Offloading Boot

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Our offloading footwear section includes boots and other footwear that redistribute pressure across the foot and play an important role in diabetes wound care.

These shoes are primarily for the benefit of diabetic patients suffering from conditions such as neuropathic ulcers or Charcot foot. Patients suffering from pressure ulcers of the foot may also benefit from offloading boots.

Most offloading shoes are designed to fit either the left or right foot.

Other ways of achieving foot offloading in order to manage the threat from diabetic ulcers (for example) is to use crutches or to a wheelchair.

What Is An Offloading Boot?

They are therapeutic shoes that redistribute pressure from vulnerable areas of the sole of the foot. For diabetic patients, these would be areas where the patient is at risk of developing an ulcer depending on his or her gait pattern and which parts of the foot carry the most weight.

In addition to treating ulcers that form as a result of diabetes, offloading footwear can also protect vulnerable areas of the foot after a patient has undergone foot surgery. By redistributing pressure away from the area that has been operated on, offloading boots can help these surgical wounds heal quickly and completely with less risk of complications developing.

There are two primary types of offloading boots – those that redistribute pressure away from the heel and those that redistribute it away from the forefoot.

Heel Offloading Boots

These shoes will reduce the pressure felt at the heel or near the back of the foot (i.e. they will offload the heel or reduce heel pressure) and increase the pressure at the forefoot area.

Excess heel pressure can cause serious skin injury behind the heel. If they are not properly treated and managed, these injuries can lead to ulceration in the area. The heel bone has a ridge that puts pressure on the skin covering the heel and makes it more liable to break down under prolonged pressure.

This vulnerability is made worse by the thinness of the skin covering the heel bone and the fact that there is little padding (e.g. muscle or fat) to protect the skin from the bone.

For an example of a heel offloading boot, please see the Darco HeelWedge.

Forefoot Offloading Boots

These boots will do the opposite of the heel offloading boots referred to above, i.e. they will shift the pressure underfoot from the forefoot area (near the toes) to the heel.

A good example of a forefoot unloading boot is the Darco OrthoWedge.

Offloading Boots & Foot Ulceration

Foot ulceration is one of the most serious complications faced by diabetics. In many cases, foot ulceration is a precursor for a lower extremity amputation.

The risk of foot ulceration  is exacerbated by the effect of peripheral neuropathy, which reduces the effectiveness of the nervous system in communicating to the brain when the pressure on vulnerable foot areas is excessive.

Offloading boots and other footwear help to reduce excess forces that may otherwise be applied to areas with ulcers (or that are vulnerable to them), which contributes to faster healing of ulcers. With better management of foot ulcers, the risk of lower extremity amputation is reduced.

Choosing The Best Offloading Boots

When choosing offloading footwear for diabetes wound care or for other patient use, one of the important features to look for is removable insoles. These will provide you with the ability to customize pressure redistribution to suit the circumstances of a wide variety of patients. It is important to note that, since gait patterns differ among individuals, the at risk places will vary across the soles of the foot. As a result, you can analyze the gait pattern of each patient to understand their most vulnerable areas. You can then modify the removable insoles accordingly.

A good offloading boot or shoe will also offer substantial cushioning support to mitigate the pressure of the patient’s body weight. It will also offer straps and other features that will enable it to accommodate dressings without putting pressure on them.

Suggested Offloading Boot Products

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