What offloading means
Offloading for diabetic foot wounds means taking pressure off the wound so the tissue has a chance to heal. Every step presses your body weight into the sole of the foot. When a wound sits on a weight-bearing spot, that repeated pressure can keep it open.
Many people with diabetes have nerve damage (neuropathy) and cannot feel the pain that would normally make them limp or rest. Offloading does the protecting that sensation no longer does. Our guide on what offloading is covers the basics.
Offloading options the treating clinician may consider
The treating clinician chooses the method. Options may include:
- Total contact cast. A cast molded closely to the foot and lower leg that spreads pressure over a wide area. A trained clinician applies and changes it.
- Removable cast walker. A tall walking boot, sometimes fitted with a custom insole.
- Offloading shoe or healing sandal. Footwear built to shift weight away from the front of the foot or the heel.
- Padding. Felt or foam shaped to relieve one spot.
- Heel protection boots. Worn in bed to keep the heels lifted off the mattress.
- Mobility aids. A wheelchair, walker, crutches or knee scooter to limit weight on the foot.
How the clinician decides
The location of the wound comes first, since a device that protects the ball of the foot may not help the heel. The clinician also considers blood flow, infection, swelling and the shape of the foot.
Daily life matters too: balance, vision, strength, stairs at home and the health of the other foot. A boot or cast can make one leg sit higher than the other and change how you walk. When falls are a concern, Gateway can help bring primary care into the conversation about mobility and fall risk.
Footwear during and after healing
Shoes are part of the plan. A shoe that rubs, pinches or hides a foreign object can cause a wound that a person with neuropathy never feels. Your clinician may ask to see the shoes you wear most.
After a wound closes, the skin over it stays fragile. The clinician or podiatrist may recommend protective shoes and insoles fitted by a footwear specialist. Our guide to choosing shoes with a diabetic foot wound lists questions to ask.
Coordination with podiatry, orthotics and primary care
A podiatrist may manage calluses, nails, foot structure and casting. An orthotist or pedorthist fits braces, boots, shoes and insoles. Your primary care clinician manages blood sugar and overall health, which Gateway can also help arrange through diabetes care at home.
Gateway sends the treating clinician’s orders and notes to the right offices, helps schedule fittings, and passes along problems with a device so the clinician who ordered it can respond. This is part of our wider diabetic foot care coordination.
How Gateway arranges offloading at home and in facilities
At home, the treating clinician assesses the wound and writes the order for any device. Gateway then helps with supplies and equipment coordination. What a plan pays for depends on the plan, the treating provider and the order.
In skilled nursing, assisted living and rehabilitation settings, the order goes to the nursing and therapy teams. Staff need to know when the device is worn, how transfers are done while wearing it and who checks the skin underneath. Gateway helps get those instructions to the facility and brings staff questions back to the treating practice.
What to report
Call the treating clinician’s office if you notice:
- A new red area, blister or sore under or near the device
- A device that is broken, loose, too tight or rubbing
- Swelling that changes how the device fits
- A fall or a near fall
- More drainage, a new odor, spreading redness or fever
A foot that suddenly turns cold, pale or blue, or becomes severely painful, needs urgent medical attention. For an emergency, call 911.
How to start
Call Gateway at 314-325-0126 or request care online. Patients and families across Greater St. Louis and the Metro East can ask with or without a referral. Tell us on the phone whether a podiatrist is already involved, so we can contact that office early.
Common questions
Do I have to wear my offloading boot inside the house?
Follow your treating clinician’s instructions. In general, short trips count, and steps to the kitchen or bathroom add up over a day. Many people are tempted to leave a removable boot off at home. If wearing it indoors is difficult, tell the clinician why, so other options can be considered.
What is a total contact cast?
It is a cast that fits snugly against the whole foot and lower leg, so your weight is spread out instead of landing on the wound. It cannot be taken off at home. It is not right for everyone, and the treating clinician decides based on circulation, infection and safety.
Can I drive while wearing an offloading boot or cast?
Ask the treating clinician before you drive. A boot or cast on the right foot can affect how you use the pedals, and neuropathy can already reduce your feel for them. Many people line up rides during this period. If getting to appointments becomes a problem, tell Gateway so that transportation arrangements can be discussed.
Is offloading only used for diabetic foot ulcers?
No. The same idea applies to other wounds caused or worsened by pressure on the foot, including heel injuries in people who spend long hours in bed. Our page on heel and foot pressure ulcers explains how those wounds are approached.
What happens once the wound has closed?
Wounds can return at the same spot. The clinician may recommend protective footwear, regular foot exams and a gradual return to normal walking. Checking your feet every day becomes a lasting habit. Our guide to daily foot checks for people with diabetes shows what to look for.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.