Faculty Sponsor

Jana Stedman

College

College of Nursing & Health Professions (CONHP)

Department/Program

Physician Assistant Program

Presentation Type

Poster Presentation

Symposium Date

Summer 7-23-2025

Abstract

Objective: Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes, often resulting in prolonged healing, infection, and lower extremity amputation. This capstone project evaluates the effectiveness of total contact casting (TCC) and hyperbaric oxygen therapy (HBOT) in promoting wound healing and reducing amputation rates in DFU patients. TCC is widely considered the gold standard for off-loading, while HBOT is emerging as an adjunct for refractory ulcers.

Methods: A comprehensive literature review was conducted using Google Scholar. Searches from 2019 onward included terms such as “HBOT AND amputation rates,” “TCC AND amputation rates,” and “DFU management.” Studies were selected based on quantitative outcomes, including healing time and amputation rates. Five peer-reviewed studies—two on TCC and three on HBOT—met inclusion criteria and were critically analyzed.

Results: TCC consistently demonstrated high efficacy in promoting ulcer healing and remains the preferred method for mechanical off-loading. Modifications such as Total Contact Soft Cast and ventral-window TCC improve usability while maintaining effectiveness. HBOT was associated with reductions in major amputations and improved healing in non-responsive ulcers. However, findings on minor amputation outcomes were inconsistent, and HBOT introduced greater risks of adverse events and logistical burdens due to variable protocols and limited access.

Conclusion: TCC remains central in DFU management. HBOT may serve as a valuable adjunct in select refractory cases but should be used judiciously. Future research should standardize HBOT protocols and compare outcomes directly against off-loading strategies.

Keywords: Diabetic foot ulcers, total contact casting, hyperbaric oxygen therapy, amputation, off-loading, adjunctive therapy.

Biographical Information about Author(s)

Cory Cramer is a physician assistant student at Valparaiso University, with an anticipated graduation in July 2025. His interest in limb preservation was sparked during his family medicine rotation, where he frequently managed diabetic foot ulcers in a clinical wound care setting. Witnessing the high prevalence of DFUs and the challenges of preventing amputations inspired his capstone project exploring hyperbaric oxygen therapy as an adjunct treatment in diabetic foot ulcer management.

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