A 15-year-old man sustained talar and navicular extrusions during a dirt-bike accident. The talus and navicular were discarded during initial débridement because of contamination. Given extensive soft-tissue injury and bone loss, the patient’s family elected to proceed with transtibial amputation, as originally described by Ertl, rather than limb salvage. Simultaneous osteomyoplastic reconstruction and acute targeted muscle reinnervation were performed to decrease neuroma formation and pain. To our knowledge, this is the first case presentation of a patient with talar and navicular extrusions reported in the literature. Our management of this unique injury was noteworthy because osteomyoplastic reconstruction and acute targeted muscle reinnervation were performed simultaneously. This video reviews the case presentation of our patient and the technical steps required to perform this procedure effectively and safely.