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

BackgroundPartial 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.MethodsA 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.ResultsThe 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.ConclusionsPartial 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