Aim: The project aimed to assess the frequency of offloading provision for diabetes-related plantar neuropathic forefoot ulcers and the factors influencing the choice.

Methods: Operational managers from 51 prosthetic and orthotic clinics in Sweden were contacted to select the participants. An online survey including seven closed-ended questions was conducted through SurveyMonkey.

Results: The response rate was 68.6%. The majority of the participants provided the least efficient offloading intervention being off-the-shelf footwear combined with the insole to treat diabetes-related plantar neuropathic forefoot ulcers.  It also resulted that the two gold-standard devices to treat this ulcer type being total contact cast (TCC) and non-removable knee-high walker, were vastly underutilized. Most of the practitioner, patient, intervention, and wound-related factors were considered a median of “often” or “always” being considered when providing offloading interventions for this type of ulcer. The majority of the participants did not consider TCC or non-removable knee-high walkers being the gold standard. 

Conclusions: A variety of offloading interventions resulted in being provided to patients having diabetes-related plantar neuropathic forefoot ulcers. Participants mainly provided the inadequate pressure distribution offloading intervention, being off-the-shelf footwear with modifications combined with an insole. The gold standards TCC and non-removable knee-high walkers were underutilized. That is, the pattern of providing offloading devices was almost exactly opposite to what evidence-based guidelines recommend. The clinicians’ unawareness regarding gold standard devices may have contributed to the underutilization of TCC and non-removable knee-high walker. Different factors were considered when providing offloading interventions to patients with diabetes-related plantar neuropathic forefoot ulcers. It is concluded that clinicians in Swedish P&O clinics need to have greater awareness regarding the most appropriate offloading device for plantar neuropathic forefoot DFUs. This is of great importance due to the choice of the offloading device greatly impacts ulcer healing.