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A diabetic offloading boot helps relieve pressure or irritation on a diabetic foot ulcer. Diabetics carry a higher risk of developing foot ulcers or sores that develop an infection. Without proper treatment, these infected ulcers can require amputation of the infected area (toes, foot, or leg). Doctors treat these ulcers with antibiotics, having the patient wear a diabetic offloading boots, and having the patient rest and avoid walking. A variety of types of boots exist including the total contact cast, removable cast walker, the non-removable cast walker or instant total contact cast, the modified Carville healing sandal, the felted foam technique, the football dressing, commercial offloading shoes, and depth footwear.

Top 5 diabetic offloading boots

  • Total contact cast
  • Non-removable cast walker
  • Removable cast walker
  • Modified Carville healing sandal
  • Felted foam technique

Total contact cast

Research studies show the best patient outcomes occur using the total contact cast (TCC). This non-removable boot encases the entire foot and creates constant pressure in appropriate areas. It defeats the issue of patient removal of the boot, a common occurrence which results in extended recovery times. Using a TCC results in ulcers healing within six to eight weeks when infection is not present.

Highlights:

  • Ulcers heal more quickly
  • Shorten recovery time
  • Can prevent or help stop infection

Non-removable cast walker

This pre-fabricated device, the non-removable cast walker, features design aspects that rival the TCC in its ability to off-load pressure on affected foot areas. Since it’s wore constantly, it helps wounds heal within a “reasonable time frame,” according to James McGuire, associate professor of podiatric medicine and orthopedics at the Temple University. This walking cast incorporates a fixed ankle design with a rigid rocker sole that prevents forward motion of the tibia during mid-stance and propulsion. It also reduces forefoot and mid-foot loading.

Highlights:

  • Patient can’t remove it
  • Fixed ankle design
  • Rigid rocker sole

Removable cast walker

Also a pre-fabricated device, the removable cast walker, features a design similar to the non-removable cast walker except the patient cn remove it as desired. When worn constantly, it helps off-load pressure on the affected foot areas. Patient removal of the boot occurs in all but 28 percent of cases. Worn constantly though, it helps speed wound healing, says McGuire. It incorporates the same fixed ankle and rigid rocker sole features as the non-removable cast walker, so it also prevents forward tibia motion during mid-stance and propulsion, and reduces forefoot and mid-foot loading.

Highlights:

  • Patient can remove it
  • Fixed ankle design
  • Rigid rocker sole

Modified Carville healing sandal

The modified Carville sandal, a surgical shoe with an innersole insert, provides superior healing to a normal surgical shoe, but it shows less positive results than a TCC. For this reason, doctors may transition the patient to a modified Carville sandal after wound closure. It features a total contact molded innersole and and thickened epithelial layer. With consistent wear, it helps prevent ulcer re-opening and/or recurrence during the two to four weeks after wound closure.

Highlights:

  • Patient can remove it
  • Less foot/leg coverage & bracing
  • Best used as transition to normal footwear after wound closed

Felted foam/football dressing technique

The non-removable wound dressing technique uses one quarter inch felt foam or adhesive felt to reduce pressure over the ulcer while a skin barrier applied over the foot to prevent irritation from the adhesive. It’s combined with a modified, molded insole surgical shoe to ensure improved gait. Its application requires specialized training, but its succeeds in both foot protection and reducing ambulation speed and step length, two keys in the reduction of plantar loading.

Highlights:

  • Patient can’t remove it
  • Combined with surgical shoe
  • Reduces step length and walking speed

Conclusion

The best diabetic offloading boots are those customized to the patient’s foot and are not removable. Their constant wear speeds ulcer healing. Your doctor may use more than one boot design in your treatment, transitioning you from a calf-height boot to bootie or sandal design once your ulcer heals. The next transition may be to prescription footwear such as a shoe with built-in orthotics. It is not recommended that you return to your previous footwear which helped cause the ulcer.