Total Contact Casting for Diabetic Foot Ulcers in Partial-Foot Amputations

OBJECTIVE: This study reports patient outcomes and predictors of outcomes after total contact casting (TCC) for diabetic stump ulceration in patients with partial-foot amputations. METHODS: Retrospective review of patients treated with TCC for diabetic stump ulcerations with ipsilateral partial-foot amputation at a tertiary center from 2015 to 2022 was performed. Patients lost to follow-up, those unable to tolerate TCC, and those with partial amputations of digits 2 to 5 were excluded. Patient demographics, outcomes, and complication rates of TCC were collected and compared. Multivariable linear regression was performed to identify demographic predictors of time to ulcer closure. RESULTS: Forty-three patients were included in this study, with a 93.5% rate of primary ulcer closure, 46.5% rate of re-ulceration, and 9.3% rate of re-amputation. Patients without re-ulceration were significantly more likely to be nonsmokers. Regression analysis also found that smoking history trended toward a longer delay to ulcer closure ( P =.097). Age, body mass index, presence of contralateral amputation, and type of amputation did not affect patient outcomes or complication rates. CONCLUSIONS: TCC effectively promotes ulcer closure in diabetic patients with high comorbidity burden and partial-foot amputation, although smoking history increases re-ulceration rates.