A patient with diabetes presented with extensive ischemic gangrene involving multiple toes and the forefoot, making local toe amputations insufficient for complete removal of non-viable tissue. Limb preservation required a more proximal but function-preserving approach.

A Lisfranc amputation was performed, removing all toes and metatarsals while preserving the tarsal bones and hindfoot. The wound was closed primarily with sutures. Minor superficial wound-healing complications at the incision line resolved with local wound care over the following 6 weeks. After healing, the patient was fitted with a custom prosthetic filler integrated into a therapeutic shoe, restoring forefoot length and improving gait.

The surgical site healed successfully, allowing the patient to regain functional ambulation with specialized footwear while preserving the heel and ankle. This case highlights that a Lisfranc amputation can provide an excellent limb-salvage solution for extensive forefoot ischemic gangrene, preserving a stable, weight-bearing foot and avoiding a higher-level amputation that would result in substantially greater functional disability.