The use of diabetic footwear is steadily growing since the Medicare Therapeutic Shoe Bill was adopted. For certain diabetics, they are essential in reducing foot-related complications. Unfortunately, excessive use of these devices prescribed by doctors and fraud in distribution could threaten the long-term viability of this program. In this article, we will look at how to use these shoes and how doctors and patients can ensure the correct use and surveillance of these devices Skechers Diabetic Shoes.
The Rationale Behind The Use of Diabetic Shoes:
Medicare started this benefit to decrease the incidence of foot wounds and general injuries that result from the improper fitting of shoes. Shoes have been the source of many friction and pressure-related injuries that lead to infection, hospitalization, and possibly Amputation. They have also caused the irritation of foot-related deformities that are already present, such as bunions and the hammertoes. Because many diabetics suffer from a level of poor sense (peripheral neuropathy) so the pain from rubbing against the shoe cannot be readily 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 chronic swelling (edema) it is possible for the shoe to contact the skin significantly increased. A diabetic shoe can be described as a shoe that has extra depth (especially for the area of toes) to alleviate pressure from above on toes as well as being sized for width in order to decrease pressure both on the inside and the outside feet. This is a great way to protect feet suffering from toe deformities or bunions as well as normal foot also. The shoe’s material must be constructed to minimize seams inside the shoe and must be strong enough for a full year of use. The most important thing is the use of an insert made mostly of a substance called plastizote. It reduces pressure and shear forces. It is able to be heated molded to the foot, or, in certain cases, is required to be custom-molded to the foot in cases where a severe foot deformity is evident. The deformities that are severe could result from amputation voids or a fracture-causing condition known as Charcot arthropathy. Medicare has established the minimum thickness of this material and recommends that any less than that is not recommended. When the shoe’s extra depth and the insert plastizote are combined, the likelihood of shoe-related complications due to diabetes is significantly decreased.
Diabetic Shoe Misuse:
Unfortunately, diabetic shoes are frequently used outside of the medical field. To be able for a diabetic to need diabetic shoes, they must be suffering from some combination of neuropathy, foot deformity of calluses or corns (hyperkeratosis) and a prior foot ulcers, amputations or arterial condition. If none of the above are present, a diabetic will not require the shoes as the likelihood of problems is minimal, and Medicare is not able to cover the cost. An examination by a qualified medical professional is necessary to determine if these components are present because a diabetic suffering from any of these disorders must be receiving medical and podiatric treatment anyway. This can be handled by the medical professional who oversees the diabetes, however an expert in foot care usually manages this. The correct prescription for shoes and a decision regarding whether heat-molded or custom inserts are required is made in addition to an assessment of any other modifications that are needed. There are times when diabetics have such grave foot defects that a regular diabetic shoe is in appropriate, and a custom molded shoe is required. This requires a much different process. After the shoe prescription is identified, the doctor managing the diabetes then certifies the treatment for diabetes and the need to wear the shoes. This document is required by Medicare.
The process described above is usually neglected when medical supply businesses and non-medical entities are involved in the distribution of diabetic footwear. It is a common scenario when patients are approached via either phone or mail from these companies (who are placed on a call list because of their diabetic condition), and an offer is made for the gift of a “free” diabetic shoe. These patients then get measured via mail in accordance to the shoe size they admit to and then they send an impression of the foam box of their foot, which is then sent to them. Events are also held in which patients go to an hotel or general conference center for a one-day opportunity to try on shoes. The majority of the time, an examination is conducted by the dispensing company, who rely solely on the approval by the doctor treating the patient to comply with Medicare documentation requirements. A majority of physicians aren’t able to look into what the shoes are made of and are simply trying to protect their diabetic patients, so they sign it. The patients are then provided with the shoes, but there is no follow-up to check if the fitting is suitable. If problems do develop There isn’t anyone available local to examine or alter the shoes. At times, the shoe styles used barely fit the criteria for a diabetic shoe, as the shoes that are sold in stores are usually utilized in lieu of a diabetic-specific shoe and the inserts used are not of the highest quality. Some companies will automatically use custom-designed inserts, regardless of whether they’re actually required since the inserts that are custom made will be reimbursed more. All of this is done without the help or knowledge of a foot doctor, or perhaps the primary physician.
If all that was not enough, in a lot of instances, companies will write off the 20% Medicare does not cover if a secondary insurance isn’t in place (or will not provide diabetic footwear), 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 the end the end, not all diabetics require diabetic shoes. Those who do need shoes that fit properly based on their particular foot and a doctor is required to prescribe the product and follow-through with the product. Medicare is required to be charged properly and accurately. The excessive and illegal utilization of diabetic shoe for profit is harming the longevity of this program. The decision on the use of these devices should rest solely in the hands of the doctor or podiatrist taking care of the diabetes. The shoes must be purchased directly from the podiatrist , or by a trained pedorthist/orthotist who can make sure that they are of the highest quality and to ensure proper monitoring of the fit and function.