A 70-year-old patient presented with a diabetic foot complicated by a severe ischemic ulcer over the lateral aspect of the fifth metatarsal. Progressive tissue necrosis made limb-preserving treatment impossible, while the remaining forefoot was adequately perfused and suitable for a limited ray resection.

A fifth ray amputation, including the fifth toe and the corresponding fifth metatarsal, was performed to completely remove all ischemic and non-viable tissue. Because of the local tissue condition, the wound was intentionally left open and managed with secondary intention healing, together with meticulous wound care and pressure off-loading.

The wound healed completely by secondary intention within three months, resulting in a durable, plantigrade foot without recurrent infection or tissue loss. By limiting the amputation to a single lateral ray and preserving the remaining forefoot, normal weight distribution was largely maintained, allowing the patient to regain stable ambulation while maximizing long-term limb function.