Recommendation 1: In patients with plantar DFU, we recommend offloading with a total contact cast (TCC) or irremovable fixed ankle walking boot (Grade 1B).

Recommendation 2: In patients with DFU requiring frequent dressing changes, we suggest off-loading using a removable cast walker as an alternative to TCC and irremovable fixed ankle walking boot (Grade 2C). We suggest against using postoperative shoes or standard or customary footwear for off-loading plantar DFUs (Grade 2C).

Recommendation 3: In patients with non-plantar wounds, we recommend using any modality that relieves pressure at the site of the ulcer, such as a surgical sandal or heel relief shoe (Grade 1C).

Recommendation 4: In high-risk patients with healed DFU (including those with a prior history of DFU, partial foot amputation, or Charcot foot), we recommend wearing specific therapeutic footwear with pressure-relieving insoles to aid in prevention of new or recurrent foot ulcers (Grade 1C).