Reduction of pressure, or offloading, is another essential aspect of diabetic wound care. Foot pressures, shock, and shear can be reduced with appropriately fitted shoes, insoles, and socks. Total contact casts (TCCs) and removal casts are effective in significantly reducing pressure but may cause additional problems when inappropriately applied. TCCs are used for offloading the plantar aspect of the foot. Published studies suggest TCCs heal greater than 72 percent of all patients treated with them. Clinical skill is required for application. Patient compliance is necessary to minimize complications. Inappropriate application may result in a new ulceration. Postural instability may be exacerbated.