Soft-Tissue Envelope Preservation After Fifth Toe Phalangeal Resection

Clinical presentation, surgical treatment and documented healing.

01 / Problem: Clinical presentation
02 / Procedure: Surgical approach
03 / Outcome: Healing & follow-up

Clinical photographs below include wounds and surgical treatment.

01 / CLINICAL PRESENTATION

Problem

A 50-year-old woman with poorly controlled type 2 diabetes presented with osteomyelitis of the fifth toe. The infection had destroyed the phalanges, while the fifth metatarsal head remained viable. Preserving the soft-tissue envelope of the toe was essential to avoid a more proximal amputation.

Soft-Tissue Envelope Preservation After Fifth Toe Phalangeal Resection before image — Problem

02 / SURGICAL APPROACH

Procedure

Radical debridement and resection of the infected phalanges were performed while preserving the soft-tissue envelope of the fifth toe. The remaining soft tissues were used as a biological flap to cover and protect the preserved fifth metatarsal head, allowing healing by secondary intention.

03 / HEALING & FOLLOW-UP

Outcome

The wound healed completely by secondary intention without further bone resection or toe amputation. Preservation of the soft-tissue envelope provided durable biological coverage of the fifth metatarsal head, maintaining foot contour and function.

This case illustrates that, even after complete phalangeal resection for osteomyelitis, preserving the soft-tissue envelope can avoid a more proximal amputation while preserving a functional foot.