# Offloading devices > Offloading devices are casts, boots and shoes that take pressure off a sore area of the foot. They're best proven for helping ulcers on the sole heal in adults with diabetes, and for lowering the chance of ulcers coming back. Wearing the device as directed matters most. Guide in [Treatments](https://footanklelowerlimb.com.au/learn/topics/treatments), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/offloading-devices Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **They take pressure off a sore spot:** casts, boots and shoes move weight away from an ulcer so it can heal. - **A cast you can't remove is usually first choice** for ulcers under the front or middle of the foot in adults with diabetes. - **Wearing it matters most:** even the best device won't work if it isn't worn. - **A cast needs regular checks:** weekly visits, and a daily look at your skin. - **Some ulcers need individual assessment,** including heel ulcers and ulcers with infection or poor blood supply. ## What are offloading devices, and how do they work? Offloading devices are casts, boots, shoes and similar devices that take pressure off part of your foot, usually a sore or ulcerated area. They help ulcers heal, and help stop them forming or coming back [1]. Clinicians call this offloading, and you may also hear it called pressure relief. Extra pressure under the sole is one of the main causes of diabetic foot ulcers [2], so a device moves weight away from the sore spot. The best-known example is the total contact cast (TCC), an enclosed cast usually applied from toe to knee, which shifts weight onto your leg [3]. A device only works by taking weight off, so it needs to be worn as directed. ## What are offloading devices used for, and how well do they work? They're best proven for healing ulcers on the sole of the foot, at the front or middle of the foot, in adults with diabetes who have lost feeling in their feet (neuropathy). A cast that can't be removed is the first choice [4][5]. On average, neuropathic ulcers treated with a cast heal in about 6 weeks [6], and uncomplicated ulcers on the sole in 6 to 8 weeks with good offloading [7]. Healing slower than this is worth reviewing with your podiatrist. How well it works depends heavily on wearing the device: even the best one won't work if it isn't worn [5]. Once an ulcer has healed, therapeutic footwear that relieves pressure, and that you actually wear, helps stop ulcers coming back [8]. For heel ulcers, ulcers on the top or sides of the foot, ulcers with infection or poor blood supply, and preventing a first ulcer, how well offloading works isn't clear yet [8]. ## Is an offloading device right for me? A non-removable knee-high device (a TCC or an instant TCC) suits adults with diabetes and an ulcer on the sole when you can tolerate it and your foot fits it safely [9]. It isn't suitable with a soft tissue infection, an infection in the bone, severe blood vessel disease or severe swelling of the lower leg or foot [10]. If you have reduced blood flow to your legs (peripheral arterial disease), a cast needs a check of your blood supply first, plus close follow-up [11]. A cast also reduces your mobility, and you can't check the ulcer yourself each day [10]. Some people can't work while wearing one [12]. It's worth talking through your daily routine with your podiatrist first. Children, people without diabetes, and people with heel, infected or poor-circulation ulcers need individual advice from a podiatrist or high-risk foot service [8]. ## What happens when I have one? A podiatry team applies a cast in about 20–30 minutes, usually from toe to knee [3]. You're usually seen weekly to have it taken off, your foot checked, and the cast put back on if needed. Treatment can take many months [3]. While it's on, keep it dry (a waterproof cast protector can help) and never take it off yourself [3]. You won't be able to travel by aeroplane in a cast [12]. People with neuropathy may not feel the cast rubbing, so checking the skin matters [3]. > [!tip] Try this > Each day, look at the skin around the edges of your cast for rubbing, swelling, redness or colour change, and notice any tingling or numbness in your toes. Check the cast isn't too tight, loose, soft, cracked, wet or soiled. With a removable device, wearing it for at least 80% of your daily activity is what makes it effective [13]. In practice, that means wearing it for almost all the time you're on your feet. ## What are the risks and side effects? Casts can rub and cause new sores on your foot or leg [12], and with neuropathy you may not notice [3]. Compared with footwear, casts have more device-related problems, mainly damage to the cast and skin problems. They're about the same as removable walkers [13]. Keeping the cast clean, dry and protected helps lower these problems [13]. Rarely, reduced movement and weight-bearing in a cast can lead to a blood clot in the leg (deep vein thrombosis) or in the lungs (pulmonary embolism) [3][12]. The signs to watch for are in the last section below. ## How do offloading devices compare with other options? A non-removable knee-high device heals more ulcers than removable devices [10]. How big that difference is isn't fully settled, because some reviews suggest removable devices may do as well [13]. If a non-removable device isn't suitable or you can't tolerate it, the next choices are a removable knee-high device, then a removable ankle-high device [4][5]. Therapeutic footwear is a last resort when no device can be tolerated or reached [9], and ordinary footwear alone isn't effective for healing [7]. Surgery is only considered if non-surgical offloading fails to heal a forefoot ulcer. It tends to add modest benefit, with more side effects and higher costs [4][9]. The best choice also depends on what you'll actually wear. ## When to see a podiatrist Any active foot ulcer needs to be seen urgently by a podiatrist or high-risk foot service, so don't wait for it to settle. Until you're seen, cover it with a suitable dressing and keep it dry. Ask about offloading as part of that care. If you're wearing a cast, never take it off yourself. Tell the clinic that applied it straight away about any worry, including a fall or trip, new or worse pain, redness, a worsening ulcer, tingling or numbness in your toes, a cast that feels too tight, or a flu-like illness. See your GP or a podiatrist the same day if you have diabetes and a new wound, sore, blister or colour change on your foot, or if you have an ulcer with a fever, spreading redness, heat, swelling or pus in the foot, pain or swelling in your calf or thigh, or sudden severe pain or numbness in a leg or foot. