The Northwest Voice

While recently examining one of my patients in our office, I noticed that the patient was not using a pair of diabetic shoes. She had had a history of ulcers and infections which could have led to a possible amputation, but with a little luck she has managed not to succumb to that horrible fate.

After examining the patient, I advised her to get a pair of diabetic shoes, which would be covered under Medicare.

The patient responded by asking, “Why do I need that type of shoe when mine seem to work fine?”

Although many of us go throughout our daily lives looking at shoes as just a part of our everyday wardrobe, for those individuals with diabetes, a pair of shoes can mean the difference between life and death.

 
The diabetic shoe program was initially started in 1998, when Congress passed the Diabetic Therapeutic Shoe Bill, which made it possible for those diabetic individuals covered under Medicare to receive a pair of extra-depth shoes and custom inserts.

Why was this bill so important?

Well, to understand this bill and how it affects us in our daily lives we must first understand what diabetes is and how it affects each of us economically, physically and socially.

 
The incidence of diabetes throughout the world continues to escalate as a major problem. In 1995, there were over 135 million diabetics worldwide, and that estimate is expected to climb to well over 300 million by the year 2020.

As for the overall cost of diabetes to the economy, it is costing us well over 1 billion dollars per year in both direct and indirect costs.

 
Diabetes is one of the most insidious diseases known to mankind. It is a progressive disease that affects almost every part of the human body.  From the eye to the foot, it causes degenerative changes that can limit our family relationships, quality of life and overall life expectancy.

 
Diabetes causes multiple complications that can occur in the foot, but the two major ones are decreased circulation to the foot and a permanent destruction of the nerves in the foot causing numbness. Although it does not seem to be that serious, these two factors can lead to amputation and even loss of life. A statistical fact states that those individuals with diabetes who receive a below-the-knee amputation will receive another to the opposite side within five years, and within five years of that amputation will die. Therefore, to help prevent the loss of limbs and the loss of lives the diabetic shoe program was started.

 
Now what does a diabetic shoe do that a normal shoe cannot? The one and only thing is that the diabetic shoe can protect the foot from pressure. Pressure is what causes calluses and corns. In a normal foot, these are often painful and limit the amount that a person wants to walk or even be in their shoes or on their feet. Unlike a normal foot, though, a diabetic foot that lacks feeling will form theses calluses, which will then form ulcers and ultimately may lead to an amputation.

Although normal shoes are often fit to specialize in activities such as sports (running, soccer) or fashion, diabetic shoes are custom fit to the individual’s foot to prevent pressure from destroying the foot.

So does Medicare pay for all diabetics to have custom shoes? No. Medicare specifically states that those individuals who have been diagnosed with diabetes and have one or more of the following complications –– history of amputation, history of ulceration, history of calluses, numbness to the feet, foot deformity (bunion or hammertoes) and/or poor circulation –– are eligible for a pair of custom shoes and three pairs of custom insoles per year.

Although there are many adequate avenues for obtaining a pair of diabetic shoes, your best possible venue with the safest results is through a podiatrist. Since a podiatrist is a physician who is specifically trained in all areas of foot and ankle pathology of the lower extremity, they are more likely to recommend a pair of shoes with the best fit for your particular condition.

 
You're probably wondering what finally happened to my patient. Well, with some convincing she finally took my advice and got a pair of diabetic shoes, and has been happy and healthy ever since she made that decision.

 
Dr. Brandon Hawkins is a podiatrist residing in Bakersfield and practicing with California Foot Doctors at 4000 Stockdale Highway  Suite C. For more information concerning the diabetic shoe program as well as types and styles of shoes you can visit www.CaliforniaFootDoctors.com.

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