For patients, families and care teams
Most diabetic foot wounds are caused by pressure. Offloading takes that pressure off so a wound can heal, then protects the foot so it stays healed.
We work with your doctor, nurse practitioner and wound care nurse at every step, from an open wound to life-long protection.
Diabetes can quietly damage the nerves and blood flow in the feet. A small sore can become a serious wound before anyone notices. Knowing the risk is the first step to preventing it.
29%
of people in Saskatchewan live with diabetes or prediabetes
Diabetes Canada
Up to 25%
of people with diabetes will have a foot ulcer in their lifetime
Diabetes Canada
85%
of diabetes-related amputations start with a foot ulcer
Diabetes Canada
80%
of diabetes-related leg amputations can be prevented with timely care
Diabetes Canada
20 times
more likely to have a lower limb amputation than people without diabetes
Diabetes Canada
7,720
hospital stays each year in Canada are linked to diabetes-related amputations
Diabetes Canada
19 days
is the average hospital stay for a leg amputation
Diabetes Canada
$21,371
average health system cost of one diabetic foot ulcer, rising to $52,360 over 3 years if it becomes chronic
Wounds Canada
Wounds Canada reports that when a diabetic foot ulcer leads to an amputation, about half of people die within five years. Early care changes that path.
Diabetes is more than a number on a meter. Over time, high blood sugar damages blood vessels all through the body. That is why it affects the feet, and also the brain, eyes, heart and kidneys.
Sugar does this by sticking to proteins in the vessel walls, a process called glycation. It forms stiff cross-links that harden the vessels. It builds up slowly over years, which is why steady blood sugar control matters.
Nerves are fed by tiny blood vessels. When those vessels narrow, and high sugar harms the nerves directly, the nerves stop working well. The longest nerves are often affected first, and the longest nerves in the body go to the feet. This is called diabetic neuropathy. In people with diabetes, narrowed arteries are most common below the knee, so blood flow to the feet often drops first.
Hospital rates are for adults with diabetes compared with adults without diabetes in Canada (Public Health Agency of Canada, 2023 to 2024). Keeping blood sugar, blood pressure and cholesterol in your target range lowers the risk of all of these.
A thick callus on the bottom of the foot means that spot is taking too much pressure. The callus is hard, so it adds even more pressure, like walking on a stone.
The skin under a callus can break down and bleed before you see a wound. In one study, foot ulcers were 11 times more likely to form under a callus.
A diabetic foot ulcer heals best when all four parts of care happen together.
A wound on the bottom of the foot heals when it stops carrying weight. We do this in two steps.
A knee-high device does more than an insole. Its rigid shell and rocker sole hold the ankle still, so the front of the foot is not pushed into the ground at each step. Part of the load is also carried by the lower leg. This is why international guidelines list a knee-high device as the first choice for an open wound on the bottom of the foot.
Spread the pressure. A shoe is often not enough. Regular shoes, even good therapeutic shoes, do not take enough pressure off an open wound. Shoes and orthotics are for after the wound has closed and matured.
Your foot and calf are pumps. Each step and each ankle movement squeezes the veins and pushes blood back up to the heart. This makes room for fresh blood with oxygen and helps keep swelling down.
While a wound is open, the guidelines say less weight on the foot helps it heal. So the goal is to move safely, not to walk more:
This path follows the International Working Group on the Diabetic Foot (IWGDF) 2023 guidelines and the Wounds Canada Wound Prevention and Management Cycle: find the at-risk foot, treat the cause, offload until the wound closes, protect the new skin, then keep the foot in remission.
Who helps: You, your family, foot care nurses and doctors
Who helps: Your doctor or nurse practitioner, wound care nurse and a Certified Orthotist
Who helps: Your wound care team and a Certified Orthotist
VACOpedKnee-high walkersTotal contact insoles
Who helps: Your care team and a Certified Orthotist
Custom orthoticsExtra depth shoes
Who helps: You, a Certified Orthotist and your care team
Multilayer orthoticsCustom shoesAFOsCROW boots
When the skin closes, the work isn’t done. The new skin is thin, and the tissue underneath keeps rebuilding for up to a year. Even then, scar tissue only gets back about 80% of its original strength.
The first weeks and months after closing are the riskiest time for a wound to open again. There is no set number of weeks in the guidelines, so we step down in stages and check your skin at each step. Coming out of the device too early is a common reason a wound comes back.
Custom orthotics built in layers to spread pressure and protect healed skin.
Enough length, width and depth for the foot and the orthotic. Custom shoes when needed.
