Aims: Bone graft substitutes have been advocated recently to avoid the potential morbidity associated with harvest of autogenous iliac crest graft. However, no commercially available graft equals autogenous bone osteo-inductive and osteoconductive qualities. We reviewed our patientsñ morbidity after harvest of 240 anterior iliac crest bone grafts for procedures involving the foot and ankle. Methods: A computerized analysis of patient records was undertaken to identify all patients under-all going a unique unicortical iliac crest bone graft harvest over a 10-year period from the senior authorñs practice. All patients were contacted either by phone or mailed questionnaire inquiring about the postoperative morbidity of the procedure. Charts were reviewed for any related complications. Results: 200 patients were available for follow-up (range 1 to 10 years). Of these patients 98% were satisþed or very satisþed with their bone graft harvest. 10 patients complained of minor residual numbness lateral to the harvest site. None complained of problems with ambulation related to graft site pain. 7% reported that their graft site pain was greater than their operative site pain during the postoperative period. 95% of patientsñ pain resolved within 4 weeks of the operative procedure. No patients incurred extra hospital days as a result of the bone graft harvest. No deep infections occurred, although there was a 6% incidence of postoperative hematoma/seroma. Conclusions: Despite common sentiment, harvesting of autogenous iliac crest bone graft yields minimal morbidity, no extra hospitalization, and optimal bone graft material at similar or lesser cost than bone graft substitutes while being overwhelmingly acceptable to patients. Bone graft substitutes may not be as cost-effective as currently thought.