Diabetic Footwear and Offloading: An Evidence-Based Guide

Per Reiber et al., 21–52% of diabetic foot ulcers begin with inappropriate footwear. Proper shoes prevent and help heal ulcers.

Footwear features

• Seamless interior
• Wide and deep toe box
• Stable heel ≤2 cm
• Adjustable closures
• Shock-absorbing outsole

Offloading the active ulcer

1. Total contact cast (TCC) — gold standard
2. Non-removable knee-high walker
3. Removable knee-high walker
4. Offloading shoe

References

1. Bus SA, et al. IWGDF 2023 offloading guideline. Diabetes Metab Res Rev. 2024;40(3):e3647. https://iwgdfguidelines.org/
2. Bus SA, et al. Custom-made footwear RCT for diabetic foot ulcer recurrence. Diabetes Care. 2013;36(12):4109–4116. https://doi.org/10.2337/dc13-0996