Homemade, Custom Offloading Shoe for Diabetic Foot Ulcers

The offloading shoe is one of the most critical tools in treating neuropathic diabetic foot ulcers. A custom-made shoe/shoe insert provides much more accuracy in offloading the ulcer. Custom-made offloading shoes made by a certified orthotist are very expensive, and most of the uninsured patients will not be able to afford them. A cheaper version with removable-peg chassis insole is available. In our experience, this product tend to disintegrate quickly and fails to provide adequate long-term offloading. Unfortunately, patients with neuropathic foot ulcers without the diagnosis of diabetes are usually not eligible to have the custom-made shoes reimbursed by insurance.

We present a very affordable homemade, custom-made shoe that is sturdy and adjustable. It provides a good option for uninsured patients and those who can’t afford the professional offloading shoe.

The shoes are made from a pair of sandals, velcro strips, and a pair of soft, comfortable rubber flip-flops. The flip-flop is cut to size to match the sandal insole and is secured in place with velcro strips. A color is placed around the ulcer and the patient takes a few steps with the sandal in place to mark the position of the ulcer on the flip-flop. The last step is to carve out a hole in the flip-flop to match the ulcer. This step is preferably done at the clinic.

From our experience, this sandal is much more comfortable for the patient than the commercial removable-peg chassis insole and produced very good clinical results. We provide a picture tutorial of how to build this offloading shoe at home.