Foot ulcers are a frequent complication and develop in 15% of patient with diabetes. Ulceration is caused by several factor including neuropathy, arterial insufficiency and infection. Neuropathy results in a loss of the protective sensation and foot deformation. Off loading is an important part of the treatment permitting to reduce pressure and improve healing. Total casting is the gold standard and healing is observed in 90%, but there are several contraindications and limitations. Alternatives include removal devices that must be evaluated to improve off-loading and patient observance. Prevention with specific follow-up and shoes adaptation is recommended to prevent recurrent ulcer.