ABSTRACT Background: Neuropathic and vascular changes in diabetic patients put them at risk for developing chronic foot wounds after minor trauma and change the normal distribution of pressure causing a breakdown in the integrity of the skin. Therefore offloading therapy have an important role to redistribute the pressure to improve healing. Aim of the work : To compare the effect of using total offloading Contact Cast Application in Heel ulcers versus regular surgical dressing in Diabetic Foot patients. Methods: This patient preference clinical trial study (PCT) was conducted at Vascular Surgery Department, Zagazig University Hospitals. Dividing patients into 2 groups (on patient preference after explanation the procedures advantages and disadvantages): Group A: This group was treated by total contact cast and regular surgical dressing. Group B: This group was treated by surgical dressing only. Results: There is statistically significant difference between the studied groups regarding area of ulcer baseline, at 2 and 4 weeks (there is significant decrease in area and number of patients with ulcer among contact cast group). There is nonsignificant difference between them regarding surface area at 6, 8, 10 and weeks (only two patients within contact cast group at 8 weeks and 1 on 10 and 12 weeks had ulcer with higher decrease in surface area). There is statistically non-significant difference between the studied groups regarding age or gender, Smoking, hypertension, previous debridement and osteomyelitis. Conclusions: The study can be concluded that there is a positive prognostic role for total contact cast application in healing of heel ulcers in diabetic foot patients. TCC achieves foot unloading by transfer of load from the leg directly to the cast wall and greater proportionate load sharing by the heel helping us preventing more major amputations and provides a better and earlier outcome than regular surgical dressing.