Support the foot and ankle when there is deformity or an unstable joint.
The VACOped Diabetic is a knee-high walker built for offloading the diabetic foot. A cushion filled with small beads moulds to the foot and leg. When the air is pumped out, the beads lock into a firm shape that touches the whole foot and leg, like a cast.
It is used for diabetic foot ulcers, after toe and forefoot amputations, and for Charcot foot.
Pressure relief
In 20 people with diabetes and nerve damage, a total contact cast lowered the force under the foot by 75% and the VACO diabetic boot by 64%. The VACO boot spread force the most evenly across the foot.
Healing
In an NHS evaluation of 20 people who could not use a non-removable device, most with infected wounds, 9 of 17 ulcers healed within 8 weeks. Ulcers still open were about 81% smaller on average.
Even pressure
Vacuum cushioned walkers relieved pressure under the front of the foot as well as post-operative shoes, and spread pressure better across the midfoot.
Wearing it matters
In a randomized trial, 83% of wounds healed in 12 weeks when a walker was made non-removable, compared with 52% when people could take it off.
Results vary from person to person. Removable devices work best when they are worn for all standing and walking.
Charcot foot can happen in feet with nerve damage. The bones get weak and brittle, almost like chalk, so they can crack and crumble during normal walking. Because the foot can’t feel it, the person keeps walking on it, and the joints in the middle of the foot collapse. The high arch on the inside of the foot can drop into a rocker bottom shape that puts high pressure on the middle of the sole.
Watch for a red, hot, swollen foot, often with little or no pain. It is often more than 2°C warmer than the other foot, and can be mistaken for a sprain, gout or infection. If Charcot foot is suspected, protect and offload the foot right away while the doctor confirms it.
A CROW (Charcot Restraint Orthotic Walker) is a custom boot made from a scan or cast of your leg. It holds the foot and ankle still, spreads pressure over the whole foot and lower leg, and has a rocker sole to help you walk. We make them in clinic, in plain colours or fun patterns.
Most foot wounds can be prevented. These everyday habits follow Diabetes Canada and Wounds Canada advice.
See your doctor right away for swelling, warmth, redness or pain in your legs or feet, or any open sore. Don’t wait.
We work with family physicians, nurse practitioners, wound care and foot care nurses, home care, vascular and orthopedic surgeons, infectious disease and endocrinology. Patients are seen by a Certified Orthotist, CO(c). You manage the wound. We manage the pressure and keep you updated.
This short video from OPED shows how a vacuum cushion forms a total contact shell around the foot and leg, much like a cast, with a rocker sole for walking. We assess each patient to choose the right offloading device.
Video: OPED
Education for your team. We can present on offloading, Charcot foot and footwear for your clinic, home care or long-term care team. Call 306-566-4666 or email [email protected].
Shoes do not take enough pressure off an open wound on the bottom of the foot. The guidelines say to use an offloading device, not regular or therapeutic shoes, until the wound closes.
Wear it for all standing and walking, indoors and out, including short trips at night. Even a few steps without it press on the wound. Healing is better when the device is worn as directed.
Less weight on the foot helps an open wound heal, so walk only as much as your team advises, and always in your device. Keep moving in safe ways, such as seated ankle pumps, to keep blood flowing and swelling down.
It depends on the wound, blood flow, infection and how closely the device is worn. Many wounds take weeks to a few months to close. Then you step down to orthotics and shoes with your care team.
Yes. A prescription from your doctor or nurse practitioner is needed before a device is made and dispensed. You can book a consultation and assessment before you have one.
Many plans and programs cover offloading devices, orthotics and footwear, in full or in part. Any amount not covered is your responsibility, and our price is the same no matter who is paying. We direct bill SAIL, NIHB, Métis Nation-Saskatchewan, SGI, Veterans Affairs Canada and WCB when you are eligible.
There is no set number of weeks in the guidelines. The new skin is weakest right after it closes and keeps strengthening for up to a year. We step you down in stages, often from a knee-high device to an ankle-high device to shoes and orthotics, and check your skin at each step.
Your foot is in remission, not cured. About 40% of healed ulcers come back within a year, so you wear custom orthotics and supportive shoes for all standing and walking. If a sore returns, go back to your offloading device and call your care team.
Early pressure relief gives a wound the best chance to heal.
Call 306-566-4666, email [email protected], or send a prescription online.
Foot and leg illustrations adapted from Servier Medical Art (smart.servier.com), CC BY 4.0. Icons from Health Icons (healthicons.org).
