A staged limb-salvage approach was undertaken. Radical debridement and resection of the infected second metatarsal were initially performed until healthy, infection-free bone margins were obtained. Following recurrence, the infected fourth metatarsal was also resected. Throughout treatment, every effort was made to preserve viable plantar soft tissues and maintain the structural integrity of the foot, allowing gradual healing by secondary intention while eradicating the infection.

The infected hallux phalanges were resected until healthy, infection-free bone margins were achieved. Particular emphasis was placed on preserving the viable soft-tissue envelope of the hallux. Rather than sacrificing the entire toe, these preserved tissues were advanced and used as a biological flap to cover the first metatarsal head, providing durable soft-tissue coverage while allowing the wound to heal by secondary intention.

Radical debridement with complete resection of the infected second metatarsal and second toe phalanges was performed until healthy, infection-free bone margins were achieved. The wound was managed with negative pressure wound therapy (NPWT) followed by secondary intention healing.

Radical surgical debridement and resection of the infected phalanges were performed while preserving the soft-tissue envelope of the hallux. The wound was managed by secondary intention until complete granulation and epithelialization were achieved.

Radical surgical debridement with resection of the infected phalanges was performed while preserving the soft-tissue envelope of the hallux. The wound was left to heal by secondary intention following complete eradication of the infected bone.

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.