Padding and Offloading
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Padding and offloading means using cushioning or devices to take pressure off one spot on your foot or heel. It is used most often for foot ulcers (open sores) in people with diabetes and loss of feeling in the foot. It is also used for heel pressure injuries and sesamoiditis, which is pain near the big toe. A non-removable knee-high cast or walker is the first choice for these ulcers. Felt or foam padding is used on its own only when no device is available. How well it works depends a lot on how much you wear it.
What is it?
Padding and offloading means using cushioning materials or devices to reduce or remove pressure from a vulnerable spot. The aim is to ease the downward pressure, the rubbing or dragging forces and the strain on the tissue, so the spot can heal or avoid breaking down further.
The options range from felt or foam pads to boots and casts that reach up to the knee. Podiatry felt padding takes the pressure off a small area, and its sticky backing keeps it in place.
Padding is one way of taking pressure off a spot. It doesn't replace working out why that spot is under pressure in the first place.
What is it used for?
The best-established use is for ulcers (open sores) on the sole of the forefoot or midfoot in people with diabetes who have lost feeling in their feet (neuropathy). For these, a non-removable knee-high device is the first choice. A removable device is the second choice. Appropriately fitting footwear with felted foam (a layer of felt and foam, often with a hole cut out at the sore) is third, and is used when no offloading device is available.
Felted foam can also be added to a removable ankle-high boot, with a hole cut at the ulcer. This seems to help ulcers heal better than wearing the boot alone.
After an ulcer heals, footwear that has been shown to relieve pressure under the foot while you walk helps stop it coming back. Your podiatrist can prescribe this for you.
Other uses include:
- Heel pressure injuries: these need treatment of the sore itself as well as proper offloading. How much you can walk depends on how deep the injury is. With milder or stable injuries you can usually walk in an offloading device. With the deepest injuries, or ones that can't yet be graded, you should avoid walking and use an offloading device when in a wheelchair.
- Sesamoiditis: a pad in your shoe or directly on your foot cushions and takes pressure off the sesamoids (small bones near your big toe). The padding is usually semi-compressed felt.
- Pressure under the ball of the foot: pads placed just behind the ball of the foot (metatarsal pads) can reduce the pressure inside your shoe.
Is it right for me?
It suits people with a pressure-related sore or injury that needs pressure taken off to heal. Most often this is a plantar (sole of the foot) ulcer in diabetes or a heel pressure injury. Your podiatrist will choose the kind of padding or device that fits your situation.
Non-removable devices heal more ulcers than removable ones, but they aren't safe for everyone. They shouldn't be used if you have:
- an infection in the soft tissue of your foot or leg
- an infection in the bone
- severe problems with the blood supply to your leg
- severe swelling of your lower leg or foot
Your clinician should check for these before using one.
Felt padding can be used when there is a mild to moderate infection, because the wound can be looked at each time the dressing is changed. It isn't suitable for wounds that leak a lot of fluid, or for wounds that extend under the skin edge, because the padding may increase pressure around the edge of the wound. Felt also has to be kept dry.
For heel offloading in bed, the choice depends on how active you are. Foam wedges suit people who stay in bed. Leg rolls suit people who move around more.
If you have a foot ulcer, a painful pressure spot or diabetes, ask a podiatrist to choose and fit padding rather than improvising.
What happens?
Your podiatrist will choose the padding or device to suit your foot and your wound. Felt can be applied quickly, with no extra hospital appointments or special skills needed. Even so, applying padding well takes time and training, so it should be done by a trained clinician.
For an ulcer, the padding is usually felted foam with a hole (an aperture) cut at the ulcer site. It is stuck to your foot or to the insole of a removable ankle-high boot. Your podiatrist will decide how thick the padding should be, how long you wear it and how many visits you need.
Padding wears flat under your body weight, so it needs replacing regularly. If you have an offloading device, your podiatrist will change the dressing regularly.
A non-removable cast is moulded closely to your foot and leg, and you can't take it off. Until a cast can be provided, your podiatrist may offer another offloading device.
For heel injuries in bed, foam wedges are positioned so the heel is lifted clear of the surface. Leg rolls are sized correctly so they don't shift.
How well does it work?
A non-removable cast or walker heals more ulcers than a removable device. In a small trial of shallow ulcers that weren't infected and didn't have blood supply problems, 89.5 per cent healed by 12 weeks with a total contact cast (a close-fitting cast that spreads pressure across the whole foot). With removable walkers or half-shoes, 61.4 per cent healed. Treat these figures as a rough guide. When casts were compared separately with removable walking casts or with footwear, the difference in healing time was not clear-cut.
