Introduction: Heel reconstruction is a surgical challenge because of unique nature of its tissue. The instep flap based on the medial plantar artery neurovascular bundle provides a sensate flap with tissue similar to that of the heel. Materials and methods: The study includes 29 patients with soft tissue defects of the heel who presented between 1998 and 2021. Medial plantar artery flap was done to cover the defect. The patients were followed up for sensations and any ulceration in the flap for a maximum period of 22 years. Results: Twenty-nine patients with soft tissue defects of the heel underwent medial plantar artery flap and were included in the study. Eleven patients continued their follow-up for 22 years. All except one flap survived and did not develop any ulceration in long-term follow-up also. Protective sensations were present in the flap in patients who had normal sensations in the foot before surgery. Results were inferior in patients who had decreased sensations in the sole before surgery such as diabetics and postspinal injury patients. Conclusion: Medial plantar artery flap is a robust and reliable option for heel reconstruction even in long-term follow-up. Clinical significance: Medial plantar artery flap can be safely opted for heel reconstruction and satisfactory results can be expected even after 20 years.