Limb salvage in the context of neuro-ischemic diabetic foot ulceration remains a clinical challenge, particularly in patients with complex comorbidities and limited vascular targets. This case presentation demonstrates what can be achieved through a coordinated, interdisciplinary approach incorporating advanced wound therapies and patient-centred goals. The patient, a 60-year-old man with type 2 diabetes, renal transplantation, and a history of Charcot neuroarthropathy, presented in December 2024 with a necrotic lesion on the lateral heel. Despite prompt offloading and antimicrobial therapy, the wound deteriorated rapidly. Vascular imaging revealed severe arterial calcification, but no suitable target for revascularisation. Surgical debridement in January 2025 was followed by a structured wound management plan including negative pressure wound therapy (VAC), regular conservative sharp wound debridement (CSWD), nutritional optimisation, offloading, and a six-week course of adjunctive hyperbaric oxygen therapy (HBOT). In this case following HBOT progressive granulation, tendon coverage, and reduction of tissue deficit was seen. In May 2025 following interdisciplinary review to address residual wound stalling, NovoSorb® MTX, a novel, biodegradable, conformable dermal scaffold, was applied. Designed to integrate with host tissue and support neodermis formation, MTX provided a critical stimulus to encourage further healing. This case presentation illustrates how combining innovation, collaboration, and continuity of care can dramatically shift healing trajectories in high-risk patients. Proving that, in complex cases, wound dressings alone may not be enough.