Importance Of Diabetic Shoes For Diabetic Patients

The use of diabetic footwear has been steadily increasing since the Medicare Therapeutic Shoe Bill was approved. For diabetics with certain conditions, they are crucial to reduce shoe related foot problems. Unfortunately, overuse of these prescription devices and fraud in distribution could threaten the long-term sustainability of this program. This article will address the appropriate use of these shoes as well as how doctors and patients can ensure the proper use and supervision of these devices Skechers Diabetic Shoes.

The Rationale Behind The Use of Diabetic Shoes:

Medicare began the benefit to decrease the number of foot wounds and general injuries resulting from improperly fitting shoes. Shoes have been the cause of many pressure and friction-related wounds, leading to infection, hospitalization, and possibly Amputation. They also allow for the irritation of foot-related deformities that already exist, such as bunions and hammertoes. Since many diabetics suffer from some level of poor sensation (peripheral neuropathy), shoe irritation pain can’t be felt immediately and wounds develop quickly within a short amount of time. Combined with foot deformity like bunions and hammertoes and chronic swelling (edema) it is possible for shoes to be rubbing against the skin is extremely high. A diabetic shoe can be described as an extra depth shoe (especially for the area of toes) to reduce pressure from above on the toes, and is also sized in width to lessen pressure to the sides and the inner of your foot. This protects the feet of people with bunions or deformities of the toes as well as normal feet as well. The shoe’s material should be constructed to minimize seams within the shoe, and it should be durable enough that can last for one year of wear and tear. Of vital importance is the presence of an insert comprised mostly of a substance called plastizote. It is a material that reduces the shear and pressure forces. It is heat-molded to the foot, or in some instances, it must be custom molded to the foot in cases where a severe foot deformity is evident. These deformities can result caused by amputation voids, or a fracture-related disease known as Charcot arthropathy. Medicare has defined the minimal thickness of this material and recommends that any less than that is not recommended. If the shoe with an extra-deep design and plastizote insert are combined, the likelihood of shoe-related complications from diabetes is greatly reduced.

Diabetic Shoe Misuse:

Unfortunately, diabetic shoes are not widely used in the medical world. For a person with diabetes to need diabetic shoes, they need to have some combination of foot deformity, neuropathy such as corns, calluses or calluses (hyperkeratosis) or a prior foot ulcers, amputations as well as arterial illness. If none of these are present, a diabetic will not need the shoe as the chance of developing problems is minimal, and Medicare is not able to cover it. An examination by a qualified medical professional is required to determine whether the components are present since a person suffering from diabetes with any of these issues should be under medical and podiatric care at all times. This can be done by the physician who manages the diabetes, but an expert in foot care usually manages this. The correct prescription for footwear and a determination on whether heat-molded or custom-designed inserts are needed is made in addition to the determination of any other modifications that are needed. At times, some diabetics suffer from such extreme foot problems that a standard diabetic shoe isn’t suitable, and a custom-molded, custom-fitted shoe is needed. This is a different process. After the shoe prescription is determined, the physician managing the diabetes must then verify the treatment of diabetes as well as the need of the footwear. This document is required by Medicare.

This process is frequently neglected when medical supply businesses as well as non-medical organizations are involved in the distribution of diabetic footwear. It is a common scenario when patients are contacted via the phone or by mail by these businesses (who are on a waiting list due to their diabetes), and an offer is made for a “free” diabetic shoe. These patients then get fitted through the mail in accordance to the shoe size they’re willing to wear, or they mail in an impression of the foam box of their foot to them. The events are also organized where patients are taken to a hotel or a general conference center for one day chance to get fitted. The majority of the time, an examination is conducted by the company who supplies the shoes which rely only on the certification by the doctor treating the patient to meet Medicare documentation requirements. A majority of physicians do not have time to investigate the sources of the shoes, and simply want to protect their diabetic patients, so they sign it. The patients are then provided with the shoes, and there is no follow-up to determine if their fit is right. If problems do develop there is no one local to examine or alter the shoes. Sometimes, the designs used do not meet the requirements for diabetic shoes, since commercially available shoes are often used in place of a diabetic-specific shoe and the inserts that are used aren’t of high-quality. Certain companies will automatically utilize custom inserts whether or not they’re actually required since the custom inserts reimburse higher. All of this is done without the involvement or experience of a foot specialist, or even the primary physician.

As if that were not enough, in many instances, companies write off the 20 percent Medicare doesn’t cover in the event that a secondary insurance is not in place (or doesn’t cover diabetic shoes) in order to keep the marketing about “free” shoes accurate. This is illegal as the providers and suppliers are required under federal law to pay this.

The Big Picture:

In short, not all diabetics need diabetic shoes. People who do require diabetic footwear that is appropriate on their individual foot, and a doctor is required to create the prescription and follow-through with the product. Medicare must be paid appropriately and accurately. The over-extensive and fraudulent use of diabetic footwear for profits is jeopardizing the sustainability of the program. The determination for the use of these devices must be the sole responsibility of the podiatrist or doctor who is treating the diabetes. The shoes should be dispensed directly from the doctor or from a skilled pedorthist/orthotist to ensure proper quality and follow-up of the fit and function.

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