Foot and ankle amputations are most commonly performed for infection, ischemia, trauma, and neoplasm. A variety of amputation levels is available, depending on the specific pathology. Knowledge of the particular functional advantages and drawbacks surrounding the level of amputation, coupled with insight regarding tissue viability and perfusion status, facilitates optimal selection of a specific amputation procedure. Advances in the multidisciplinary fields of trauma and vascular surgery, as well prosthetics, rehabilitation, and patient management have combined to usher in a new perspective regarding foot and ankle amputation.