Introduction: The management of extracranial arterio-venous malformations (AVMs) is complex and often requires a multidisciplinary approach. Currently, treatment includes surgical resection and embolotherapy. Methods: We present the case of a foot AVM that was managed with adjuvant radiotherapy after previous surgery and embolotherapy had been attempted, and we discuss the role of radiotherapy in the management of extracranial AVMs. Results: The malformation was successfully eradicated with complete obliteration of the nidus and no recurrence. Conclusions: The addition of radiotherapy in the management of extracranial arterio-venous malformations offers promising results using similar doses to those used in brain AVMs.