SHOES & INSERTS

Footwear For People With Diabetes

Patients With Diabetes Need To Be Careful                                         Where They Get Their Shoes & How They Fit

Foot problems are a common complication of diabetes.  As a person with diabetes, you should always be extra careful when you buy therapeutic shoes and inserts. If you are getting them under the Medicare Therapeutic Shoe Bill, you need to insure you are receiving the level of service intended by the regulations.

The evaluation, measuring, casting, and fitting of therapeutic shoes and inserts is a process that involves considerable personal contact between the specialist and the patient. It is best done in a clinical setting with qualified professionals.

A foot specialist needs to insure shoes fit and function properly for each individual client. They also need to educate the patient on proper foot and shoe care, and schedule follow-up sessions with you to check for new or ongoing foot issues.  Modifications and adjustments to your shoes and inserts are often needed - and should only be done by specialists with the proper training and equipment.

The potential complications from improper fitting of therapeutic shoes and inserts can be serious for people with diabetes.  It pays to be extra cautious about who you choose to do business with.
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CONSUMER ALERT                                                 From AsYouAge

Sales of Therapeutic Shoes and Inserts                   To People with Diabetes By Non-Professionals

There is a lot of money to be made in the diabetic shoe business by high volume, minimal patient contact operations. These companies often use the Internet to solicit new customers. They may send someone to measure and cast you - they may not. Often the shoes are mailed to you to try on yourself and you are expected to call them if there are any "problems."

Diabetic shoes are also sold as a sideline in a retail establishment, such as a specialty shoe store or pharmacy. These companies usually do not have any fitting stock or the necessary facilities for private and comprehensive evaluation and fitting that is required. Rarely will they have the equipment needed to make proper modifications and adjustments. Their store personnel may also lack the training to be considered a "qualified individual" under the Medicare Therapeutic Shoe Bill.

Be Extra Cautious If You Are A Medicare Patient.

These businesses receive the same reimbursement from Medicare for your your care and the therapeutic shoes, inserts and other foot care products that the certified and licensed professional receives for spending time with you in his or her clinical office. But you the patient  are clearly not receiving the level of care that was intended when Congress passed the Medicare Therapeutic Shoe bill.

These businesses have not made a significant investment in patient care, and diabetic shoes and inserts are in effect, just another retail item on their shelf. Once again, there is a lot of money to be made when the provider's investment is confined to a few display shoes and a measuring stick.

The question you should always ask yourself when you need therapeutic shoes or inserts because of your diabetes is,                   Will this business give me the level of care and service that Medicare specifies?"  Because this is about much more than just shoes.
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Medicare’s Durable Medical Equipment Specifications

Medicare’s Durable Medical Equipment specifications define the professions that are trained and qualified to fit therapeutic shoes.

  1.     The particular type of footwear (shoes, inserts, modifications) which is necessary must be prescribed by a podiatrist or other qualified physician, knowledgeable in the fitting of diabetic shoes and inserts.

  2.     The footwear must be fitted and furnished by a podiatrist, or other qualified individual such as a pedorthist, orthotist or prosthetist.

  3.     The certifying physician (i.e., the physician who manages the systemic diabetic condition) may not furnish the footwear unless he/she practices in a defined rural area or a defined health professional shortage area.

  4.   The prescribing physician (podiatrist or other qualified physician) can be the supplier (i.e., the one who furnishes the footwear)."

The original legislation to create the Therapeutic Shoe for Diabetes benefit from MedicARE dates back to 1993. Although other foot specialists are listed in the legislation, only pedorthists are actually specialists in footwear and shoe fitting.
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(source: http://www.ngsmedicare.com/ on the Region B Medicare Durable Medical equipment Website.)


NOTE:                                                                                            Medicare Does Not Provide Free Shoes or Inserts To All Diabetics

  1.     The physician responsible for your primary diabetic care must certify additional medical complications, attesting that you really need special shoes.

  2.     Prefabricated inserts are sometimes indicated; not every patient needs the custom made inserts. The custom inserts cost Medicare and the tax payer more and of course provide additional income to the provider.

        If the additional cost is not justified, this is Medicare abuse.

  1.     Some outfits will bill medicare on your behalf for "custom diabetic shoes" while only providing off the shelf shoes slightly modified or fitted with custom inserts.

This is what many would call Medicare fraud.

Many states have laws which provide direction as to who is qualified to dispense and fit therapeutic shoes in their respective jurisdictions.

