Key Points
- Chairside offloading can provide immediate pressure reduction for localised plantar pressure and pressure-related lesions.
- Identifying the pressure point is key: Clinical presentation, tenderness, lesions, inflammation and structural or functional changes can all help locate the area requiring offloading.
- ZeroSole can be customised chairside in minutes by removing individual hexagonal cells to create a targeted offloading cavity.
- Patient response can be assessed immediately by having them stand and walk in the customised insole.
- The right offloading approach depends on the patient, with felt, silicone putty (Otoform), bespoke orthoses and modular insoles each having different clinical applications.
Chairside offloading can be an effective, immediate intervention in clinical podiatry.
By identifying the area contributing to a patient's symptoms and creating a targeted offloading cavity directly beneath it, practitioners can assess the patient's response during the appointment and make adjustments where needed.
ZeroSole is a modular silicone insole designed for chairside offloading. Its individual hexagonal cells can be removed by hand to create a targeted offloading cavity beneath a specific plantar pressure point. Find out more here.
When is chairside offloading appropriate?
Chairside offloading can be considered for almost any pressure-induced foot lesion, with corns and calluses among the most common clinical presentations.
It’s particularly beneficial for patients presenting with high-pressure points driven by joint deformities, bony prominences or repetitive mechanical load concentrated in one area of the foot, such as:
- Focal hyperkeratosis: Recurrent corns, calluses and localised plantar pressure points.
- Forefoot load distribution: Metatarsalgia, such as capsulitis (inflammation of the joint capsule) caused by increased load concentrated beneath one of the metatarsal-phalangeal joints, commonly the 2nd or 3rd.
- Structural strain: High-pressure points over rigid joints or prominent bony structures.
In these cases, reducing pressure directly beneath the affected area can help address the mechanical cause of the tissue irritation.
How to identify the pressure point
Accurately locating the pressure point relies on assessing the patient's clinical presentation.
Key indicators include:
- Visible skin lesions or fixed structural deformities
- Specific areas of tenderness on direct pressure or palpation
- Localised signs of inflammation
- Noticeable structural or functional changes during gait assessment
How do you fit a chairside offloading insole?
Once the site has been identified, the standard approach is to create an offloading cavity directly beneath the problem area.
1. Map
Mark the pressure site, then transfer the indicator directly to the corresponding area on the insole.
2. Customise
Remove the individual hexagonal silicone cells beneath the marked area by hand to create the offloading cavity.
3. Assess and redistribute
Have the patient stand and walk in the customised insole to assess their response.
This allows the offload to be assessed and adjusted during the appointment rather than relying on a fixed configuration.
Managing patient expectations and tissue recovery
In many cases, the pressure-relieving benefit is apparent as soon as the patient stands and bears weight.
This provides immediate clinical feedback on whether pressure has been successfully reduced at the symptomatic site.
However, where tissues are heavily inflamed, it’s completely normal for symptoms to take a few days to a few weeks to settle as the affected area recovers.
Reducing mechanical pressure helps remove the ongoing source of irritation, but the affected tissue may still require time to heal.
What are the advantages of a modular, chairside approach?
For me, the primary advantage of a modular offloading insole such as ZeroSole is the balance of speed and durability.
Because it can be customised and fitted within a couple of minutes, the patient can experience the effect during the consultation rather than waiting for a bespoke device to be manufactured.
For plantar lesions and focal pressure points, a silicone insole provides a durable option for targeted offloading while allowing the practitioner to customise the offload position for the individual patient.
Pressure-mapping research found up to a 32% reduction in peak plantar pressure when ZeroSole was customised to create a targeted offloading cavity.
How does ZeroSole compare with other offloading options?
Selecting the appropriate modality depends on the location and cause of the pressure, the patient's foot mechanics and the level of support or correction required.
| Modality | Clinical application | Performance & limitations |
| Semi- compressed felt | Short-term relief; toe pressure points | Convenient for temporary use, but compresses under load and is less durable for longer-term plantar offloading. Requires cutting, shaping and skin adhesion. |
| Silicone props (Otoform) | Custom moulding around or between toes | An effective option for digital isolation and offloading prominent digital joints; lasts significantly longer than felt but is primarily suited to digital applications. |
| Fully bespoke orthoses | Advanced foot deformities; complex functional changes | Moulded to the patient's foot profile to accommodate significant structural deformities and provide greater correction or support. However, they involve longer lead times and higher costs, even when only simple focal offloading is required. |
| Modular silicone insole (ZeroSole) | Immediate, targeted plantar offloading | Can be customised chairside to create a targeted offload, providing a durable option for focal plantar pressure points. Pressure-mapping research found up to a 32% reduction in peak plantar pressure when customised for targeted offloading. |
How to match the intervention to the patient
There isn't a single offloading approach that’s right for every patient.
The most appropriate option will depend on the location and cause of the pressure, the patient's foot structure and function, and the level of correction or support required.
Chairside offloading gives podiatrists a way to address localised pressure during the appointment and assess the patient's response straight away.
For appropriate patients, a modular insole such as ZeroSole provides a quick, targeted and durable option for plantar offloading, while giving the practitioner the ability to customise and assess the offload during the appointment.
Discover ZeroSole for your practice
To find out more about using ZeroSole in your clinical practice, get in touch with our team.