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This guideline is on the use of offloading interventions to promote the healing of foot ulcers in people with diabetes and updates the previous IWGDF guideline.<\/jats:p><jats:p>We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical\u2010scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention.<\/jats:p><jats:p>For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, we recommend that a nonremovable knee\u2010high offloading device is the first choice of offloading treatment. A removable knee\u2010high and removable ankle\u2010high offloading device are to be considered as the second\u2010 and third\u2010choice offloading treatment, respectively, if contraindications or patient intolerance to nonremovable offloading exist. Appropriately, fitting footwear combined with felted foam can be considered as the fourth\u2010choice offloading treatment. If non\u2010surgical offloading fails, we recommend to consider surgical offloading interventions for healing metatarsal head and digital ulcers. We have added new recommendations for the use of offloading treatment for healing ulcers that are complicated with infection or ischaemia and for healing plantar heel ulcers.<\/jats:p><jats:p>Offloading is arguably the most important of multiple interventions needed to heal a neuropathic plantar foot ulcer in a person with diabetes. Following these recommendations will help health care professionals and teams provide better care for diabetic patients who have a foot ulcer and are at risk for infection, hospitalization, and amputation.<\/jats:p>","DOI":"10.1002\/dmrr.3274","type":"journal-article","created":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T13:07:41Z","timestamp":1584364061000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":159,"title":["Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-9163","authenticated-orcid":false,"given":"Sicco A.","family":"Bus","sequence":"first","affiliation":[{"name":"Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine Amsterdam Movement Sciences  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David 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