Felt does reduce pressure under the foot. On average it lowered it by 10.77 kilopascals (a measure of pressure). Felt on the skin and felt on the shoe gave similar healing rates, but that doesn't show they work equally well. Felted foam ranks below casts and other devices, so it is used on its own when no device is available.
Whether you wear the device matters most. Even the best device doesn't work if it isn't worn. Wearing it for at least 80 per cent of your daily activity is considered essential. On average, people wear removable walking casts for about 59 per cent of their daily activity and therapeutic footwear for about 50.3 per cent. A cast that you can't take off makes sure you are protected. If you choose a removable device, choose the one you can actually wear for most of your walking time.
Whether metatarsal pads ease symptoms such as pain or callus, rather than just lowering pressure inside the shoe, isn't clear yet.
Risks and side effects
The best-known risks come from casts and other non-removable devices. They are linked with more device-related problems, such as skin irritation and rubbing. They also stop you and your clinician from checking the ulcer every day. They may lead to new sore spots, although they may also cut infections and make it more likely that you stay with the treatment. A well-moulded cast helps avoid pressure spots and rubbing. Keeping your foot clean and dry helps prevent soggy skin and infection.
Felt and foam padding can wear flat and stop working well. On a wound that extends under the skin edge, a pad may increase pressure at the wound edge. Dressing adhesive can injure the skin of a heel pressure injury, and a silicone dressing is strongly recommended to help prevent this.
Surgery to lengthen the Achilles tendon (the large tendon at the back of your ankle) is sometimes suggested if non-surgical offloading hasn't healed a forefoot ulcer. It carries higher costs and risks than other pressure-relieving methods, including more new heel ulcers. It is only considered when other methods have failed. Other operations may also be considered at that point.
If you can't feel your feet well, check them every day, including under any device, for cuts, blisters and rubbing. If a device is causing skin problems or you aren't wearing it, tell your clinician instead of stopping or adjusting it yourself.
Afterwards
Keep your follow-up visits. Your podiatrist will check that the offloading is working and that you are wearing the device, replace padding that has flattened, and look at the wound at each dressing change.
Keep wearing your prescribed device or footwear as instructed. After an ulcer has healed, therapeutic footwear that has been shown to relieve pressure while you walk helps prevent it coming back.
If you have diabetes, check your feet every day. If you find a new ulcer or a new break in the skin on your foot, see your GP, podiatrist or another doctor today.
When to see a podiatrist
Book an appointment if
You have a pressure sore or painful pressure spot that isn't improving. Your padding has flattened or come off. A device is rubbing, irritating your skin or hard to wear. Your daily foot check shows a cut, blister or rubbing. Book an appointment with your podiatrist for any of these. If a sore keeps coming back or doesn't get better, see your podiatrist or GP soon.
Seek prompt assessment if
Call your local emergency number if your leg, foot or toes suddenly turn cold and pale or blue, or go numb. Also call if you have a foot wound or infection and feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, as this could be sepsis. See your GP or another doctor today, without waiting to be contacted, if you notice increased pain, spreading redness, swelling, more discharge, a fever, an offensive smell, a new break in the skin, a pocket of pus (abscess), a large area of ulceration, or severe pain. Do the same if your clinician suspects Charcot foot (a condition affecting the bones and joints of the foot). If you have diabetes, a new ulcer or new break in the skin on your foot also needs a doctor today. If your GP can't see you today, go to an urgent care clinic or an after-hours GP. Padding and offloading should never delay any of this.
Frequently asked questions
Can I buy felt or foam and pad my foot myself?
It's best not to, especially if you have diabetes, an ulcer or reduced feeling in your feet. Padding in the wrong place or on the wrong kind of wound can increase pressure. A podiatrist can choose the right material, fit it and check it as it wears flat.
Why can't I take my cast off?
A cast that can't be removed makes sure the ulcer stays protected whenever you walk. Because it also stops daily checks of the ulcer, your clinician will look at it at your follow-up visits. If the cast rubs or causes skin problems, tell your clinician.
How long do I need to wear an offloading device?
Your clinician will decide this for you. For ulcers, wear your device or footwear for as much of your walking as you can. About 80 per cent of your daily activity is considered essential. Your clinician will review how it is working at your follow-up visits.
Is a total contact cast better than a removable boot?
For healing most foot ulcers, a non-removable device is the first choice, because it can't be left off. A removable boot can still work well if you wear it consistently. Casts aren't safe for everyone, so your clinician will check your foot and leg first.