One of the great challenges to diabetes care is leg and foot wounds and ulcers. Diabetic patients are more prone to leg ulcers than any other patient. Diabetes is the primary cause of non-traumatic leg amputation.

Diabetic foot ulcers are commonly located on the sole of the foot and can result in infection or other wounds/ulcer-related complications.

The primary aim of treating foot ulcers is for it to heal as soon as possible so as to reduce the risk of infection.

There are many ways to treat foot ulcers, and one of them is off-loading, which involves taking pressure off the affected part of the feet. This technique is used especially for ulcers and pressure sores on the bottom of the foot.

Pressure off-loading may involve the use of crutches, wheelchairs, wearing special casting, foot gears or shoes. Again, the aim is to reduce pressure and irritation to the part of the feet affected by ulcer and speed up the healing process.

One of the leading brands for foot and ankle wound care solutions after surgery and trauma care is Darco Inc.

Founded in 1985, DARCO International Inc. (USA) focus on the solution to foot and ankle wounds. Today, they have branches in other places such as Germany and India.

Darco offers a full product line of footwear specially designed to control plantar pressure (flat arch pressure), and also for the circumstances where diabetic ulcers or wounds are present on foot, or after a foot or ankle surgery.

DARCO Diabetes Off-loading and Wound Care product includes the following.

  • PegAssist Off-loading Insole, a range of full-contact orthoses and total contact inserts (TCI)
  • Wound Care Shoe System with a healing shoe
  • OrthoWedge, a negative heel rocker bottom sole shoe.
  • HeelWedge, a toe-only rocker bottom sole shoe.
  • MedSurg, a postoperative/ healing shoe
  • GentleStep diabetic shoe, a customizable, extra depth and therapeutic shoe

These products, offer great value, can be effectively placed on patients and/or customize in minutes and more so, they are readily available.

With the perfect outlook noted above, one of the repetitive questions that our readers ask is whether the Darco off-loader footwear range is really effective in the management of their diabetic foot condition.

So, here we are addressing all those doubts in this Darco offloading shoes and insoles Review.

Let’s review each of Darco offloading shoes and insoles products one by one.

Darco PegAssist Insole System Review

Do you need targeted off-loading? Then you need a Peg-Assist Insole.

The DARCO PegAssist™ Insole System promotes a removable-peg chassis with multiple indications that effectively off-loads the sole after foot and ankle surgery or when there are leg wounds.

PegAssist Insole System

It reduces the leg pressure by almost 60% while allowing the patient to move around. With a Patent #8201346 and suggested code: A9283 it plays a unique function.

PegAssist™ Insole System is available in two styles for use with most DARCO footwear.

  • Seven Size model (PTQ Series Insole)

This is for styles that have specific men’s and women’s sizes, such as Med-Surg™ Shoe.

  • Five Size model (PQ and PW Series Insole)

It works with unisex shoes and standard walkers.

Darco PTQ Series Insole – 7 Size model

This is for styles that have specific men’s and women’s sizes, such as Med-Surg™ Shoe.

The PTQ Series PegAssist Insole is designed to fit the DARCO Square-Toe MedSurg Shoe. It helps to significantly reduce pressure after a surgical operation, and it is a cost-effective option for wound care.

The PTO series for square Toe Med-Surg shoe comes in 7sizes as noted below.


Female sole sizes Shoe size
Small 4 – 6
Medium 6.5 – 8
Large 8.5 – 10
Male sole sizes Shoe size
Small 6-8
Medium 8.5 – 10
Large 10.5 – 12
X-Large 12.5 – 14


PQ Series Insole – 5 size model

It works with unisex shoes and standard walkers.

PegAssist Insole System in Action

The PQ Series PegAssist System is designed to fit the HeelWedge, OrthoWedge, APB and SlimLine.

There are 5 PQ insole sizes, and they are as below.

Size Women’s Size Men’s Size
X-Small 4 -7
Small 7.5 -10 6 – 8
Medium 10.5 – 13 8.5 – 10
Large 13+ 10.5 – 12
X-Large 12.5 – 14


PW Series Insole – 5 size model

It also works with unisex shoes and standard walkers.

