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Background and Purpose: Osteomyelitis occurs in a significant portion of open tibial fractures (up to 20%). Deformities and leg length discrepancies (LLDs) following tibial osteomyelitis are rare and difficult to treat. Numerous methods exist to correct LLD, including shortening of the longer leg by femoral subtrochanteric osteotomy and rod placement. Currently, there is sparse literature, if any, to describe prognosis of return to normal gait and return to sport with a unique combination of these comorbidities. Case Description: The patient in this case is a 15-year-old female with extensive history of compound fracture, tibial osteomyelitis, leg length discrepancy, and surgical femur reduction. Following surgery, the patient presented to outpatient physical therapy for strengthening and functional training. Outcomes: Functional improvements were observed, most significantly in decreased abnormalities of gait and a return to sport. Outcome measures including the Lower Extremity Functional Scale (LEFS) also reflected this improvement with over 50% reported improvement. Discussion: Patient’s gait normalized, a 1 cm discrepancy remained, not anticipated to cause problems, cleared by surgeon for all activities 4 months after surgery. This case involves a unique combination of complex historical factors where prognosis was unknown. Although prior literature on prognosis of individual factors suggested positive functional results, no described cases included all major events experienced by this patient. This case is an example of the potential for excellent return to function despite a challenging course of treatment.