A 50-year-old woman with Type 1 Diabetes Mellitus presented with infected gangrene of the great toe. Despite the extensive soft-tissue destruction, careful clinical and surgical assessment confirmed that all phalanges remained viable, making complete preservation of the toe possible.

Meticulous excision of all necrotic soft tissue was performed while preserving every phalanx. Only non-viable tissue was removed, maintaining the toe’s anatomy and creating optimal conditions for secondary wound healing.

Complete healing was achieved within 2.5 months without infection recurrence. The toe and all phalanges were successfully preserved, maintaining toe length, stability, and function.

This case demonstrates that even extensive infected gangrene does not always require phalangeal resection. Careful surgical assessment and meticulous debridement can preserve both the toe and every phalanx when bone viability is maintained.