Foot Care - Alternative Offloading Devices

Prefabricated sandals or healing shoes vary in design, materials and intention of use.For some patients these devices offer better fit, support, protection and cosmesis than our standard options.

Prefabricated sandal


If the treatment of choice being cast or splint is contraindicated there are numerous choices available. It is our experience that these devices still require some type of molded footbed to adequately provide pressure relief and structural support.

Darco with metatarsal bar
Darco with custom plastizote insert with cutout for relief
Hightop Darco boot
Darco with custom plastizote insert

We intend the use of such devices, much like the use of the Carville sandal, as an interim or a household device. We consider the use of these devices as adequate but not optimal.


Toe pillows and toe crests can be fabricated from a variety of different materials to provide local direct relief to one or more toes.

Toe pillow made of moleskin and a rolled 2" X 2" gauze"

Toe pillow made of moleskin and a rolled 2" X 2" gauze"

Birkoplast custom toe crest

Birkoplast custom toe crest


Adhesive backed felt cut out to relieve ulcerated area

Wound, felt covered with gauze and all wrapped with 2" kling

Adhesive backed felt cut out to relieve the ulcerated area can also be applied to the foot and left on for up to a week. The wound is covered with one 2" x 2" gauze and all is wrapped with a 2" kling. The felt can be worn inside a shoe or with an orthopedic shoe/sandal (ex. Darco, Ambulator).


An offshoot of the "Carville" sandal is the plastizote boot. The footbed is molded the same as a sandal but the upper is made of plastizote and rises to just below the gastroc muscle belly. This device offers added support for moderate to severely deformed feet such as resolved Charcot fractures for in-house and shower/bath use.

Plastizote boot


Plastizote boot with cutout to accommodate heel ulcer

Heel ulcers are also a common occurrence in the insensitive foot population secondary to long term bedrest or positioning during surgery. These ulcers can be located on the medial, lateral or posterior aspect with some plantar component. The boot is cut out to appropriately relieve the area. The boot is to be worn at all times especially when the involved foot is in contact with any surface (i.e. bed, recline, foot stool or sofa).

Date Last Reviewed:  April 2017

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