In the diabetic and peripheral vascular disease population there is a high risk of further amputation following a primary amputation. Amputation surgery is often approached negating the biomechanics of the lower extremity leading to complications or additional surgery. Implementing appropriate tendon balancing of stump and applying orthoplastic techniques will improve outcomes. This article introduces the basic techniques to a wider audience of foot and ankle surgeons. Specifically, this article is intended to be a descriptive guide for the use of tendon balancing and intrinsic muscle advancements in the various levels of foot amputations.