Papineau grafting, or open cancellous bone grafting, was initially described 40 years ago for the management of cavitary defects resulting from radical debridement of infected bone and soft tissue. Although minor modifications have been made to the original protocol as described by Papineau, the main stages of the procedure have been largely preserved. The 3 stages of the protocol include debridement of necrotic or infected tissue, open cancellous bone grafting, and soft tissue coverage. This paper will provide a review of the recent literature and describe the technique of open cancellous bone grafting. Illustrative cases of its application in foot and ankle surgery are also provided.