Predictors of Healing and Limb Salvage Following Partial Calcanectomy for Refractory Heel Ulcers: A Retrospective Cohort Analysis of 156 Patients

Abstract

Background

Partial calcanectomy is a limb-salvage procedure for recalcitrant heel ulcers; however, predictors of outcome remain poorly defined. This study aimed to evaluate healing rates, limb salvage, and prognostic factors.

Methods

A retrospective review was conducted of 156 patients who underwent partial or subtotal calcanectomy. The primary outcome was complete healing within 6 months. Secondary outcomes included limb salvage, recurrence, ambulation, and complications. Univariate and multivariate analyses were performed to identify predictors of healing failure.

Results

The 6-month healing rate was 87.2% (136/156), and the limb salvage rate was 89.7% (140/156). Recurrence occurred in 6.4% (10/156), and 79.5% (124/156) achieved independent ambulation. On multivariate analysis, HbA1c > 9% (OR 3.4, 95% CI 1.2–9.6; p = 0.02), CKD stage 5 (OR 4.1, 95% CI 1.4–12.2; p < 0.01), high medial arterial calcification (MAC) (OR 2.9, 95% CI 1.1–7.9; p = 0.03), and high pedal acceleration time (PAT) (OR 2.7, 95% CI 1.1–6.9; p = 0.04) were independent predictors of healing failure.

Conclusions

Partial calcanectomy is an effective limb-salvage procedure. Poor glycemic control, end-stage renal disease, severe medial arterial calcification, and abnormal pedal perfusion are significant independent predictors of healing failure and should be considered in preoperative patient selection and counseling.