Off-loading

Patients with diabetic neuropathy no longer feel the pressure or pain that normally precedes tissue damage. Therefore, relieving pressure from plantar tissues—known as off-loading—is key to treating and preventing ulcers. Off-loading can be accomplished using nonsurgical and surgical interventions.

Nonsurgical interventions

• Therapeutic footwear (possibly with rocker soles)
  
• Custom orthotics
  
• Walking casts (such as a total contact cast)
  
• Walkers
  
• Splints
  

This shoe has a toe box with extra depth and width to accommodate bony deformities, such as claw toes and hallux valgus (displacement of the great toe toward other toes). The shoe can also be modified to allow room for a widened hindfoot/heel. The soft, thick inlay provides comfort and protection.

This ankle-foot orthosis is used to relieve pressure from the heel.

Surgical interventions

• Exostectomy
  
• Digital arthroplasty
  
• Bone and joint resections
  
• Partial calcanectomy