How do Podiatrists Off Load the Foot?

There are many reasons that a podiatrist or other health professional might want to offload the foot or part of the foot. Offloading refers to getting the load off the foot. This is required when the higher load or pressure is contributing to the foot problem. This could be as simple as a corn or it could be as serious as an ulcer in someone with diabetes. It could be a musculoskeletal problem that needs a period of time in which there is no load on it to help it get better. One of the big problems with treating foot problems is that we still need to walk on it to get around and carry out our daily activities. If it was, for example, a sore elbow, it is much easier to stop using it. This makes the treating of foot problems more challenging and the need to use various offloading strategies.

There are lots of different methods to offload the foot. The commonest and oldest is probably the use of podiatry felt. This is generally self adhesive and it is cut to shape so it fits around the area of the high pressure and not over it. That way the pressure is removed from the area. Typically, tape is also used to help keep the padding in the right place. The foot must be kept dry and if needed the felt can be replaced every few days. Podiatry felt is also relatively cheap compared to other methods. The felt is typically used for smaller areas that need offloading such as a corn, an ulcer or something like a sesamoiditis which is a painful problem of the small bones under the big toe joint.

Another common method of offloading is the use of foot orthotics. A foot orthotic that is made to the shape of the foot, spreads the weight out evenly over the whole foot, so can reduce the load on an area that has too much and spread it to other areas of the foot. In some cases, cavities or holes can be cut in the foot orthotic to further off load a painful area. The foot orthotic can either be custom made or of the pre-made type which could be modified to fit the foot more precisely.

In the more extreme cases, the most effective way to offload a foot that has an ulcer is to use a total contact cast or one of the similar prefabricated walking braces. If the problem is a musculoskeletal one, then a moon boot or walking brace can be used. These types of devices are very effective at offloading and are widely used by podiatrists and other health professionals who treat foot and lower limb problems. They do make walking a bit more difficult, but if that does encourage the user to walk less then that is a good thing. Sometimes that limp that the brace causes may lead to other problems in the hip and back and there also can be an increased risk for falls, so it has to be managed carefully.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.