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Therapeutic Shoes for Persons with Diabetes

The Importance of Proper Footwear for Individuals with Diabetes
 
Proper fitting footwear is important to most of us as we like to be comfortable in our shoes.  However for those with diatetes, its more than just comfort, its a matter of life and limb. Wearing the wrong shoe or the wrong size can potentially cause serious health problems that can sometimes result in amputations. With approximately 20 million Americans diagnosed with diabetes, the need for proper fitting footwear is essential in maintaining a healthy lifestyle. Improper fitting shoes can cause nerve damage and poor circulation, facilitated by the diabetes. Moreover,  according to the American Podiatric Medical Association, poorly fit shoes are involved in as many as half of the problems that lead to amputations, making it the most common cause of non-traumatic lower limb amputations.  In fact, current statistics show that approximately 30% of diabetics that lose one limb from amputation will lose the other limb within three years. More disturbing is that approximately 60% of people with diabetes will die within five years of their first lower limb amputation.
 
The first step to the healthy diabetic feet is proper caring, cleaning and examination of the feet. This starts with regular visits to the primary care doctor. It is critical that persons with diabetes and peripheral neuropathy follow the advice of their doctor relating to proper foot care and maintenance.  About 65% of individuals with diabetes have a mild to severe form of nerve damage (called peripheral neuropathy) that can deprive them of their protective sensation in their feet. Diabetics suffering with peripheral neuropathy means that diabetics lacks the very sensation required to feel the fit of the shoe, and may be unable to trust their "senses" as to whether the shoe fits well or not. It is not unusual that people with peripheral neuropathy sometimes insist on wearing a shoe size that is too small because without proper sensation, the correct size seems to be too big.  The smaller size shoe can sometimes cause blisters or abrasion that can result in a diabetic ulcer, which can eventually lead to an amputation if untreated. 
 
Footwear should be examined and checked by the individual and family members as well as a Therapeutic shoe fitter or Pedorthist to ensure there is enough room in the shoe and that there are no pressure points obstructing a good fit.    Getting expert help to ensure proper fitting shoes might seem overboard to most of us, but it is one of the best preventative and proactive measures diabetics can take to stay on the healthy path.
 
People with diabetes usually require foot orthoses to balance and protect the foot and to unload and alleviate diabetic foot problems. The diabetic foot is the hardest foot to manage because it has all of the biomechanical challenges that non-diabetic feet have, coupled with the soft tissue challenges related to diabetes. Certified Pedorthists are specifically trained to manage diabetic feet and to help in the healing of current ulcers and the prevention of future ulcers
     
Most diabetic feet can be managed with off-the-shelf shoes and diabetic inserts. However, in some cases, including moderate to severe Charcot foot conditions, a custom molded shoe is the best treatment for the person with diabetesGood diabetic shoes are the base of support, cushion and comfort for the diabetic feet.  If the shoes don't fit well, then the custom or diabetic orthotics will not function properly and may cause potential problems. It is advisable that diabetics ask their physician, podiatrist or pedorthist to explain the construction and performance expectations of your shoes, inserts, or foot orthotics.  It is also extremely important that diabetics check and examine their feet and the fit of the shoes and inserts on a regular basis.
 
At Foot Companion, our Certified Pedorthist is trained in shoe fitting and diabetic foot management, and can expertly select and fit the proper shoe for a person with diabetes.   If you are a diabetic or know someone who is diabetic and needs good fitting shoes, please visit our shop or call us to set up an appointment.  Even if you cannot make it to our shop, we can set up an appointment to come to you, or we will try our best to answer your questions by phone at 1-540-904-7823 or email at info@footcompanion.com.
 
 
Tips on Caring For the Diabetic Feet
 
• Always follow your doctor’s instructions for proper foot care and maintenance.
• Revisit the practitioner who dispensed your shoes one to two weeks after getting new shoes, to address any issues and to recheck for proper fit.
• Inspect your feet for trouble signs everyday.  Look for any irregularities, redness or unusual swelling.  Contact your physician with any concerns.
• Dry your feet carefully with a soft towel, especially between the toes, as moisture can be trapped in these sensitive areas.
• Dust your feet with talcum powder or cornstarch to keep them dry..
• Check your shoes, socks, and orthotics daily for fit and defects and objects as foreign objects that can cause sores.
• Wear socks that are designed for the diabetic foot. These socks are softer, are seamless and without elastic.
• Always wear your shoes with socks.  This may seem obvious, but its worth mentioning.
• Never go barefoot outside – Always wear some sort of supportive footwear at all times to avoid cuts or other potential foot injuries, particularly if you have loss of sensation.
• Shop for shoes in the afternoon, as your feet are likely to be at their largest at this time of day.
• Visit your doctor on a regular basis for all of your foot care needs, especially to get your toenails clipped. 
 
