graft.