Pressure redistribution and specialized footwear to protect diabetic ulcers and prevent amputation.
Offloading—removing pressure from a diabetic foot ulcer—is the single most important factor in healing. Studies show that ulcers with proper offloading heal 90% of the time, while those without offloading heal only 30% of the time. Every step you take on an unprotected ulcer causes micro-trauma that prevents healing and increases infection risk. Without offloading, even the best wound care treatments will fail.
85% of diabetes-related amputations start with a foot ulcer. Proper offloading reduces amputation risk by 70%.
A specially designed plaster or fiberglass cast that distributes pressure evenly across the entire foot and lower leg, completely offloading the ulcer. The cast cannot be removed by the patient, ensuring 24/7 offloading compliance. Healing rate: 90% in 6-8 weeks.
Pros: Most effective, guaranteed compliance, fastest healing. Cons: Cannot be removed for bathing, requires skilled application, weekly reapplication needed.
A boot-style walker with a rocker sole that shifts pressure away from the ulcer. Can be removed for bathing and sleeping. Medicare provides these at no cost. Healing rate: 60-70% when worn consistently.
Pros: Can shower, more comfortable, easier to apply. Cons: Relies on patient compliance—many patients remove it too often, reducing effectiveness.
Extra-depth shoes with custom-molded insoles that redistribute pressure away from the ulcer. Medicare covers one pair annually plus three pairs of inserts for qualified diabetic patients. Best for prevention or after healing.
Pros: Normal appearance, can wear daily. Cons: Less effective than casts/boots for active ulcers, primarily preventive.
Layers of felt or foam are cut to create a donut-shaped pad around the ulcer, redistributing pressure to surrounding tissue. Applied by the wound care provider and changed at each visit. Used as an adjunct to other offloading methods.
Best for: Temporary offloading between fittings, supplementing other offloading devices.
Beyond devices, limiting weight-bearing activity is essential. Bed rest or wheelchair use may be necessary for severe ulcers. Every step delays healing. Use crutches, knee scooters, or wheelchairs to keep weight off the affected foot. Once healed, gradual return to activity prevents recurrence.
Medicare Part B covers offloading devices when medically necessary for diabetic foot ulcer treatment. This includes CAM boots, total contact casts, therapeutic shoes, and custom inserts. Medicare covers 80% after deductible. Diabetic patients with neuropathy qualify for one pair of therapeutic shoes and three pairs of inserts annually at no cost with Medicare and supplemental insurance.