DIABETIC SHOES/MEDICARE THERAPEUTIC SHOE PROGRAM
By: Corinne Gehegan, DPM
It is well known that diabetic patients are prone to foot complications. These complications may arise if a diabetic individual has peripheral vascular disease (poor circulation), diabetic neuropathy (loss of sensation involving the foot and sometimes even as far as the knee), impaired ability to heal wounds, or structural deformities such as bunions and hammer toes. Many foot complications can be prevented by wearing a proper fitting shoe or sneaker. Diabetic foot wear is available in regular, wide, and extra wide widths. The shoes must be considered extra depth. The materials may vary and the soles tend to allow for increased shock absorption. Medicare recognizes the benefit of preventative diabetic foot care and allows coverage for certified diabetic shoes and inserts through the Therapeutic Shoe Program.
A depth shoe must meet the following definition to qualify for the benefit category
a) Has a full length, heel-to-toe filler that when removed provides a minimum of 3/16 inch of additional depth used to accommodate a pre-fabricated or custom-molded insert, and
b) Is made from leather or other suitable material of equal quality, and
c) Has some form a shoe closure, and
d) Is available in a full and half sizes with a minimum of three widths so that the sole is graded to the size and width of the upper portions of the shoe according to the American standard last sizing schedule or its equivalent.
The physician managing the beneficiary’s diabetic condition must document and certify the beneficiary’s need for therapeutic shoes. To be covered by Medicare, therapeutic shoes must be prescribed by a podiatrist or other qualified physician, and furnished or fitted by a podiatrist or other qualified physician. The podiatrist can perform a diabetic foot exam to assess the vascular status and neuro-sensory status of the feet. He or she will also evaluate the skin and nails as well as the overall structure of the feet. A thorough medical and surgical history is also obtained in addition to any previous foot complications. The podiatrist can measure the feet and assist in selecting the most appropriate style. Prefabricated inserts which are also known as orthotics are included as a component of the diabetic foot wear. They are heat molded to accommodate any deformities or areas of increased pressure. In some cases the patient may be casted for custom orthotics. Commercial insurances other than Medicare may provide full or partial coverage for diabetic shoes if certain criteria are met. Of course, patients who are not diabetic are welcome to purchase the shoes as they would any pair of shoes at a store. The good news is that the styles have improved over the years!
Article written by Dr. Corinne Gehegan
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