A 30-year-old woman with type 2 diabetes was referred from another hospital with extensive diabetic foot osteomyelitis involving the second and fourth metatarsals. Bone cultures revealed a multidrug-resistant organism, resistant to all available intravenous antibiotics. The infection was extensive and later recurred in the fourth metatarsal despite the initial procedure, making limb preservation particularly challenging.

A staged limb-salvage approach was undertaken. Radical debridement and resection of the infected second metatarsal were initially performed until healthy, infection-free bone margins were obtained. Following recurrence, the infected fourth metatarsal was also resected. Throughout treatment, every effort was made to preserve viable plantar soft tissues and maintain the structural integrity of the foot, allowing gradual healing by secondary intention while eradicating the infection.

Complete wound healing was achieved after approximately five months.

Despite multidrug-resistant osteomyelitis, multiple infected metatarsals, and disease recurrence, limb preservation was achieved. The patient regained independent ambulation using a customized therapeutic shoe, avoiding a major amputation while maintaining a functional, weight-bearing foot.