What it is
Offloading is the practice of taking pressure, friction and repetitive force off a wound. With a diabetic foot ulcer, which often forms on the bottom of the foot, everyday walking and standing can keep pressing on the same spot.
Many people with diabetes have reduced feeling in their feet (neuropathy), so they may not notice pain from pressure or a sore. Because of this, an ulcer can be stressed repeatedly without the person realizing it.
Offloading is not a single device. It is a goal that can be approached in several ways, and which approach fits a particular person is something only a licensed clinician can decide after an evaluation.
How it’s traditionally been approached
Traditionally, offloading has been approached with devices that redistribute pressure away from the ulcer. These include total contact casts, removable walking boots, specialized shoes, cushioned insoles, and sometimes crutches, walkers or wheelchairs to limit weight on the foot.
Some devices are fixed in place by a clinician and some can be removed by the person wearing them. Specialists often discuss the differences in how consistently each type may be used in daily life, along with comfort, mobility, safety and the ulcer's location.
Offloading is usually talked about alongside other parts of wound care, such as cleaning and removing unhealthy tissue, protecting the wound with dressings, managing infection, checking circulation, and supporting blood sugar management. No single approach is right for everyone.
How the right wound care specialist may help
A wound care specialist, such as a physician, podiatrist, or wound care nurse, may help by examining the ulcer, looking at its cause and depth, and checking sensation, circulation and foot shape. They may then discuss whether offloading is appropriate and which options could fit your situation.
A visit generally includes a review of your health history, a look at your footwear and daily activities, and a conversation about goals. A specialist may also explain how to protect the other foot, since it often bears extra load.
Good questions to ask a licensed provider include: What caused my ulcer and how is it staged? What offloading options are available for me and why? How long might healing take? What should I watch for? What does my insurance cover, including devices and visits?
The whole-person view
Foot health is tied to the whole person. Blood sugar, circulation, sleep, nutrition and stress all interact, and living with a wound or limited mobility can feel frustrating, tiring or isolating. Those feelings can in turn make daily routines harder to keep up.
Some people find that body-based support such as Somatic Experiences helps them feel more connected to their body and stress responses, and others find talk therapy through Therapists.plus useful for coping with the emotional side of a chronic condition. These are optional supports that can sit alongside medical care, not replacements for it.
Somatic Experiences: trauma and emotional healing →Somatic Experiences: embodiment and movement →Therapists.plus: mind body connection →
Keep in mind
- Seek medical care promptly for any sign of infection: spreading redness, red streaking, increasing warmth or pain, pus, foul odor, fever or chills, or a wound that is quickly getting worse.
- Call 911 or go to the ER for heavy bleeding, exposed bone or tendon, signs of sepsis such as confusion with fever and fast heartbeat, or a deep or severely contaminated wound.
- Only a licensed clinician can decide which offloading device or treatment is appropriate after an evaluation; do not stop or change a prescribed device on your own.
- If you are in emotional distress or crisis, call or text the 988 Lifeline.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Frequently asked questions
What does offloading a diabetic foot ulcer mean?
Offloading a diabetic foot ulcer means reducing pressure and friction on the sore so it is not repeatedly stressed while healing. It can involve casts, boots, special shoes, insoles or limiting weight on the foot. A licensed clinician decides which approach fits a given person.
Why is offloading important for diabetic foot ulcers?
Offloading is considered important because continued pressure on an ulcer can interfere with the body's healing process. Because neuropathy can hide pain, people may keep walking on a sore without realizing it. A wound care specialist can explain how it applies to your situation.
What are common offloading devices?
Common devices include total contact casts, removable walking boots, therapeutic shoes, and custom or cushioned insoles. Crutches, walkers or wheelchairs are sometimes used too. Which one is suitable depends on the ulcer's location, depth, infection status, circulation and your daily needs.
Can I offload a diabetic foot ulcer at home on my own?
It is best not to decide this on your own, because the right approach depends on the ulcer's cause, location and any infection or circulation issues. A licensed provider can evaluate the wound and explain what is appropriate. Ask them what is safe to do at home between visits.
How long does offloading take to work?
There is no single timeline, since healing time varies with the ulcer's size, depth, blood flow, infection, blood sugar and how consistently pressure is relieved. No outcome can be promised. Ask your provider for an expected healing time based on your own evaluation.
Does insurance cover offloading for a diabetic foot ulcer?
Coverage differs by device, plan and payer, so it is hard to say in general. Some devices and visits may be covered and others may not. Ask your provider's office and your insurer what applies to your specific situation before starting.
Educational resource. WoundKare shares general information and connects people with independent wound care specialists. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health.