When your feet hurt, you seem to hurt all over. That is a popular statement among patients with foot pain. We tend to take our feet for granted until they start to hurt. They are literally the furthest thing from our minds. Understanding proper foot care is the key to preventing future diabetic foot ulcerations. Pedorthic care for the diabetic foot consists of proper shoe fit, weight distribution, and reduction of sheer within the shoe.
Proper shoe fit comes by accurate measurement of the foot when purchasing shoes. A Brannock device is the most common measuring device found in shoe stores. As a common side effect of diabetes is peripheral neuropathy, or loss of sensation in the extremities, care must be taken to ensure proper fit due to the possible lack of sensation in the customer's feet. If the shoe is too tight, it could cause pressure ulcers to develop, which in turn may lead to more serious matters. Make sure the shoe bends at the ball area. Take caution, for if the shoe bends in the middle, it may cause undue pressure in certain areas of the foot. During normal gait, our feet bend at the ball, or the metatarsophalangeal joint. The shoe should bend where our feet bend.
Weight distribution is achieved by the use of a custom foot orthosis, an insole made specially to fit the patient's foot, and worn inside the shoe. The primary goal of using custom orthosis is to distribute pressure from any one specific area of the foot.
Reduction of sheer, or movement within the shoe, is accomplished by proper shoe fit as well as using a custom orthosis. Sheer within the shoe can be harmful to a patient with peripheral neuropathy. If the patient's foot is sliding around in the shoe, it could be building calluses, which if left unattended, could eventually lead to pressure ulcers and again, to more serious matters.
If you are a diabetic, always have your feet measured for proper shoe fit. Brand to brand, shoe sizes may vary. If you have decreased sensation, you may not be able to feel the difference. The shoe should not be too tight or too loose. If you have calluses or ulcerations on your feet due to excessive pressure, talk to your doctor. If the areas are on the bottom of your foot, the use of a properly made custom orthosis, along with your doctor's care, may be extremely helpful in healing the affected areas.
Insurance coverage can be confusing and may vary from state to state. Check your benefit plan to see if diabetic shoes and diabetic insoles are covered. Medicaid coverage varies as well. Medicare coverage is the same nationwide. Medicare allows $126 per one pair of diabetic shoes and $32 per each diabetic insole. Of that amount, Medicare will only pay for 80 percent. The other 20 percent is either the patient's responsibility or may be covered by a Medicare supplement insurance. Medicare will only allow coverage of one pair of diabetic shoes and three pair of diabetic insoles per year. Medicare may require a $100 deductible to be met before paying their portion for the shoes and insoles.
Pedorthics: The design, manufacture, modification and fit of footwear, including foot orthosis, to alleviate foot problems caused by disease, overuse, or injury.
Richard Graham is a Board Certified Pedorthist and co-owner of Palmetto Pedorthic Care, in West Columbia, South Carolina.
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