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. Go to the nearest emergency department if you have diabetes and a foot infection that's spreading fast, with a fever and feeling very unwell, or if your toes turn blue or white in a cast. Call 000 and ask for an ambulance if you have chest pain or pressure, sudden severe breathlessness, chest or upper back pain that's worse when you breathe in, or you cough up blood. Call too if your leg or foot suddenly turns cold and pale or blue, or you have signs of sepsis: confusion, severe shivering or muscle pain, passing little or no urine, or mottled or discoloured skin. ## Common questions ### Can I take my offloading boot off at night or to shower? Ask your podiatrist, because it depends on the device. A cast that can't be removed stays on: keep it dry with a waterproof cast protector and never take it off yourself. A removable device only works when it's worn, so the aim is to wear it for almost all the time you're on your feet. ### Can I work while wearing a cast? A cast reduces how much you can move, and some people can't work while wearing one. Before a cast is applied, it's worth talking through your job and daily routine with your podiatrist, so you know what to expect and can plan around the weeks or months it may be needed. ### What is an instant total contact cast? An instant total contact cast is a ready-made knee-high walker that's made non-removable with a wrap, so you can't take it off. Like a custom total contact cast, it's a first-choice option when you can tolerate it, have no condition that rules it out, and your foot fits it safely. ### What shoes should I wear after my foot ulcer heals? Ask your podiatrist about therapeutic shoes and insoles that relieve pressure under your foot. They lower the chance of an ulcer coming back compared with regular shoes, but only when you wear them. Your podiatrist can check the fit and show you which kind suits your feet. ## Further reading - [Offloading devices on Clindice](https://clindice.com/offloading-devices) - [Diabetes - foot ulcers: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/patientinstructions/000077.htm), MedlinePlus - [Podiatry - Non-removable Cast :: Northern Care Alliance](https://www.northerncarealliance.nhs.uk/patient-information/patient-leaflets/podiatry-non-removable-cast), NHS - [Looking after your foot ulcer](https://www.esht.nhs.uk/wp-content/uploads/2020/05/0807.pdf), NHS - [Decision Aid for Device Selection for Diabetic Foot Ulceration](https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/decision-aid-for-device-selection-for-diabetic-foot-ulceration/), NHS - [Diabetes and what it means to your feet - NHS Lanarkshire](https://www.nhslanarkshire.scot.nhs.uk/services/podiatry/diabetes/), NHS ## Sources 1. Basic Low-cost Removable Footwear for Diabetic Foot Ulcer Offloading: A Systematic Review · Sood S, Geng R, Mufti A et al. · Advances in Skin & Wound Care · 2026. https://doi.org/10.1097/asw.0000000000000385 2. A systematic review and meta-analysis of off-loading methods for diabetic foot ulcers · Elraiyah T, Prutsky G, Domecq JP et al. · Journal of Vascular Surgery · 2016. https://doi.org/10.1016/j.jvs.2015.10.006 3. Podiatry - Non-removable Cast · NHS. https://www.northerncarealliance.nhs.uk/patient-information/patient-leaflets/podiatry-non-removable-cast?q=%2Fpatient-information%2Fpatient-leaflets%2Fpodiatry-non-removable-cast 4. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update) · Bus SA, Armstrong DG, Crews RT et al. · Diabetes/metabolism Research and Reviews · 2024. https://doi.org/10.1002/dmrr.3647 5. Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review · Lazzarini PA, Jarl G, Gooday C et al. · Diabetes/metabolism Research and Reviews · 2020. https://doi.org/10.1002/dmrr.3275 6. [Why and how to off-load a diabetic foot ulcer ?] · Ha Van G · La Revue du Praticien · 2019. https://pubmed.ncbi.nlm.nih.gov/31626416/ 7. Off-loading the diabetic foot for ulcer prevention and healing · Cavanagh PR, Bus SA · Journal of Vascular Surgery · 2010. https://doi.org/10.1016/j.jvs.2010.06.007 8. Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review · Bus SA, van Deursen RW, Armstrong DG et al. · Diabetes/metabolism Research and Reviews · 2016. https://doi.org/10.1002/dmrr.2702 9. Knee-High Devices Are Gold in Closing the Foot Ulcer Gap: A Review of Offloading Treatments to Heal Diabetic Foot Ulcers · Lazzarini PA, Jarl G · Medicina (Kaunas, Lithuania) · 2021. https://doi.org/10.3390/medicina57090941 10. Pressure-relieving interventions for treating diabetic foot ulcers · Lewis J, Lipp A · The Cochrane Database of Systematic Reviews · 2013. https://doi.org/10.1002/14651858.cd002302.pub2 11. Total Contact Cast Use in Patients With Peripheral Arterial Disease: A Case Series and Systematic Review · Tickner A, Klinghard C, Arnold JF et al. · Wounds · 2018. https://pubmed.ncbi.nlm.nih.gov/29481330/ 12. Total contact cast · Kent Community Health NHS Foundation Trust · 2024. https://www.kentcht.nhs.uk/leaflet/total-contact-cast/ 13. Total contact casts versus removable offloading interventions for the treatment of diabetic foot ulcers: a systematic review and meta-analysis · Li B, Lin A, Huang J et al. · Frontiers in Endocrinology · 2023. https://doi.org/10.3389/fendo.2023.1234761 --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.