A 67-year-old patient with type 2 diabetes presented with osteomyelitis involving the second, third, and fourth metatarsals. Rather than performing multiple segmental metatarsal resections, a more functional limb-salvage strategy was selected to preserve foot stability and provide a durable weight-bearing surface.

A Lisfranc amputation was performed, removing the metatarsals and phalanges at the tarsometatarsal joint while preserving the tarsal bones. This approach created a balanced residual foot, offering better alignment and more stable contact with the ground than partial metatarsal resections.

The wound healed successfully following primary closure, with only minor superficial wound-healing issues that resolved during follow-up. The patient was subsequently fitted with a custom prosthetic filler and specialized therapeutic footwear, restoring a stable, plantigrade foot and enabling safe ambulation. This case demonstrates that, in selected patients with extensive metatarsal osteomyelitis, a Lisfranc amputation may provide superior long-term function compared with multiple isolated metatarsal resections.