Lateral column lengthening is a frequently used procedure for the surgical treatment of stage II-B posterior tibial tendon dysfunction with flexible acquired adult flatfoot deformity. Evans first described an opening wedge osteotomy of the anterior os calcis with tricortical iliac crest bone graft for use in flatfoot correction. The use of porous metal biomaterials with unique characteristics for bone ingrowth has been recently integrated into a variety of reconstructive orthopedic surgical applications. A newer porous titanium foam metal material (Biofoam Cancellous Titanium) has a larger pore size comparable with trabecular bone, lower modulus of elasticity, and improved surface characteristics. In light of its unique inherent features that mimic physiologic cancellous bone, Biofoam has been developed into presized wedges designed for lateral column lengthening procedures in adult flatfoot reconstruction and offers the surgeon an alternative to traditional autografting/allografting for this procedure.