Offloading Devices For Pressure Injuries

Original Editor - Syeda Bushra Zehra Zaidi

Top Contributors - Syeda Bushra Zehra Zaidi, Kim Jackson and Ewa Jaraczewska

Introduction

offloading shoe

Offloading devices are specialized footwear, orthotics, and mechanical supports designed to reduce the pressure on a specific area of the foot, typically where an ulcer is present. These devices work by redistributing the body's weight away from the ulcerated area, preventing further injury and aiding in the healing process.

Key Goals of Offloading Devices:

Pressure Redistribution: Offload pressure from the ulcer to promote healing.

Protection from Further Injury: Avoid further irritation of the area of pressure injury.

Relief from Pain: Alleviate the discomfort due to pressure on the ulcer.

Accelerated Healing: Facilitate natural healing by minimising friction and mechanical stress at the wound site.

Types of Offloading Devices:

1. Total Contact Casting (TCC):
   • Description: A custom-made, rigid plaster or fiberglass cast that covers the entire foot and ankle. It redistributes pressure evenly across the foot.
   • Indications: Ideal for individuals with large, deep, or non-healing ulcers, particularly on the plantar surface of the foot.
   • Benefits: Provides maximum offloading and promotes ulcer healing by completely immobilizing the foot.
   • Considerations: Requires professional application and monitoring to avoid complications such as skin irritation or poor circulation.
2. Removable Cast Walkers (RCWs):
   • Description: A boot-like device that can be easily removed for wound care and inspection. Made from hard plastic, it provides support and reduces pressure on the ulcer.
   • Indications: Suitable for mild to moderate ulcers and those requiring frequent wound dressing changes.
   • Benefits: Easier to manage than a total contact cast, with the flexibility of removal for daily activities or medical visits.
   • Considerations: Less effective than total contact casting for more severe ulcers, but offers a balance between pressure relief and convenience.
3. Specialized Shoes:
   • Description: Shoes designed with extra padding, soft insoles, and a rocker bottom to help redistribute pressure from ulcerated areas.
   • Indications: Appropriate for less severe pressure injury or for use after more intensive offloading devices like total contact casts.
   • Benefits: Easier to wear daily, with some shoes designed to accommodate foot deformities such as bunions, hammertoes, or Charcot foot.
   • Considerations: May not provide sufficient offloading for severe or deep ulcers but useful for maintenance and protection.
4. Custom Orthotics:
   • Description: Custom-made insoles or foot supports designed to redistribute pressure across the foot evenly.
   • Indications: Suitable for individuals with moderate ulcers or those with a history of recurrent ulcers.
   • Benefits: Can be worn in regular shoes, providing both comfort and pressure relief.
   • Considerations: Customization is key for effectiveness, and the devices may need to be adjusted as healing progresses.
5. Offloading Sandals or Slippers:
   • Description: Specially designed sandals or slippers with cushioned soles and an open-toe design to prevent pressure on the foot.
   • Indications: For patients with smaller pressure injury that do not require complete immobilisation but still need relief from daily pressure.
   • Benefits: Comfortable, easy to wear indoors, and less conspicuous than other devices.
   • Considerations: Limited offloading ability for more severe pressure injuries.
6. Aircast and Pneumatic Boots:
   • Description: Boots that use air or foam cushions to reduce pressure on the ulcer while providing support to the foot and ankle.
   • Indications: Mild to moderate foot pressure injuries that need localised offloading.
   • Benefits: Adjustable levels of pressure relief, ease of use, and comfort.
   • Considerations: May not provide as much pressure relief as a total contact cast for larger or deeper injuries.

Factors to Consider When Choosing an Offloading Device:

1. Location and Severity of the Pressure Injury:
   • Larger, deeper pressure injury may require more aggressive offloading (e.g., total contact casting), while smaller ulcers may only require customised shoes or sandals.
2. Patient’s Mobility Needs:
   • If the patient requires mobility for daily activities, removable cast walkers, specialized shoes, or orthotics may be more appropriate.
3. Wound Type and Healing Status:
   • Active wounds may require complete immobilisation, while healing wounds may benefit from less restrictive devices that allow for movement and proper weight distribution.
4. Patient Compliance and Comfort:
   • Devices should be comfortable and convenient for the patient to wear, as consistent use is crucial for successful healing. Compliance is often improved with devices that allow for easier removal for wound care.