Use of Pressure Offloading Devices in Diabetic Foot Ulcers

Do we practice what we preach?

  1. Stephanie C. Wu, DPM, MSC1,
  2. Jeffrey L. Jensen, DPM23,
  3. Anna K. Weber, DPM34,
  4. Daniel E. Robinson, DPM3 and
  5. David G. Armstrong, DPM, PHD15
  1. 1Scholl's Center for Lower-Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
  2. 2MedEfficiency, Denver, Colorado
  3. 3North Colorado Podiatric Surgical Residency Program, Denver, Colorado
  4. 4Private Practice Chicago, Chicago, Illinois
  5. 5Department of Surgery/Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona, and the Department of Surgery, Southern Arizona VA Health Care System, Tucson, Arizona
  1. Corresponding author: Stephanie C. Wu, stephanie.wu{at}


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.


  • Published ahead of print at on 11 August 2008.

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    • Accepted August 1, 2008.
    • Received April 28, 2008.
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This Article

  1. Diabetes Care vol. 31 no. 11 2118-2119
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