Foot Care
Managing Your Diabetes by Taking Care of Your Feet.
By Richard Egan
CPED, LPED, Pedorthist
We have all heard the saying “an ounce of prevention is worth a pound of cure”. That is so with managing Diabetes. By the year 2030, a third of the population will have diabetes. This disease affects the entire body. Many complications occur in the eyes, kidneys and the feet as a result of neuropathy. By getting the patients in proper fitting footwear with inserts that help offload pressure in problem areas, many times we can prevent foot ulcers and amputation. In the United States, infected foot ulcers are the most frequent admitting diagnosis for hospitalization of patients with diabetes. The cost to treat these problems is in the Billions of dollars.
As a Pedorthist, we are part of the allied health community, working to help prevent complications of the foot. Patients with diabetes should check their feet regularly to make sure they aren’t getting callusing or red spots on their feet. They need to have their toe nails trimmed properly to prevent infection and wear socks that do not bind or cut off circulation of the feet. By being pro-active, many problems can be avoided.
With the introduction of the Therapeutic shoes bill more than ten years ago, vendors were quick to jump on the bandwagon, producing shoes that were not only functional but stylish as well. A diabetic shoe that is billable with Medicare must meet Medicare’s guidelines and be coded. The shoe must have an extra 3/16th depth to accommodate heated or custom molded inserts. The shoe must come in 3 widths and have tie or Velcro closure. Many of the shoes have reinforced medial counters and rocker soles to help the patient with stability offloading pressue in the ball of the foot. We are seeing many styles,in the diabetic shoe line, to accommodate a multitude of foot problems We now have shoes made out of stretchable Lycra that help reduce pressure on the bunion and bunionette areas. Shoes are being made that have a deeper opening to allow the patient with edema and swelling problems ease in putting on the shoes. Shoes are now available with different colors of Lycra to choose from. It is no longer black, black, or black! Some shoes have Velcro closures on the medial side to help the person who has arthritis in the hands and has trouble gripping.
Medicare will cover three pairs of either heat molded or custom molded inserts that help with shear and relieving pressure on the plantar surface of the foot. Inserts are made of plastazote and poron. Custom molded inserts made from a mold of the patients foot seem to be the Gold Standard. Custom molded inserts allow the technician making them to add additional metatarsal support, posting and other modifications to accommodate callusing and help offload pressure in sensitive areas that are prone to ulceration. Heat molded inserts are heated to 225 degrees and then shaped to the patients foot.
Every foot is different and what works for one patient may not be the best choice for everyone. One of the biggest problems in fitting shoes is to get the patient to realize that prevention of foot problems is our goal. Although style is important, function is our main goal.