 
Therapeutic Shoes For Diabetics - Meidcare Shoe Bill
 
In May 1993 Congress amended the Medicare statutes to provide partial reimbursement for depth shoes, custom-molded shoes, and shoe inserts or modifications to qualifying Medicare Part B patients with diabetes.
     
To qualify, the medical doctor (MD or DO) who manages the patient’s systemic diabetic condition, (i.e. prescribes insulin) must certify in a Statement of Certifying Physician that the patient has diabetes, that the patient is being treated under a comprehensive plan of care for diabetes, and that the patient has one or more of the conditions that Medicare describes as placing the patient at risk for amputation and that the patient therefore needs therapeutic footwear. 
 
With the two required documents, the above-mentioned Statement of Certifying Physician and a Footwear Prescription, Medicare will partially reimburse the beneficiary for the footwear, footwear modifications and foot orthoses needed to protect their feet. More information regarding the program can be obtained from Medicare at 800-270-2313 or www.cms.gov.
 

Diabetics Shoe with Inserts

Foot Companion now offers a full line of both off-the-shelf  Diabetic shoes and inserts.  We are participating providers for the Medicare Therapeutic Shoe Program.  We carry styles from quality manufacturers such as Aetrex, Apex, Drew Shoe, Orthofeet and PW Minor.

 HOW MUCH DO DIABETIC SHOES AND INSERTS COST?

Diabetic shoes and inserts are covered under Medicare providing certain criteria are met and your physician completes the necessary forms.

If you have met your deductible and qualify for shoes, Medicare will pay 80% of the cost of the shoes and inserts.  

If you have Medicare and a secondary insurance (including Medicaid) and have met your deductible for the year then the shoes and inserts will be paid in full and you will have no balance due. 

Diabetic Shoes and insoles Process:

Visit our shop and we will provide to you the forms your doctor treating you for your diabetes will need to sign and return to us. Once we receive the forms back from you, we will verify your eligibility, and complete a not cost foot evaluation, sizing, and shoe selection.

We will provide you with a follow up appointment once your shoes and inserts are ready for pickup.

If you have any questions or feel you may qualify for diabetic shoes through the Medicare shoe program, please feel free to contact one of our staff for more information at 540-904-7823. 

Medicare/Insurance Beneficiary Eligibility

Medicare covers diabetic shoes, inserts and modifications for program beneficiaries only if the following criteria are met:

(a) The patient has diabetes and one or more of the following conditions:

*Previous amputation of the other foot, or part of either foot

*History of previous foot ulceration of either foot

*History of pre-ulcerative calluses of either foot

*Peripheral neuropathy with evidence of callus formation of either foot

*deformity of either foot

*Poor circulation in either foot

(b) The certifying physician who is managing the patient‘s systemic diabetes condition has certified that:

(1) one or more of the indications required by (a) above are present,

(2) he or she is treating the patient under a comprehensive plan of care for his or her diabetes, and

(3) the patient needs diabetic shoes, inserts or modifications.

If the requirements of both (a) and (b) are met, then you may qualify for diabetic shoes at little or no out of pocket expense.

 Coverage Limitations

For Medicare beneficiaries meeting criteria described above, coverage is limited to one of the following within 1 calendar year:

*1 pair of off-the-shelf depth shoes and 3 additional pairs of multi-density inserts. or

*1 pair of off-the-shelf depth shoes with a modification, and 2 additional pairs of multidensity inserts, or

*1 pair of custom-molded shoes and 2 additional pair of multi-density inserts.   

Documentation Requirements

Medicare program carriers generally require the following before reimbursement will be made for shoes, inserts or modifications furnished to a program beneficiary.

  • A certification of medical necessity from the physician who manages the patient’s diabetes, which certifies that the patient (a) has diabetes mellitus, (b) has at least one of the qualifying conditions, (c) is being treated under a comprehensive plan of care for his or her diabetes, and (d) needs diabetic shoes. Medicare carriers recommend that suppliers use the Medicare approved “Statement of Certifying Physician for Therapeutic Shoes” form to fulfill this requirement.
  • A prescription for a particular type of footwear (e.g., shoes, inserts, modifications) from a podiatrist or physician who is knowledgeable in the fitting of diabetic shoes and inserts. Suppliers are required to keep file copies of signed and dated physician prescriptions.

Furnishing The Footwear

The footwear must be fitted and furnished by our  pedorthist, with the knowledge and ability to identify and make needed alteration to the shoe and or insole.

 
Additional Sources of Information
 
American Diabetes Association: (1-800-342-2383)
Pedorthic Footwear Association: (1-800-673-8447)
 
 

Disclaimer: The information provided by Foot Companion, Inc. should never take the place of advice and guidance from your doctor. Be sure to check with your doctor about changes in your treatment plan. If you don’t have a doctor, we would be happy to provide you with a list of several health care providers in your area.