Selection Of Shoes For Diabetic Patients

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The usage of diabetic shoes is steadily growing following the Medicare Therapeutic Shoe Bill was passed. For diabetics with certain conditions, they are essential in reducing foot complications. The problem is that overuse of these prescription devices as well as fraudulent distribution threatens the long-term effectiveness of this program. This article will address how to use these shoes and 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 started this benefit to help reduce the incidence of foot wounds and general injuries that result from wearing improperly fitted shoes. Shoes have been the source of numerous pressure and friction-related injuries that lead to infections, hospitalization and even the possibility of amputation. They have also caused irritation of foot deformities that are already present, such as bunions and the hammertoes. Because many diabetics suffer from a degree of difficulty in feeling (peripheral neuropathy) so the pain from rubbing against the shoe is not easily felt, and so wounds are easily formed within a short amount of time. In conjunction with foot defects such as bunions and hammertoes as well as persistent swelling (edema) and the possibility of the footwear to scratch against the skin is extremely high. A diabetic shoe is defined as an extra-depth shoe (especially in the toe box) to alleviate pressure from above on the feet, as well as being sized for width , so that pressure is less on the inside and outside feet. This protects the feet of people with bunions or toe defects as well as normal feet also. The shoe’s material should include a design that minimizes seams within the shoe, and should be durable to last a year of daily use. Important is the use of an insert comprised mostly of a substance called plastizote. This material reduces the pressure and shear force. It can be heat molded into the foot, or, in certain cases, must be custom molded to a person’s foot when a serious foot deformity is present. These deformities can result due to amputation-related voids or a fracture-causing disease called Charcot arthropathy. Medicare has defined the minimum thickness of this substance and recommends that anything less is inappropriate. If the extra-depth shoe and plastizote inserts are combined the chance of shoe-related complications due to diabetes is significantly decreased.

Diabetic Shoe Misuse:

Unfortunately, diabetic shoes are over-utilized outside the medical community. To qualify as a diabetic to be required to wear diabetic shoes they must have a combination of neuropathy, foot deformity, calluses or corns (hyperkeratosis) as well as a previous foot ulcer, amputation, as well as arterial illness. If none of the above are present, the diabetic does not require a shoe since the risk of complications is very low and Medicare will not cover the cost. An examination by a qualified medical professional is needed to determine if these elements are present, because anyone suffering from one of these ailments should be receiving medical and podiatric attention in any case. The exam can be performed by the physician managing the diabetes, but an expert in foot care usually is the one to handle this. A proper prescription for the shoes and a determination regarding whether heat-molded or custom-designed inserts are needed is made, as well as an assessment of any other changes that may be required. There are times when diabetics suffer from such severe foot deformities that a standard diabetic shoe is not suitable, and a custom-made shoe is needed. This requires a much different process. Once the prescription for the shoe has been identified, the doctor managing the diabetes will then confirm the treatment for diabetes and the necessity for the particular shoe. This documentation is obligatory by Medicare.

This process is frequently neglected when medical supply businesses and other non-medical companies are involved when it comes to the sale of diabetic footwear. It is a common scenario when patients are contacted by the phone or by mail by these firms (who are on a calling list due to their diabetic condition) and an offer is made for an “free” diabetic shoe. The patients are placed in a mailer based on the shoe size they’re willing to wear, or they mail in a foam box impression of the foot sent to them. The events are also organized that allow patients to go to a hotel or general conference center to have a day-long opportunity to try on shoes. Rarely is an exam performed by the company that supplies the shoes, who rely solely on the endorsement of the treating physician to ensure that they are in compliance with Medicare documentation standards. Many of these doctors do not have time to investigate the origins of the shoes and want to ensure the safety of their diabetic patients, so they simply sign the document. Patients are then given the shoes, and no follow-up is performed to check if the fitting is suitable. If there are any issues There isn’t anyone available local to examine or alter the shoes. At times, the shoe designs used do not meet the requirements for a diabetic shoe, as commercially available shoes are often utilized in lieu of the sole diabetic shoe and the inserts that are used are not of the highest quality. Certain companies will automatically utilize special inserts, regardless of whether they actually are required as the custom inserts reimburse higher. All this is done without the involvement or experience of a specialist in foot care, or perhaps 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 a secondary insurance isn’t in place (or will not cover diabetic shoes) in order to keep the marketing about “free” shoes accurate. This is illegal, as providers and suppliers are obligated by federal law to collect this.

The Big Picture:

In the end the end, not all diabetics require diabetic shoes. People who do require diabetic shoes that fit properly based on their foot type, and a doctor is required to prescribe the product and then follow up with the product. Medicare must be paid in a timely and accurate manner. The over-extensive and illegal use of diabetic shoes for profits is jeopardizing the sustainability of this program. The decision to use of these devices needs to be solely the responsibility of the doctor or podiatrist who is treating the diabetes. The shoes should be dispensed directly from the podiatrist or by a trained pedorthist/orthotist who can ensure proper quality and follow-up of function and fit.

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