A suicidal 66-year-old female patient was run over by a train. The lower extremities were amputated at different levels. On the right side, there was a complete amputation in the distal third of the lower leg. Proximal to the amputation site, there was an extensive soft-tissue and bone defect. On the left side, there was a crush injury of the tarsus and mid-tarsal bones. The left lower leg showed only minimal injuries. An ipsilateral (anatomic) replantation was not possible. In order to save one lower extremity, a cross-over (contralateral) replantation of the right foot to the left lower leg was carried out. After a follow-up of 6 years, the patient is able to walk well with a prosthesis on the right side, and the right foot replanted to the left lower leg. From a psychological point of view, it seemed better for the patient to preserve one extremity, even with a cross-over replanted foot.