Aims <p>Diabetic foot ulcers (DFUs) pose a significant global health concern, particularly in countries with high diabetes prevalence, such as India. This review aims to explore the role of offloading in DFU management, focusing on its relevance to the Indian healthcare system. It evaluates both global and India-specific offloading strategies for the treatment and prevention of DFUs.</p> Methods <p>A comprehensive review of literature was conducted, examining the epidemiology, pathophysiology, and offloading modalities used in DFU management. Systematic reviews and studies on total contact casting, removable cast walkers, therapeutic footwear, and innovative Indian offloading systems such as the Bohler iron walking cast, Mandakini offloading system, Samadhan, and Suvidha systems were evaluated. Socioeconomic and cultural challenges in implementing offloading in India were also addressed.</p> Results <p>The review found that effective pressure redistribution through various offloading techniques is crucial for DFU treatment and prevention. Indian innovations, including cost-effective and accessible offloading systems, provide viable alternatives for resource-limited settings. However, barriers such as cultural and socioeconomic factors limit the widespread adoption of these strategies in India.</p> Conclusions <p>Adapting global best practices to the Indian context, along with local innovations, is essential for improving DFU management. A multidisciplinary approach, community-based education, and India-specific research are key to addressing the challenges in offloading strategies. This review provides actionable recommendations for clinicians and policymakers to reduce the burden of DFUs in India.</p>