It pays to be cautious when it comes to therapeutic shoes and inserts. Your health and your pocketbook is involved.
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More About Medicare’s Therapeutic Shoe Program


In an effort to prevent foot ulcers in people with diabetes who are at risk, Medicare will help pay for therapeutic shoes. For those who qualify, Medicare will pay 80% of the allowed amount for one pair of shoes and up to three pairs of molded innersoles per year. (The allowed amount varies depending on the kind of footwear you need.) Most secondary insurers will help pay the other 20%.

Who Qualifies For Medicare’s Therapeutic Shoe Program?             Not everyone with diabetes needs special shoes. To qualify, you must be under a comprehensive diabetes treatment plan and have one or more of the following:

▪Partial or complete amputation of the foot

▪Previous foot ulceration

▪History of pre-ulcerative calluses

▪Peripheral neuropathy with evidence of callus formation

▪Foot deformity

▪Poor circulation


Who Doesn’t Qualify For Medicare’s Therapeutic Shoe Program? People with diabetes who do not have one of the above conditions. It is not enough to just have diabetes.

What Paperwork Is Required To Participate In The Shoe Program? The physician treating you for your diabetes must certify that you have diabetes, that you have one or more of the foot problems just mentioned, that you are under a comprehensive diabetes treatment plan, and that you need the special shoes. Medicare has a form for this certification. You will also need a prescription for the shoes.

Who Prescribes The Shoes For The Therapeutic Shoe Program?         A prescription is required from a podiatrist or physician who knows how to fit shoes and inserts for people with diabetes. The prescription should indicate a particular type of footwear, such as shoes, inserts, or modifications.

Who Supplies Shoes For Medicare’s Therapeutic Shoe Program? The footwear must be fitted and furnished by a podiatrist or other qualified individual, such as a pedorthist, orthotist, or prosthetist. The certifying physician may not furnish the footwear unless he or she practices in a defined rural area or area where there is a shortage of health professionals. The prescribing podiatrist may be the supplier.

What footwear is covered under the Therapeutic Shoe Program? Coverage is limited to one of the following per calendar year:

▪One pair of off-the-shelf extra-depth shoes and three additional pairs of special inserts that your podiatrist will select for you. Extra-depth shoes have room to accommodate innersoles or orthotics.

▪One pair of off-the-shelf extra-depth shoes including a modification, and two additional pairs of inserts.

▪One pair of custom-molded shoes and two additional pairs of special inserts.
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There are many footwear options available for men and women with diabetes.  Proper fit and comfort is key.

Image showing significantly reduced pressure points on the foot of a patient in a shoe with properly fitted orthotic inserts.

Image showing painful pressure points on the foot of a patient in a shoe without orthotic inserts.

Poorly fitted shoes are a major reason for diabetes-related foot problems, and 63% of diabetic patients wear the wrong size shoes.  Footwear that fits badly puts diabetics at higher risk of developing foot ulcers, which can lead to amputations. 

You and your foot specialist should look for several features in footwear (example above). Your feet can be affected by diabetes in two ways: (1) the blood supply may be impaired, resulting in slower healing, and (2) some loss of sensation due to nerve damage.  It is imperative for people with diabetes to wear well designed, properly fitted shoes that that protect their feet.
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Proper Fitting Shoes, Checked and Adjusted By a Qualified Foot Specialist Are Essential

Properly designed and fitted shoe inserts may take several visits to a specialist to arrive at an insert that will comfortably accommodate your needs. It is well worth the extra time and trouble.

The problem stems from the inability to feel pain - called diabetic neuropathy, or numb feet.  When you can’t feel your feet, you can’t feel the shoe rubbing. 80% of eventual amputations start with an ulcer, often caused by rubbing and improperly fitting shoes. 

Properly designed shoe inserts protect your feet  against rubbing & chafing.

I have diabetes and need new shoes.                                             Why shouldn’t I get them free from Medicare? 

There is no such thing as a free lunch;                                                 and there is no such thing as a free pair of shoes.

There are over 16 million people with diabetes in the United States. Many of them are of Medicare age. If every Medicare beneficiary with diabetes gets special shoes - without a valid medical reason to have them - there will be no money left for the other important aspects of the Medicare program.

If people abuse the shoe benefit, the Medicare program itself suffers - along with everyone who depends on Medicare for its programs and benefits in every area of its service.    Don’t be an abuser of Medicare.
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Footwear For People With Diabetes

The content on AsYouAge.com is provided as a courtesy for our site visitors. The information, resources, links, advertisements and other material on AsYouAge does not constitute a professional opinion or advice; nor does it constitute an endorsement of any organization or the information, products and/or services they may offer.

From ABC News Medical Unit: If the Shoe Doesn’t Fit . . .

Article by KGammon ABCNews Medical Unit  http://abcnews.go.com/Health/DiabetesResource/story?id=3888637&page=1

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