Acute lower limb trauma can cause complex functional damage and lead to amputation as treatment of choice. Nevertheless, salvage surgery is recommended in order to restore the limb function. The preservation of a stable, sensitive and plantigrade foot provides better function than prosthesis. In this report we treated a complex foot injury after motorbike accident using a conservative reconstructive management, never described before. The patient reported several skin, muscle and bone defects, especially involving phalanges, second and third metatarsal bones. During the procedure the damaged III metatarsal bone was transferred to the fourth bone in the position of the lateral cuneiform and, at the end of the surgery, we maximized the plantar skin coverage to preserve the three points of weight bearing. An appropriate intravenous drug therapy and Negative pressure wound therapy promoted wound healing. A split thickness skin graft was necessary to cover the dorsal defect. An acceptable physiological gait was restored at 9 months follow up. This case may be useful for surgeons who are approaching combined procedures (plastic and orthopaedic) in these types of complex foot injuries.