A patient with type 2 diabetes presented with toe gangrene caused by critical limb ischemia. Successful endovascular revascularization (angioplasty) restored adequate perfusion, making limb-salvage surgery feasible instead of a more proximal amputation.

A transmetatarsal amputation was performed, removing the phalanges and the distal halves of the metatarsals while preserving the proximal metatarsals and hindfoot. The wound was closed with primary suturing, providing a stable, well-contoured residual foot.

The surgical wound healed well without major complications. The patient was subsequently fitted with a custom forefoot prosthetic filler and specialized therapeutic footwear, allowing comfortable ambulation and restoration of daily activities. This case demonstrates how successful revascularization combined with a transmetatarsal amputation can preserve limb function while avoiding a major lower-extremity amputation.