Background: Non-removable knee-high devices are the gold-standard offloading treatments to heal plantar diabetic footulcers (DFUs). These devices are underused in practice for a variety of reasons. Recommending these devices for all patients,regardless of their circumstances and preferences influencing their ability to tolerate the devices, does not seem a fruitfulapproach.

Purpose: The aim of this article is to explore the potential implications of a more personalized approach to offloading DFUsand suggest avenues for future research and development.

Methods: Non-removable knee-high devices effectively heal plantar DFUs by reducing plantar pressure and shear at theDFU, reducing weight-bearing activity and enforcing high adherence. We propose that future offloading devices shouldbe developed that aim to optimize these mechanisms according to each individual’s needs. We suggest three differentapproaches may be developed to achieve such personalized offloading treatment. First, we suggest modular devices, wheredifferent mechanical features (rocker-bottom sole, knee-high cast walls/struts, etc.) can be added or removed from thedevice to accommodate different patients’ needs and the evolving needs of the patient throughout the treatment period. Second, advanced manufacturing techniques and novel materials could be used to personalize the design of their devices,thereby improving common hindrances to their use, such as devices being heavy, bulky, and hot. Third, sensors could be usedto provide real-time feedback to patients and clinicians on plantar pressures, shear, weight-bearing activity, and adherence.

Conclusions: By the use of these approaches, we could provide patients with personalized devices to optimize plantartissue stress, thereby improving clinical outcomes.