Offload First: The Antidote to Neuropathic Plantar Ulcers

In this episode Dr. G explains why offloading — removing pressure from the ulcer site — is the single most important intervention for neuropathic plantar diabetic foot ulcers. He reviews evidence and guidelines that favor non-removable total contact casts, practical offloading options, and how to integrate offloading into a full treatment plan. Key points include screening and treating infection and ischemia, sharp debridement, ensuring patient adherence through non-removable devices, and using adjunctive therapies when appropriate. The episode emphasizes multidisciplinary care, patient education, and frequent monitoring to optimize healing.