What is off-loading and how can it be measured?
Why is off-loading needed?
The evidence base: What works and what does not work?
International Consensus on the Diabetic Foot and Practical Guidelines on the Management and Prevention of the Diabetic Foot.
- •Relieving pressure on ulcers should always be a part of the treatment plan.
- •TCCs and nonremovable walkers are the preferred interventions; however, the clinician should be aware of possible adverse effects of these devices.
- •Forefoot off-loading shoes or cast shoes may be used when above the ankle devices are contraindicated or not tolerated by the patient.
- •Conventional or standard therapeutic footwear should not be used since many other devices are more effective.
- •Regular callus removal should be provided by a skilled health care professional.
- •Patients should be urged to not walk barefoot at any time.
- •Therapeutic footwear, including a custom-molded insole in a shoe with adequate depth, is the preferred intervention.
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Competition of interest: Peter R. Cavanagh holds equity in DIApedia LLC. He is an inventor on U.S. patents 6,610,897, 6,720,470, and 7,206,718, which elucidate a load-relieving dressing and a method of insole manufacture for off-loading. He has received honoraria from Merck, Eli Lilly, and ConvaTec and is the recipient of grants from the National Institutes of Health and NASA .
This article is being co-published in the Journal of Vascular Surgery® and the Journal of the American Podiatric Medical Association.
The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.
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