PW Series PegAssist is easy to use a product that turns most standard walkers into an effective off-loading device.

With a low profile molded hook strip attached to the stabilizer board, this sticks to the liner of the walker liner to prevent shifting while walking.

It Fits the FX Pro Walker and other standard walkers and comes in 5 sizes.

Size Women Men
XS 3.5 – 6
S 6.5 – 9 5 – 7.5
M 9.5 – 12 8 – 10.5
L 12.5+ 11 – 13
XL 13.+

Tip: Did you know that Calming Comfort® Cooling Knee Pillow can help you to Align Your Spine While Sleeping.

Features and Benefits

  • Single-use marking compound ensures proper peg removal during fitting.
  • The removable pegs enable one to localize the off-loading of wounds and ulcerations of the foot.
  • Each of insole has a combination of 15mm Plastazote and Multi-Foam base with a 3mm Poron cover.
  • The Platazote layer absorbs shock and conforms to the foot comfortably.
  • With PORON Cushioning cover which minimizes friction, helps to
    eliminate the incidence of ring edema and edge abrasion.
  • Comes with a stabilizer board/Peg Support Board that adheres to the black side of the insole to keep offloaded area intact and helps to maintain product integrity.

YouTube video


  • Cost-effective
  • Moldable and allows you to offload pressure at almost any spot under the sole of your feet.
  • It fits both the left and the right feet.


  • It doesn’t come in pairs
  • The insoles easily start collapsing around the area the pegs have been removed from.


Darco Wound Care Shoe (WCS) System Review

Darco Wound Care Shoe System™ is the best product when dealing with stage 3 diabetic foot ulcers (Wagner Grade 3) or severe ulcerations. It can also help with bony prominences and long-term treatment of wounds and ulcerations.

Designed with four multi-density insoles that can be customized to effectively eliminate pressure from the sole of the foot. It allows the patient to move about freely and still achieve maximum post-operative off-loading.

The shoe comes as open or close toes with the Suggested Code: A9270.

YouTube video

Features and Benefits

  • Four multi-density insoles, which
    allow one to modify and accurately target off-loading.
  • It comes with an Ultra-soft Plastazote Lining that provides a friction-free contact surface that won’t worsen the wounds. (open-toe only)
  • Genuine Leather Upper layer can be modified or cut away to provide higher levels of pressure relief. (open-toe only)


  • Sold in pairs to eliminate lack of comparability in shoe height.
  • Compatible for use in all stages of wounds
  • It offers long-term pressure relief.
  • It is easy to customize

Tip: Check it out this Guide to AirCasts, AirCast Ankle Braces and AirCast Boots.


· No available in different color options


WCS Size Women’s Shoe Men’s Shoe
XS 4 – 5.5
S 6 – 8.5 6 – 7.5
S/M 9 – 9.5 8 – 8.5
M 10 – 10.5 9 – 9.5
L 11 – 12.5 10 -11.5
XL 13 – 14.5 12 -13.5
2XL 15 – 17 14 – 16

Wound Care Shoe (WCS) System



Size of Replacement Insoles

Size Women’s Shoe Size Men’s Shoe Size
X-Small 4 – 5.5
Small 6 – 8.5 6 – 7.5
Small/Medium 9 – 9.5 8 – 8.5
Medium 10 – 10.5 9 – 9.5
Large 11 – 12.5 10 – 11.5
X-Large 13 – 14.5 12 – 13.5
2X-Large 15 – 17 14 – 16


Darco OrthoWedge Off-loading Shoe Review

The DARCO OrthoWedge™ half shoe is scientifically proven to minimize weight-bearing pressure on the forefoot. Due to that reason, it can promote faster wound healing after surgery, forefoot trauma or when there are wounds or ulcerations under metatarsal heads and toes and any condition that requires forefoot pressure off-load.

