A 45-year-old man with poorly controlled type 1 diabetes presented with ischemic gangrene of the fifth toe. Tissue necrosis was confined to the toe, while imaging and clinical evaluation confirmed that the fifth metatarsal and its head remained viable, with no evidence of osteomyelitis. Preserving these structures was considered essential to maintain the mechanical stability of the foot.

The necrotic fifth toe was removed through an open minor amputation. Because of the ischemic tissue and the local wound conditions, the surgical site was intentionally left open and allowed to heal by secondary intention rather than being closed with sutures. The fifth metatarsal head was completely preserved, avoiding unnecessary bone resection.

The wound healed completely by secondary intention without further surgery. By preserving the fifth metatarsal head, the lateral column of the foot and normal load distribution during walking were maintained, allowing the patient to retain a stable, functional gait while successfully treating the ischemic infection with the smallest possible amputation.