If a wound on the sole is exposed to pressure with every step, healing may be delayed and a closed wound may reopen.
Offloading aims to move weight away from the wound or distribute it more evenly across the foot.
- Protecting the wound area
- Distributing pressure more evenly
- Reducing repeated trauma
- Selecting a device suited to the person and wound
Why does pressure matter?
People with loss of sensation may not notice excessive pressure. Repeated loading on the same point can damage tissue and keep a wound from healing.
The evidence-based sequence for plantar wounds
For a neuropathic plantar forefoot or midfoot ulcer, the first choice is a nonremovable knee-high offloading device when there are no contraindications. If it is unsuitable or not tolerated, a removable knee-high or ankle-high device is considered second choice and used during all weight-bearing activities.
- First choice: A nonremovable knee-high device; infection, ischemia, balance and other contraindications are assessed clinically
- Second choice: A removable knee-high or ankle-high device, used whenever bearing weight
- If devices cannot be used: Lower-tier options, such as felted foam with appropriate footwear, are considered
- Standard or therapeutic footwear does not replace an offloading device for an active plantar ulcer
Wound location and clinical condition affect the choice
Wounds on the heel or elsewhere than the sole, significant infection or ischemia, balance problems and daily needs may require a different device or weight-bearing plan. Selection follows examination.
Correct and consistent use
It is important to use the device for the duration and in the circumstances advised by the physician, including beyond outdoor use. Fit checks look for new pressure areas on the skin.
Offloading is part of treatment
An appropriate device should be selected through examination; an unsuitable product may create new pressure points and skin damage.
Offloading in daily life
The offloading plan considers your balance, mobility needs and ability to use a device as well as wound location. Learn through demonstration when and how to use your recommended device. Tell the team if you have difficulty putting it on or removing it, checking the skin or walking.
Rubbing, new redness or impaired balance caused by the device requires reassessment. Do not cut or reshape it yourself. Follow-up helps monitor both protection of the wounded area and prevention of new problems elsewhere.
Related content
Scientific sources
This information is for general education. The assessment and treatment appropriate for you are determined by a medical examination.
Further reading: NIDDK foot health · NICE NG19 · AAOS patient guide
