A 67-year-old woman with type 2 diabetes presented with an ischemic ulcer and gangrene of the third toe caused by diabetic peripheral arterial disease. To maximize the chances of limb salvage, endovascular revascularization (angioplasty) was performed before definitive surgical treatment.

Following successful restoration of blood flow, the patient underwent amputation of the third toe together with partial resection of the third metatarsal head to ensure complete removal of all ischemic and non-viable tissue. The wound was intentionally left open and managed by secondary intention healing with meticulous wound care and pressure off-loading.

The wound healed completely by secondary intention within three months, preserving the adjacent rays and maintaining forefoot stability. This case demonstrates that successful revascularization followed by a limited, well-planned ray amputation can eradicate ischemic disease while preserving foot function, avoiding a more extensive amputation, and allowing the patient to return to stable ambulation.