If you have a diabetic foot ulcer (DFU) or another type of wound on the bottom of your foot (the “plantar surface”), one of the most important parts of healing is offloading—taking pressure off the wound so it can heal.
Two commonly used offloading tools are Darco offloading boots and PegAssist insoles. Here’s what they are, how they work, and what you need to know.
Darco offloading boots are special medical footwear designed to reduce pressure on the bottom of your foot. They look like a postoperative shoe but have a stiff, supportive sole and can fit different kinds of insoles.
They are used to:
They are often used for:
PegAssist insoles are customizable pressure-relieving inserts that fit inside Darco boots.
They contain small removable “pegs.”
Your clinician removes the pegs under the area of your wound, which creates:
This type of “selective offloading” is helpful when only one area needs pressure relief.
Healing requires pressure reduction. When you walk normally, the bottom of your foot absorbs a lot of force. For people with diabetes or neuropathy, that pressure can make an ulcer worse—or prevent it from healing.
Darco boots + PegAssist insoles help by:
Studies show that peg-based insoles significantly reduce pressure under the ulcer site and are helpful both for healing and for preventing ulcers from coming back.
Major medical organizations—including the Society for Vascular Surgery, the American Podiatric Medical Association, and the Society for Vascular Medicine—recognize Darco boots and PegAssist insoles as acceptable offloading options when the gold standard isn’t possible.
Why?
Because patients cannot remove it. This enforces strict adherence and leads to the fastest and most reliable healing.
However, a TCC is not appropriate for everyone. It may not be suitable if you:
When TCC can’t be used, doctors commonly recommend:
Research shows:
That’s because patients cannot take the cast off—so the offloading is consistent.
Real-life studies show that removable devices (like Darco boots) are worn for less than 30% of daily walking time.
When people remove the boot often:
Clinicians sometimes secure the walker so it cannot be taken off.
In this case, healing rates become similar to TCC.
| Offloading Type | Healing Rate | Notes |
|---|---|---|
| Total Contact Cast (TCC) | Highest | Best pressure relief; cannot be removed |
| Irremovable walker boot | Similar to TCC | Better healing because adherence improves |
| Removable Darco boot + PegAssist | Lower healing rate | Works only if worn consistently |
| Regular footwear + insoles | Lowest | Not recommended for active DFUs |
Even the best offloading boot will not work if:
Every step without offloading adds repetitive stress to the ulcer.
Healing depends on:
Darco boots and PegAssist insoles are:
They allow targeted offloading without fully immobilizing your foot.
It may be recommended if you:
✔ Have a diabetic foot ulcer
✔ Can safely walk using a boot
✔ Need frequent wound checks
✔ Cannot tolerate or safely use a total contact cast
✔ Need a temporary or long-term offloading option
Your wound-care provider will help decide the safest and most effective option for you.
With proper use—and consistent wearing—these tools can significantly improve healing and help prevent future ulcers.
