Offloading devices take pressure off a diabetic foot ulcer so it isn't bearing weight when you stand or walk; the main options are total contact casts, removable cast walkers, custom shoes or insoles, and crutches or wheelchairs. Pressure relief is treated as a central part of ulcer care, not an optional extra.
What is offloading for a diabetic foot ulcer?
Offloading means relieving pressure from a specific area of the foot, usually the ulcer site, during walking or standing. Continued pressure on a wound is one of the most common reasons diabetic foot ulcers fail to heal, whatever topical care is being used.
For the bigger picture of ulcer care, see supporting diabetic foot ulcer care: what to know.
What are the main types of offloading devices?
They range from casts applied by a specialist to shoes, insoles and mobility aids, chosen based on the ulcer and your needs.
- Total contact casting. Often considered the most effective offloading method, this is a specialized cast molded to the foot and lower leg that redistributes pressure away from the ulcer. It's typically applied and changed by a wound care specialist.
- Removable cast walkers. Boot-like devices that redistribute pressure similarly to total contact casting, but can be removed, which requires more discipline to wear consistently.
- Custom offloading shoes or insoles. Designed to reduce pressure on a specific area of the foot, often used for less severe ulcers or after more intensive offloading has helped a wound progress. Our guide to choosing better shoes covers everyday footwear.
- Crutches, walkers, or wheelchairs. Sometimes used temporarily to remove weight from the foot entirely, particularly for more severe or slow-healing ulcers.
Are non-removable offloading devices better than removable ones?
Non-removable devices like total contact casting tend to show better outcomes, largely because they can't be taken off, so the pressure relief is continuous.
Offloading only works if it's used consistently. Removable devices can redistribute pressure just as well while worn, but their benefit depends on wearing them as directed, and people often wear them less than recommended. If you use a removable device, wearing it every time you're on your feet matters as much as the device itself.
What should you ask your provider about offloading?
Ask which device fits your ulcer, how long to wear it each day, and when it's safe to step down.
- Which offloading method is recommended for my specific ulcer?
- How many hours a day does the device need to be worn?
- How often will it need to be checked, adjusted, or replaced?
- What are the signs that the device isn't fitting or working correctly?
- When will it be appropriate to transition to less intensive offloading?
Offloading usually continues in some form after healing; see why diabetic foot ulcers come back and how to keep an ulcer from getting worse.
How Lavior's Diabetic Wound Hydrogel fits in
Lavior™ Diabetic Wound Hydrogel helps maintain a moist wound environment when used for the indications described on its label. Follow the product instructions and your healthcare professional's wound care plan. Like every Lavior formula, it is built around Inula AGS-RIED, Lavior's proprietary extract of the Mediterranean plant Inula viscosa. It works alongside offloading, never as a substitute for it, as part of a care plan guided by your provider.
Sources
- Schaper NC, et al. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3657. doi:10.1002/dmrr.3657
- Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–2375. doi:10.1056/NEJMra1615439
