Extensive tissue loss in a weight-bearing area of the foot almost invariably heralds limb loss. We report on a 74-year-old man with diabetes mellitus who had an ischaemic foot that was affected by prolonged pressure, which resulted in a necrotic heel. After two sessions of debridement, the calcaneum became exposed. Amputation was initially suggested but was refused by the patient. The foot was subsequently salvaged by staged operations. The first operation was a femoro-anterior tibial bypass using an autogenous saphenous vein to revascularise the foot. This was followed by debridement and attachment of a free subscapular flap to cover the defect 2 weeks later by a plastic surgeon. After 85 days of rehabilitation by physiotherapy and education of foot care by a podiatrist, the patient was discharged home and was able to walk with a walking-stick. This multidisciplinary approach avoided an almost certain below-knee amputation.