First toe ray amputation addresses pathologies compromising the first ray by removing the diseased toe and metatarsal head while preserving foot biomechanics and soft-tissue coverage. This surgical technique balances functional outcomes and cosmetic considerations, minimizing the need for future interventions. The procedure involves precise incision marking, radical debridement, metatarsal head disarticulation, and tension-free flap closure. The choice between ray and toe amputation depends on pathology and surgeon judgment, highlighting the importance of selecting the appropriate technique and level to optimize healing and limb function.