A 50-year-old woman with poorly controlled type 2 diabetes presented with osteomyelitis of the fifth toe. The infection had destroyed the phalanges, while the fifth metatarsal head remained viable. Preserving the soft-tissue envelope of the toe was essential to avoid a more proximal amputation.

Radical debridement and resection of the infected phalanges were performed while preserving the soft-tissue envelope of the fifth toe. The remaining soft tissues were used as a biological flap to cover and protect the preserved fifth metatarsal head, allowing healing by secondary intention.

The wound healed completely by secondary intention without further bone resection or toe amputation. Preservation of the soft-tissue envelope provided durable biological coverage of the fifth metatarsal head, maintaining foot contour and function.

This case illustrates that, even after complete phalangeal resection for osteomyelitis, preserving the soft-tissue envelope can avoid a more proximal amputation while preserving a functional foot.