OrthoWedge Off-loading Shoe

The shoe is designed in a way to help minimize the number of steps taken by the patient while still allowing them to be mobile when necessary.

It helps to reduce forefoot pressure by almost 60%. And, it comes with the suggested code: A9283.

This shoe is available in five sizes – see the sizing chart tab below

Features and Benefits

  • The wide sole, square toe design, and ankle strap provide more toe protection and increase stability while walking.
  • Square-toe design helps to protect the toes by acting as a bumper.
  • Ankle strap assists you to keep the foot firmly in shoe to minimize the chances of heel slippage and also eliminate friction.
  • Removable forefoot closure removes buckle pressure. And, also it can house dressings circumference up to 17″.
  • The zoned outsole has an aggressive tread beneath the mid foot area where traction is needed the most.
  • EVA insole features twice the padding compared to a standard insole and it even can be modified as needed. The insole can be removed totally to accommodate the customizable DARCO’s innovative Peg Assist off-loading insole for more targeted off-load.

YouTube video


Size Women’s Shoe Size Men’s Shoe Size
X-Small 4 – 7
Small 7.5 – 10 6 – 8
Medium 10.5 – 13 8.5 – 10
Large 13 + 10.5 – 12
X-Large 12.5 – 14



  • It is compatible with PegAssist Insole System (PQ) and Body Armor Toe Guard (BATGQ)
  • Fits Left or Right foot


  • The shoe is not sold in pairs.
  • Highly elevated at the middle, which makes walking with it a little awkward.

Tip: Rooke® Vascular Boots can help you Prevent Leg Ulcers, and Protect and Heal Wounds Fast too.

Darco HeelWedge Off-loading Shoe Review

Darco HeelWedge™ shoe shifts weight to the mid foot and forefoot and is proven scientifically to off-load pressure from the heel area by at least 26%. This pressure reduction promotes faster healing after surgery, injuries, or when there are wounds or ulcerations on the heel.

The insole can be removed fully to provide space for a Darco’s innovative Peg Assist customizable off-loading insole for an even more targeted off-load functionality. It comes with the Suggested Code: L3260.

DARCO HeelWedge Off-loading Shoe

Features and Benefits

  • Its square toe design acts as a ‘bumper’ which protects the toes while the ankle strap holds the foot firmly on to the shoe.
  • It comes with a Forefoot Closure, which is removable, eliminates buckle pressure.
  • It has an aggressive tread under the mid foot, which is called Zoned Outsole. It provides traction support to where the traction is needed most.
  • The EVA Insole can be customized and features twice the padding of standard insoles.


Size Women’s Shoe Size Men’s Shoe Size
X-Small 4-7
Small 7.5 – 10 6-8
Medium 10.5 – 13 8.5 – 10
Large 13 + 10.5 – 12
X-Large 12.5 – 14



  • Fits left or right foot.


  • The shoe is sold individually and not in pairs.

Darco MedSurg Postoperative Shoe Review

MedSurg™ postoperative shoe is the most versatile after surgery shoe in the market. It is designed to provide your foot with safer protection and to accommodate any bulky bandages comfortably.

This double-padded and removable insole can be customized to accommodate the PegAssist (PTQ Series) off-loading insole. It is designed with rocker bottom sole and removable EVA insole that can be customized to eliminate or reduce pressure under the surgery site or wounds sites on the sole, by reducing the pressure up to 25% for a comfortable walking experience.

You can wear this shoe in a few circumstances.

  • Following a leg or foot surgery or when K-wires are present,
  • When large bandages or dressing are used to cover your wounds,
  • When off-loading wounds, as a platform for the PegAssist (PTQ Series) insole.

Its square toe shoe design allows better right/left fit and good protection when K-wires protrude from the toes.

MedSurg Postoperative Shoe

The aggressive tread at the shoe mid foot offers excellent traction and stability. The reduced-friction tread at the heel and toe positions of the shoe also helps to prevent accidental tripping.

