The Proper Use of Diabetic Shoes to Protect Diabetic Feet
The use of diabetic footwear has steadily increased ever since Medicare Therapeutic Shoe Bill was approved. For diabetics with certain conditions, they are essential to prevent foot problems. However, the overuse of these devices prescribed by doctors and fraud in distribution could threaten the long-term effectiveness of this program. This article will address the proper use of these shoes and the ways in which doctors and patients can ensure the proper use and supervision of these devices.
The Rationale Behind The Use of Diabetic Shoes:
Medicare started this benefit to reduce the risk of foot injuries and general injuries resulting from improperly fitting shoes. Shoes are the cause of numerous pressure and friction-related injuries, which can lead to infections, hospitalization and even the possibility of amputation Skechers Diabetic Shoes. They have also caused discomfort of foot deformities that are that are already present, such as bunions and the hammertoes. Since many diabetics suffer from some degree of poor feeling (peripheral neuropathy) the pain of irritation to shoes is not easily felt, and wounds can develop easily within a short amount of time. When combined with foot deformities such as bunions and hammertoes and chronic swelling (edema) the chance of the footwear to be rubbing against the skin is extremely high. A diabetic shoe can be described as a shoe with extra depth (especially within the foot box) to alleviate pressure from above on the toes and is also sized for width , so that pressure is less on the outside and inside feet. This is a great way to protect feet suffering from bunions or toe deformities as well as normal feet too. The material used in shoes should generally be constructed to minimize seams inside the shoe and it should be durable enough to last a year of use. The most important thing is the addition of an insert comprised mostly of a substance called plastizote. It reduces the shear and pressure forces. It is able to be heated molded to fit the foot, or, in certain cases, will require a custom-made mold to the foot in cases where a severe foot deformity is evident. The deformities that are severe could result caused by amputation voids, or a fracture-causing condition known as Charcot arthropathy. Medicare has established the minimum thickness for this material and suggests that any less than that is not recommended. If the shoe with an extra-deep design and the plastizote insert are paired the risk of developing complications from diabetes is greatly reduced.
Diabetic Shoe Misuse:
Unfortunately, diabetic footwear is frequently used outside of the medical field. To be able for a diabetic to require diabetic shoes, they must have a combination of foot deformity, neuropathy such as corns, calluses or calluses (hyperkeratosis) or a prior foot ulcers, amputations, and arterial diseases. If none of these conditions are present, a diabetic will not require the shoes as the chance of developing problems is minimal, and Medicare does not pay for the cost. A thorough medical examination is required to determine if the components are present since a person suffering from diabetes with any of these ailments must be receiving medical and podiatric treatment regardless. This is usually done by the doctor who is managing the diabetes, however the foot specialist typically is the one to handle this. The proper prescription for the shoes , as well as a determination on whether heat-molded or custom-designed inserts are required is taken along with the determination of any other adjustments that are required. Sometimes, diabetics suffer from such extreme foot problems that a normal diabetic shoe is not suitable, and a custom-molded shoe is required. This is a different procedure. Once the prescription for the shoe is established, the doctor who is managing the diabetes will then confirm the treatment for diabetes and the necessity to wear the shoes. This is mandatory by Medicare.
The process described above is usually overlooked when medical supply companies as well as non-medical organizations are involved with the supply of diabetic footwear. The most common scenario occurs when diabetic patients are contacted via telephone or mail by these businesses (who are on a waiting list because of their diabetic condition), and they are offered the purchase of a “free” diabetic shoe. Patients are then measured via mail according to the size of shoe they are willing to accept or send in an impression of a box made of their foot to them. There are also events where patients are taken to an hotel or general conference center for one day chance to get fitted. The majority of the time, an examination is conducted by the company that supplies the shoes that rely on the endorsement by the doctor treating the patient to ensure that they are in compliance with Medicare documentation specifications. The majority of doctors are not able to examine the origins of the shoes and just want to protect their diabetic patients, so they simply sign the document. Patients are then given the shoes, but there is no follow-up to see if the fit is suitable. If there are any issues there is no one local to examine or alter the shoes. Sometimes, the shoe designs used do not meet the requirements for diabetic shoes, since the shoes that are sold in stores are usually utilized in lieu of the sole diabetic shoe and the inserts are not of the highest quality. Certain companies automatically employ customized inserts regardless of whether they actually are required as the inserts that are custom made will be reimbursed more. This is all done without the help or knowledge of a foot specialist or even the primary doctor.
As if this were 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 does not provide diabetic footwear) to ensure that the advertising for “free” shoes accurate. This is illegal as the providers and suppliers are required under federal law to pay this.
The Big Picture:
In the end the end, not all diabetics require diabetic shoes. The ones who do require shoes that are appropriate based on their particular foot and a doctor is required to develop the prescription and then follow up with the product. Medicare must be paid correctly and accurately. The excessive and illegal use of diabetic footwear for profits is jeopardizing the viability of the program. The decision on the use of these devices should be the sole responsibility of the physician or podiatrist who is treating the diabetes. The shoes must be purchased directly from the podiatrist , or by a trained pedorthist/orthotist who can ensure proper quality and follow-up of function and fit.