A 75-year-old man with type 2 diabetes was referred with an extensive diabetic foot infection complicated by a chronic ulcer and draining sinus tract. Imaging and intraoperative findings demonstrated osteomyelitis involving the first, second, and third metatarsals, making local bone preservation no longer feasible and placing the limb at high risk for major amputation.

Following complete assessment, a Lisfranc amputation was performed to eradicate all infected bone while preserving the maximum possible length of the foot. All infected tissues were excised until healthy, bleeding margins were obtained, and the plantar soft tissues were carefully preserved to create a durable, weight-bearing stump suitable for future ambulation.

The wound healed uneventfully, allowing preservation of a functional foot and avoiding a major lower-limb amputation.

This case demonstrates that, when forefoot osteomyelitis is too extensive for isolated bone resections, a well-planned minor amputation such as a Lisfranc amputation can provide definitive infection control while maintaining limb function. Preserving a stable, weight-bearing residual foot offers substantially better rehabilitation potential than a major amputation and should be considered whenever oncologically—or in this case infectiously—safe margins can be achieved.