The Rationale Behind The Use of Diabetic Shoes

The use of diabetic footwear has steadily increased in the years since Medicare Therapeutic Shoe Bill was adopted. For some diabetics, these are of vital importance to minimize foot problems. Unfortunately, overuse of these devices prescribed by doctors and untruthful distribution can threaten the success of this plan Skechers Diabetic Shoes. This article will discuss the correct use of these shoes, and how patients and physicians can assure the correct use and surveillance of these devices .

The Rationale Behind The Use of Diabetic Shoes:

Medicare began the benefit to decrease the incidence of foot wounds as well as general injuries caused by improperly fitting shoes. Shoes have been the cause of numerous pressure and friction-related wounds, leading to infections, hospitalization and sometimes an amputation. They also allow for discomfort of foot deformities that are that are already present, such as bunions and hammertoes. Since many diabetics suffer from some degree of poor feeling (peripheral neuropathy), shoe irritation pain isn’t easily felt and so wounds are easily formed in a short period of time. In conjunction with foot defects such as bunions, hammertoes and so on, as well as persistent swelling (edema) and the possibility of the footwear to rub against the skin is extremely high. A diabetic shoe can be described as an extra-depth shoe (especially for the area of toes) to alleviate pressure from above on toes and is also sized in width to lessen pressure on the inside and outside of your foot. This immediately protects feet with bunions or deformities of the toes and is beneficial for normal feet as well. The shoe’s material should be constructed to minimize seams inside the shoe and must be strong enough that can last for one year of use. Of vital importance is the presence of an insert that is made of a substance called plastizote. It reduces stress and shear forces. It can be heat molded to the foot, or in some instances, it should be custom-molded to a person’s foot when a serious foot deformity has been identified. These deformities can result from amputation voids or a fracture-causing condition known as Charcot arthropathy. Medicare has set the minimal thickness of this material, and the use of anything less is inappropriate. When the shoe’s extra depth and plastizote insert are combined, the likelihood 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 foot deformity, neuropathy and calluses, corns, or calluses (hyperkeratosis) as well as a previous foot ulcers, amputations, and arterial diseases. If none of these conditions are present, a diabetic does not require the shoes as the chance of developing problems is very low and Medicare will not cover the cost. A proper medical exam is needed to determine if these components are present, because a diabetic suffering from any of these ailments is required to receive medical and podiatric care anyway. The exam can be performed by the medical professional who oversees the diabetes, but a foot specialist usually handles this. A proper prescription for the shoes and a decision as to whether heat molded or custom-designed inserts are required is made along with an evaluation of any other changes that may be required. There are times when diabetics have such severe foot deformities that a normal diabetic shoe may not be suitable and a custom molded shoe is needed. This requires a much different process. Once the prescription for the shoe is confirmed, the medical professional who manages the diabetes then certifies the treatment of diabetes and the need for the shoe. The documentation required by Medicare.

This process is frequently neglected when medical supply businesses and other non-medical entities participate in the distribution of diabetic shoes. It is a common scenario when patients are contacted via the phone or by mail by these firms (who are on a calling list because of their diabetes), and an offer is made for an “free” diabetic shoe. These patients are then measured via mail in accordance with the size they have admitted to or send in a foam box impression of the foot sent to them. Also, there are events that allow patients to go to a hotel or general conference center for a one-day opportunity to be fitted. Rarely is an exam performed by the company that supplies the shoes which rely only on the certification by the doctor treating the patient to meet Medicare documentation guidelines. The majority of doctors are too busy to scrutinize the sources of the shoes and want to provide protection to their diabetic patients, and so they agree to sign the form. The patients are then sent the shoes, and there is no follow-up to see if the fit is appropriate. If problems do develop the patient is not able to contact anyone local to examine or alter the shoes. Sometimes, the shoe styles are not compatible with the requirements of diabetic shoes, because commercially available shoes are typically used in place of a dedicated diabetic shoe, and the inserts used aren’t of high-quality. Certain companies will automatically utilize custom inserts whether or not they actually are required as the inserts that are custom made will be reimbursed more. This is all done without the involvement or experience of a foot doctor, or even the primary doctor.

As if that were not enough, in a lot of instances, companies write off the 20 percent Medicare does not cover if a secondary insurance isn’t in place (or does not provide diabetic footwear), in order to maintain the claims on “free” shoes accurate. This is not legal, as suppliers and providers are bound by federal law to collect this.

The Big Picture:

In short there is no need for all diabetics to have diabetic shoes. Those who do need shoes that are appropriate based on their individual foot, and a doctor is required to create the prescription and to follow-up with the products. Medicare should be billed properly and accurately. The over-extensive and fraudulent utilization of diabetic shoe for profits is jeopardizing the long-term viability of this program. The determination for the use of these devices has to be the sole responsibility of the podiatrist or doctor caring for the diabetes. The shoes must be purchased 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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