Bone grafting with demineralized bone matrix (DBM) is useful in reconstructive surgery to ultimately provide anatomic alignment, restore function, or augment/change the biomechanics of the foot and ankle. DBM should be used in conjunction with a transplant or implant displaying mechanical strength. DBM can augment cortical grafts used for bridging gaps or defects and lengthening procedures by increasing the connectivity of the structural graft with the host bone. Another useful application is providing a biologic boost to patients who have less-than-ideal physiology. Because DBM has higher concentrations of available bone morphogenic proteins, it can aid in the incorporation of other grafts. Other uses include delayed unions, nonunions, packing joints for arthrodesis, filling resected cysts, and filling gaps of debrided infected bone.