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How to Select Offloading Devices

How to Select Offloading Devices

How to Select Offloading Devices



This topic provides guidance on selection of Offloading Devices. For an overview on offloading devices from the clinical, coverage and reimbursement perspective, see " Offloading Devices". For topics on diabetic foot ulcers see "Diabetic Foot Ulcer".  For customized case discussions, send a message to WoundReference advisory panel through Curbside Consult


For successful outcomes, choice of offloading devices may be guided by the criteria outlined in Algorithm 1 below.

Algorithm 1: Algorithm for Selection of Offloading Devices (click this link to enlarge) 

Criteria relevant for decision making is also itemized below: 

  • Evidence, as defined by availability of RCTs. See section 'Evidence and Recommendations' in topic "Offloading Devices"
  • Careful weighing of benefits and harms, appropriate, patient and ulcer-specific product selection 
    • Presence of comorbidities, such as peripheral artery disease and infection
    • Local factors such as location of the ulcer, ulcer chronicity/ recurrence/ healing rate, callus thickness and hardness
    • Offloading device indications, contraindications and features 
  • Patient’s and clinician’s preference and familiarity with the product
    • Clinician's familiarity with the device
    • Patient adherence to use of the device
    • Patient work and life-style requirements
  • Availability of resources and cost-effectiveness
    • Availability of a podiatrist for consideration of surgical offloading if indicated
    • Reimbursement
      • See section 'Coding, Coverage and Reimbursement' in topic "Offloading Device"
      • Patient co-pay
  • Adherence to standard of care :
    • Meticulous wound bed preparation, including removal of exudate and necrotic tissue, infection control, nutritional support
    • Diligent patient preparation and correction of systemic cofactors that impair healing;
    • Aggressive correction of the underlying wound etiology;
    • Proper application of offloading device (e.g. total contact cast)
    • Consistent, regular monitoring of outcomes
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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.
Topic 1462 Version 1.0


Practical guidance with step-by-step pictures, protocol and tips on how to apply different types of cellular and/or tissue products (CTPs), also known as skin substitutes