Use of pressure offloading devices in diabetic foot ulcers: do we practice what we preach?

Diabetes Care. 2008 Nov;31(11):2118-9. doi: 10.2337/dc08-0771. Epub 2008 Aug 11.


Objective: Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers. We therefore discuss characteristics and considerations associated with the use of offloading devices.

Research design and methods: A diabetic foot ulcer management survey was sent to foot clinics in all 50 states and the District of Columbia in 2005. A total of 901 geographically diverse centers responded. The survey recorded information regarding usage frequency and characteristics of assessment and treatment of diabetic foot ulcers in each center.

Results: Of the 895 respondents who treat diabetic foot ulcers, shoe modifications (41.2%, P < 0.03) were the most common form of pressure mitigation, whereas total contact casts were used by only 1.7% of the centers.

Conclusions: This study reports the usage and characteristics of offloading devices in the care of diabetic foot ulcers in a broadly distributed geographic sample. Less than 2% of specialists use what has been termed the "gold standard" (total contact cast) for treating the majority of diabetic foot ulcers.

Publication types

  • Multicenter Study

MeSH terms

  • Diabetic Foot / epidemiology
  • Diabetic Foot / therapy*
  • Health Surveys
  • Humans
  • Pressure*
  • Shoes
  • United States / epidemiology