Features and Benefits

  • The Square toe design to provide additional protection, especially when K-wires are present.
  • The meta-shank design at the sole of the shoe gives additional support to the metatarsal region, especially when walking
  • Forefoot hook and loop (strapless) closure helps to get rid forefoot buckle pressure, and it can expand to allow dressing circumference up to 17 inches.
  • The elastic strap at the ankle and raised heel counter help eliminate heel slippage
  • It is compatible with Darco’s PegAssist (PTQ Series) off-loading insole.
  • It uses Patent #7231728.

Men’s Sizes


Men’s Size Shoe Size
Small 6-8
Medium 8.5 – 10
Large 10.5 – 12
X-Large 12.5 – 14


Women’s Sizes

Women’s Size Shoe Size
Small 4 – 6
Medium 6.5 – 8
Large 8.5 – 10


Children’s Sizes

  Children’s Size
Pediatric size 12 – 1



  • Shoes can fit either left or right foot.
  • Comfortable to wear all day.
  • It is compatible With PegAssist Insole System (PTQ) and Body Armor Toe Guard (BATGQ).


  • Shoe not sold in pairs but single. If you need it for both legs, then you must buy two items. Single-use marking compound ensures proper peg removal during fitting. Peg Support Board adheres to the black side of the insole to keep offloaded area intact.

Darco GentleStep Diabetic Shoe Review

The Darco GentleStep™ Shoe is an extra-depth therapeutic shoe approved by Medicare to meet the needs of certain diabetic patients. This is the best shoe for patients with forefoot deformities or lesions.

This shoe is fitted with a pair of multi-density, removable insoles and is vented for breathability and moisture control.

This shoe conforms to the Medicare Therapeutic Shoe Bill.

It is machine washable.

Sold as a pair.

GentleStep Diabetic Shoe

It is recommended for those with Edema, Heel Pain, Bunions, Pronation, Flat Feet, Arch Pain, Ankle Pain and Back Pain.

Features & benefits

  • Molded Outsole provides a lower profile which enhances the style by concealing the extra depth.
  • The Light-weight upper LYCRA provides extra comfort for patients with forefoot deformities or lesions.
  • The Firm Heel Counter for rear foot stability guarantees a stable and comfortable fit.
  • Machine Washable. This means that only a Gentle Step is needed to continue looking clean.
  • The smooth outsole at the toe area helps to minimize the risk of falling accidentally or tripping on carpets.
  • Fitted with a single hook and loop strap fastener for easy closure.
  • A removable insole makes sure to accommodate the custom-made orthotics.
  • It has 22 sizes.
  • Every size comes in 3 width – medium (B & C), Wide (D & E) and extra wide (E & EE)

Tip: This is our Guide to Selection The Best Footwear for your Diabetes.


Note that the Sizing is in Men’s size but convert for Women’s Size b cutting 1.5 sizes down for Women’s to Men’s size.

Women’s Sizes Men’s Sizes
5.5 4
6 4.5
6.5 5
7 5.5
7.5 6
8 6.5
8.5 7
9 7.5
9.5 8
10 8.5
10.5 9
11 9.5
11.5 10
12 10.5
12.5 11
13 11.5
13.5 12
14 12.5
14.5 13
15 13.5
15.5 14
16 14.5



  • Low profile
  • Unisex
  • Machine washable
  • Sold as a pair
  • They look just like ‘normal’ shoes
  • Accommodates Ankle – Foot orthotics (AFOs) and Knee – Ankle – Foot orthotics (KAFOs)


  • It comes in only black color


The incidence of wounds and ulcerations are increasing with the increase in the number of people from diabetes worldwide.

The healing and offloading Diabetes foot ulcers are challenging, and it is essential to take care of and treat diabetic foot ulcers. The good news is that this can be done by using reputable off-loading devices and shoes such as the ones made by Darco.

One of the main focus of DARCO International is the diabetic foot and ankle care. They provide devices to help to avert the development of wounds and ulcers as well as to encourage and faster the healing process of existing wounds.

Tip: For heal protection and to prevent pressure sores, you could consider one of these Heel Protectors.


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