What does offloading mean for a diabetic foot ulcer?

It means taking the weight off the ulcer. Special shoes, a brace, a cast, a wheelchair or crutches take pressure off the ulcer area to speed healing, and pressure for even a few minutes can reverse healing already gained.

Offloading means taking the weight off the ulcer, which is why taking pressure off your foot ulcer is its own step in care. Foot ulcers are partly caused by too much pressure on one part of your foot.

Pressure is not an obstacle that arrives after the wound. It is part of what made it, and it continues unless something changes.

In practice, offloading means equipment rather than instruction. Your provider may ask you to wear special shoes, a brace, or a special cast. You may need to use a wheelchair or crutches until the ulcer has healed. These devices will take the pressure off the ulcer area, and this will help speed healing.

Here’s why it is taken so seriously: sometimes putting pressure on the healing ulcer for even a few minutes can reverse the healing that happened up to that point.

Offloading is not the same as resting, and that difference is worth keeping. The devices let you move while the ulcer is protected. The point is not to stop moving — it is to not put weight on the ulcer.

One rule applies in all circumstances: do not walk barefoot unless your provider tells you it is OK.

Footwear carries the same idea into everyday life. Be sure to wear shoes that do not put a lot of pressure on only one part of your foot — canvas, leather or suede; laces, Velcro or buckles; properly fitting and not too tight; and no pointed or open toes.

Sticking with it is harder than it sounds because the foot usually does not hurt. Diabetic ulcers are often painless, because of decreased feeling in the feet, so there is no feedback telling you the device has shifted or the weight is back on the wound.

What to watch for

Sometimes putting pressure on the healing ulcer for even a few minutes can reverse the healing that happened up to that point.

Do not walk barefoot unless your provider tells you it is OK.

Because these ulcers are often painless, a device that has shifted or stopped working may not announce itself. A device that feels different, rubs, or has loosened is worth reporting.

Signs of infection to contact a provider about: redness, increased warmth, or swelling around the wound; extra drainage; pus; odor; fever or chills; increased pain; increased firmness around the wound.

Wound Wizard is general education and cannot assess your foot or your device. Your own clinician is the right person to ask.

What we look at

  • Examining and measuring the ulcer
  • Deciding how pressure will be taken off it
  • Fitting or arranging shoes, a brace, a cast or crutches
  • Checking the device is doing its job at each visit

Sources

  1. Diabetes - foot ulcers — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000077.htm
  2. Diabetes - taking care of your feet — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000081.htm