Proximal Midfoot Amputation as a Functional Alternative to Major Amputation in Advanced Diabetic Foot Infection: A...

Diabetic foot infection complicated by severe ischemia is associated with high morbidity and frequently culminates in major amputation.

We report the case of a 62-year-old man with poorly controlled type 2 diabetes mellitus (HbA1c 11.0%), severe peripheral arterial disease, and chronic heavy smoking who presented with a chronic gangrenous, non-healing right foot wound after multiple failed partial amputations and lower-extremity angioplasties. The patient repeatedly refused major amputation. A multidisciplinary limb-salvage approach involving vascular surgery, infectious disease, endocrinology, podiatric surgery, and wound care was, therefore, undertaken. Management included repeat revascularization, targeted antimicrobial therapy, serial debridement, proximal midfoot amputation with Achilles tendon lengthening, negative pressure wound therapy, acellular dermal matrix grafting, and local flap coverage. The wound gradually stabilized with progressive granulation and resolution of infection. At 12-month follow-up, the patient remained free of recurrent infection, required no further amputation, reported minimal pain, and was ambulating independently with custom footwear.

This case highlights proximal midfoot amputation as a functional alternative to major amputation in selected high-risk patients when supported by sustained multidisciplinary care.