The Medicare Therapeutic Shoe Bill has increased the popularity of diabetic shoes as a medical device for those with diabetes. The shoes are helpful to many diabetics as they reduce complications related to non-diabetic shoes. Diabetic shoes are prescription devices and the overuse and fraud of the shoes are threatening the program. It may not be around for much longer.

It is important to know how to use the shoes appropriately and how physicians and patients can both assure proper monitoring and use of the diabetic shoes.

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Use of Diabetic Shoes

Wearing improperly fitting shoes can cause foot wounds and injuries. Medicare began to offer diabetic shoes to reduce these foot wounds and injuries. Most of the time, the injuries occur when shoes are too tight and the friction causes blisters which can lead to infection and hospitalization. Amputation is also a side effect. Other injuries that can occur with improperly fitting shoes are the irritation of bunions and hammertoes. A lot of diabetics have a poor sense of feeling so pain caused from shoe irritation can be easily felt and the irritation can quickly form into wounds. When combined with bunions, hammertoes and other foot deformities, along with chronic swelling, the potential for wounds and injuries is greatly increased.

What exactly is a diabetic shoe? It is a shoe that has extra depth built in. This relieves the pressure from above the toes. The shoes are also wider than standard shoes to relieve pressure on the inside and outside of the foot. This makes it less likely that feet with bunions or hammertoes will be irritated and it can benefit normal feet. Diabetic shoes are constructed to limit the amount of seams used in the shoe. They are constructed to last for at least a year of use daily.

The most important part of a diabetic shoe is the insert that is made of plastizote. Plastizote will reduce the shear force put onto the foot and it reduces the pressure on the foot. The insert can be molded to the shape of the foot or they can be custom molded to a foot with deformities. Deformities are formed from a Charcot arthropathy, a disease that causes fractures, and amputation voids. The minimum thickness of plastizote has been regulated by Medicare and anything less should not be used. The likelihood of shoe-related complications due to ill-fitting shoes is greatly reduced when using a shoe that combines extra depth and a plastizote insert.

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Diabetic Shoe Mistakes

Diabetic shoes are greatly over-used by the general public. Only diabetics with certain feet problems should use diabetic shoes. These feet problems can include amputation, prior foot ulcer, calluses or corns, neuropathy, or a foot deformity. If they have none of these foot problems, then they do not need diabetic shoes ans their risk for foot irritation is low. Medicare will not cover diabetic shoes for these people. To get a pair of diabetic shoes, a medical exam is needed to determine if any foot problems are present. The diabetic will already have a doctor to treat their diabetes. The exam can be completed by the doctor that already manages their diabetes but they may be refereed to a foot specialist. Once a prescription for diabetic shoes has been made, the doctor will determine whether a mold will be needed for the inserts and if a custom mold will be needed. Other modifications may be needed for the shoes. Diabetics with severe foot deformities will need more than a standard diabetic shoe. A custom molded shoe will be needed. If a pair of diabetic shoes is needed, the Medicare process can be started. The physician managing the diabetes will sign off on the need for a diabetic shoe and will send the patient to a foot specialist. The foot specialist will issue a prescription for a diabetic shoe. The documentation is then sent over to Medicare.

When medical supply stores are involved in this process, certain things can be ignored. A lot of times, patients are contacted by mail or phone and asked if they want to get a free daibetic shoe. They can then choose the shoe size they want and will be able to mail in a foam mold impression of their foot. Sometimes, there are events held at local hotels where patients can go and get fitted for a diabetic shoe. An exam is almost never performed by the company, but they will use the doctors referral as documentation for Medicare requirements. Most physicians will sign the form that the company provides because it is an easy way for their patient to get diabetic shoes quickly. The shoes are sent to the patient's home and, unfortunately, no one follows up to see if the shoe works for the patient. It is up to the patient to inspect the shoe and call the company if problems arise. Often times, the shoe does not fit the patient right and they do not even qualify as a diabetic shoe. The inserts are not molded to the foot and the shoes are constructed poorly. A few companies will use custom inserts automatically, even if they are not needed and will charge the Medicare a higher price. The company does not seek the advice of a foot specialist or a primary physician. The companies will then try to screw over system by writing off the 20 percent that Medicare does not cover to another insurance company. This makes it look like the shoes were really free. Of course, this is completely illegal, but they do not care. They are out to get a buck.


In summary, diabetic shoes are only for those who really need them. Not everyone needs diabetic shoes. Those who need diabetic shoes should get shoes that fit properly by getting a specialist to write a prescription and to follow-up once they get the shoes. They should send Medicare the correct bill and follow all procedures set forth by Medicare. By preventing fraud and over-use of diabetic shoes, the program will be able to last for many years. Diabetic shoes should only be used by diabetics and the podiatrist or the physician treating the diabetes should be the only ones issuing the shoes. Always make sure they have a follow-up meeting to make sure the shoes fit correctly.