A 68-year-old man with type 2 diabetes presented with a diabetic foot ulcer complicated by osteomyelitis of the hallux phalanges. The infection extended throughout the phalanges, threatening exposure of the first metatarsal head and increasing the risk of a more proximal amputation if adequate soft-tissue coverage could not be maintained.

The infected hallux phalanges were resected until healthy, infection-free bone margins were achieved. Particular emphasis was placed on preserving the viable soft-tissue envelope of the hallux. Rather than sacrificing the entire toe, these preserved tissues were advanced and used as a biological flap to cover the first metatarsal head, providing durable soft-tissue coverage while allowing the wound to heal by secondary intention.

Complete wound healing was achieved within approximately 2.5 months.

By preserving and utilizing the hallux soft tissues as a biological flap, stable coverage of the first metatarsal head was achieved, infection was eradicated, and the biomechanical role of the first ray was preserved without the need for a more proximal amputation.