[Why and how to off-load a diabetic foot ulcer ?]

The off-loading of diabetic foot ulcers is the most urgent and theoretically the easiest treatment to implement. Its effectiveness has been proven for decades by randomized controlled studies on neuropathic ulcers that heal with a cast in an average of 6 weeks with a high level of evidence. Total contact casts are not widely used throughout the world, although it is the standard treatment. Off-loading shoes are certainly effective but only if they are worn. It is the prescriber's challenge to obtain maximum compliance that makes it possible to avoid infections and secondary amputations that are totally avoidable most of the time and only related to the delay in optimal care, of which off loading is the essential part.