The Medicare diabetic shoe program

Shoes are a hot commodity. Look at the advertising dollars spent by the big shoe companies, including the millions paid to sports stars for wearing the company’s shoes. Many people, should they develop some foot or ankle pain, will look to a different pair of shoes. They are blamed for many problems they are not responsible for, and by the same token, they are seen as treatment for things they can’t possibly improve.

For someone with diabetes, the wrong shoes can lead to a lifetime of disability. The complications for those with this disease which result from improper shoe gear are largely due to the nerve changes. Although gradual and insidious, these can make it hard to feel shoe pressure, or irritation of the skin. Blisters, sores, calluses can all cause skin breakdown, allowing bacteria in. Immune function is also impaired in the diabetic population, which can lead to a rapidly spreading infection.

Many seniors have developed bent toes, termed hammer toes. Numerous variations of the deformity exist, but a common result is excessive pressure to some area of skin. To those with healthy, functioning nerves, the chronic pressure leads to pain. Pain is a great motivator and usually results in some change, from taking off the shoe to wearing excessively large shoes. But the wrong shoes can set in motion a chain of events ending in amputation, even death. All from a simple pair of shoes.

Many people with diabetes never receive any education about the importance of shoes and their potential to lead to infection. Too often, they assume a shoe that is comfortable is the best for them. How well a diabetic with neuropathy can gauge proper shoe fit, function, and form, is questionable. Simply because a particular pair of shoes doesn’t produce pain does not mean it is healthy. And that does not mean they can’t cause skin injury (at least in the presence of neuropathy).

In recognition of these facts, almost a quarter of a century ago the U.S. government created a program providing a specialized pair of shoes every year. A surprise to many is that not every Medicare recipient with diabetes qualifies for these diabetic shoes. There are requirements: the candidate must have either neuropathy, some orthopedic deformity, or arterial disease. The prescribing physician must determine if one or more is present.

Predictably, if there is money to be made, there s going to be abuse. Many less scrupulous shoe stores, shoe fitters, and medical supply stores, and others, realized the oversight for this program was lacking. They were able to dispense pairs to anyone with a Medicare number. Eventually, the tide turned and the pendulum swung. Nowadays, should an “I” not be dotted, and all your ducks not in a row, you risk the government’s wrath.

An appropriate question at this juncture is what’s so special about these shoes? Numerous characteristics make them safer for individuals who have lost sensation in their feet. Because regular shoes vary greatly in their length, their width, and obviously the overall shape, it’s easy for the average citizen to select an inappropriate shoe.. Many commercially sold shoes don’t have a very anatomical configuration … for the average foot. Only about 20% of the human population have one of those, consequently shoe fit is variable and often less than optimal.

Diabetic shoes tend to be wider in the ball of the foot, thus causing less pressure to that part of the foot. In addition, they often have a higher toe box (the part of the shoe found above the toes) reducing stress to the skin in this region. There should be no seams or thickened parts of the shoe over bony prominences. The innersole, the part of the shoe the foot physically rests on, should be partially composed of a material which effectively protects the skin against pressure and shearing forces. These are intended to relieve pressure but are far too forgiving to provide any orthopedic support, and so are ineffective for relief of any kind of musculoskeletal problem, like arch pain.

Perhaps the most important characteristic is sizing. When left to their own devices, people with neuropathy often buy shoes that are too small, which is understandable when you think about it. These individuals need a tighter shoe to stimulate more nerve receptors in the feet. But this technique comes at a price since a tighter shoe causes more pressure to any bump or prominence, normal foot or not. This will cause pain for most of us, but not the diabetic with neuropathy. A professional sizing, with a standardized sizing device, is the proper way to prescribe a correctly fitting diabetic shoe.

A quick note on the style factor is relevant, since many Americans have the impression that these are not fashionable foot gear. Indeed, when this program began, the shoes available were less than desirable from an aesthetic perspective. Initially, there were two styles, both bad. But that is no longer the case. Many of the diabetic shoes now available are downright stylish.

Although many diabetics don’t need diabetic shoes, and many don’t qualify, this program has aided thousands in staying ulcer-free, and so, out of the hospital. Because this effort allows for one pair per year, it brings these individuals into their podiatrist’s office, providing for an evaluation and thorough inspection, all part of the standardized “Comprehensive Diabetic Foot Exam.” Many potential problems have been addressed in these individuals before they became big ones, because of this exam.

If you have diabetes, or you know someone who does, check into your eligibility for these. A foot ulcer is the primary condition preceding infection and amputation, and these sores too often develop from the wrong shoes. Amputation, especially in the diabetic, is an independent risk factor for mortality, meaning regardless of any other medical conditions, losing a foot and leg eventually results in death.

When we save a leg, we likely have saved a life. If you’re a diabetic, find out if you qualify for diabetic shoes. Along with a pair of stylish kicks, you’ll probably also get a detailed education on how to take care of your feet, how to keep them healthy, and, quite literally, to keep your feet. Put plainly, you need them!

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.


Today's breaking news and more in your inbox

I'm interested in (please check all that apply)
Are you a paying subscriber to the newspaper *

Starting at $4.62/week.

Subscribe Today