Offloading boots are footwear products designed for wound care of the foot. They redistribute pressure across the sole of the foot from areas that are more vulnerable to diabetic or other ulcers towards other less vulnerable areas. The areas that are more vulnerable are those that bear more body weight or that are more subject to friction or other sources of irritation due to the way you walk (your gait).
Offloading boots are sometimes alternatively referred to as healing sandals. Another common name for them is “half shoes”.
Generally, offloading boots have a thick wedge shaped sole section in the area to which pressure is being transferred. There is also a thin platform section over the area from which pressure will be transferred (i.e. the area to be “offloaded”). The boots are normally held in position by means of Velcro straps.
How Offloading Boots Work
Generally speaking, there are two types of offloading boot.
Heel offloaders reduce heel pressure by transferring pressure from the back of the foot (heel area) to the front.
Forefoot offloaders, on the other hand, transfer this pressure from the front of the foot (the metatarsalgia area) to the back of the foot, near the heel bone.
Offloading the heel tends to be a greater priority in most cases as excess pressure behind the heel can cause serious skin injury there. There is a ridge on the heel bone that is a constant source of pressure to the skin covering the heel. This makes this area more liable to skin breakdown under sustained pressure and/or friction. The Darco HeelWedge is an excellent example of an offloading boot designed for relieving pressure on the heel.
These shoes move pressure in the opposite direction to heel offloaders. They redistribute it to the back of the foot and away from the vulnerable area just behind the toes. The Darco OrthoWedge is an outstanding example of such a shoe.
Offloading Boots – Advantages & Disadvantages
Their main advantage lies in the fact that they require little expertise to fit and put on.They are also easy to remove (for showering, bathing, sleeping, etc.) and can accommodate bulky wound dressings when the patient needs them.
The main disadvantage of offloading boots is the fact that their design creates an inherent limb length discrepancy. Patients need to undergo some training in how to properly use these shoes and they also need to make a conscious effort to maintain proper use of them.
Who Might Benefit From Wearing An Offloading Boot?
These boots are increasingly widely used to treat diabetic patients suffering from conditions like pressure ulcers, neuropathic ulcers, Charcot foot or other pressure injuries. The main causes of foot ulceration among diabetics are protective sensory loss that typically results from neuropathy and excessive pressure to vulnerable areas while walking or standing.
Offloading boots are also useful in treating surgical foot wounds by reducing the pressure on them due to the patient walking or standing. They help these wounds to heal by redistributing pressure away from the wound and towards other areas of the sole of the foot. This allows the wounds to heal with less interference from this pressure. They help to reduce the risk of infections that may retard the healing process.
Some alternatives to offloading boots include:
Items like crutches or wheelchairs. These too help the patient to avoid putting pressure on the foot but are less suitable and convenient for long term use;
Total contact casts that encase the entire leg. They are made primarily from paster of Paris and use a small rubber rocker to offload pressure as intended. These are the traditional gold standard for offloading mid and forefoot lesions. However, they are less comfortable for the patient and cannot be removed for the entire 5-8 week period it may take to heal an ulcer.
Below knee walking casts that are modeled on the casts used for treating lower leg fractures, albeit with some modifications. These casts use accommodative padding on the contours of the foot as well as under cast padding to the leg and bony prominences before application of the cast tape. The ulcerated area can be either totally enclosed or, alternatively, a window can be cut in the cast for monitoring the wound and re-dressing as needed.