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Diabetes and Foot Problems
Diabetes is a serious condition that can develop from the lack of insulin production in the body or due to the inability of the body's insulin to perform its normal everyday functions. Insulin is a substance produced from the pancreas gland that helps process the food we eat and turn it into energy. |
Neuropathy
Of the sixteen million Americans with diabetes, 25% will develop foot problems related to the disease. Diabetic foot conditions develop from a combination of causes including poor circulation and neuropathy. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the insensitivity. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can cause deformities such as Bunions, Hammer Toes and Charcot Feet.
Poor Circulation
Diabetes often leads to peripheral vascular disease which inhibits a person's blood circulation. Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, therefore causing injuries to heal poorly. Poor circulation can also lead to swelling and dryness of the foot. Preventing foot complications is more critical for the diabetic patient since poor circulation impairs the healing process, and can lead to ulcers, infection, and other serious foot conditions.
Ulcers of the Foot
An ulceration or ulcer is usually a painless sore at the bottom of the foot or top of the toes, resulting from excessive pressure at that site. Ulcers frequently underlie a pre-existing corn or callus that was allowed to build up too thickly. Trauma from heat, cold, shoe pressure, or penetration by a sharp object are also potential causes. Neuropathy allows the lesions to develop because the normal warning sense of pain has been lost and they go unrecognized. Continued pressure or walking on the injured skin creates even further damage and the ulcer will worsen. The open sore will frequently become infected and may even penetrate to bone.
Infection
Persons with diabetes are generally more prone to infections than non-diabetic people. Due to deficiencies in the ability of white blood cells to defend against invading bacteria, diabetics have more difficulty in dealing with and mounting an immune response to the infection.
Infections often worsen and may go undetected, especially in the presence of diabetic neuropathy or vascular disease. Often, the only sign of a developing infection is unexplained high blood sugar, even without fever. The combination of fever and high blood sugar often warns of a severe infection requiring hospitalization. Lesser degrees of infection are often treated on an outpatient basis. |
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Footcare Guidelines:
- Inspect your feet daily for blisters, bleeding, and lesions between your toes.
- Use a mirror to see the bottom of your foot and heel.
- Do not soak your feet unless the temperature of the water is lukewarm, not as hot as you can stand it. (95°-100° Fahrenheit).
- Avoid temperature extremes - do not use hot water bottles or heating pads on your feet.
- Wash your feet daily with warm, soapy water and dry them well, especially between the toes.
- Use a moisturizing cream or lotion daily, but avoid getting it between the toes.
- Do not use acids or chemical corn removers.
- Do not perform "bathroom surgery" on corns, calluses, or ingrown toenails.
- Trim your toenails carefully and file them gently. Have a podiatrist treat you regularly if you cannot trim them yourself without difficulty.
- Contact your podiatric surgeon immediately if your foot becomes swollen or is painful, or if redness occurs.
- Do not smoke.
- Learn all you can about diabetes and how it can affect your feet.
- Have regular foot examinations by your podiatric surgeon.
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Footwear Guidelines:
Shoes must always fit comfortably and have adequate width and depth for the toes. Leather shoes easily adapt to the shape of your feet and allow them to "breathe." Athletic shoes, jogging shoes and sneakers are usually excellent choices if they are well fitted and provide adequate cushioning. Your podiatric surgeon may recommend "extra depth" shoes, custom molded shoes to adapt to your particular needs, or orthoses to provide cushioning and support.
Always check your shoes for foreign objects or torn linings before putting them on. You should wear two or three pairs of shoes each day so that one pair is not worn for more than four to six hours. New shoes should be worn for only a few hours at a time, and you should take care to inspect your feet for any points of irritation.
Socks should be well fitted without seams or folds. They should not be so tight as to interfere with circulation. Well-padded socks can be very protective if there is an abundance of room in your shoes.
Avoid wearing open-toed shoes or sandals until you have discussed this with your podiatric surgeon. Above all else, do not walk with bare feet. |
MEDICARE'S THERAPEUTIC SHOE BILL:
Introduction
According to the American Diabetes Association, there are approximately 16 million Americans with diabetes. Unfortunately, this number continues to grow. Twenty-five percent of persons with diabetes develop foot problems related to the disease. Recognizing this problem, Congress approved the Medicare Therapeutic Shoe Bill, helping thousands of persons with diabetes obtain protective footwear and inserts.
Medicare Beneficiary Eligibility
Medicare covers diabetic shoes, inserts and modifications for program beneficiaries only if the following criteria are met:
(a) The patient has diabetes and one or more of the following conditions:
- Previous amputation of the other foot, or part of either foot, or
- History of previous foot ulceration of either foot, or
- History of pre-ulcerative calluses of either foot, or
- Peripheral neuropathy with evidence of callus formation of either foot, or
- Foot deformity of either foot, or
- Poor circulation in either foot; and
(b) The certifying physician who is managing the patient's systemic diabetes condition has certified that (1) one or more of the indications required by (a) above are present, (2) he or she is treating the patient under a comprehensive plan of care for his or her diabetes, and (3) the patient needs diabetic shoes, inserts or modifications.
What is Covered?
Coverage Limitations
For Medicare beneficiaries meeting criteria described above, coverage is limited to one of the following within 1 calendar year:
- 1 pair of off-the-shelf depth shoes and 3 additional pairs of multi-density inserts.
- 1 pair of off-the-shelf depth shoes including a modification, and 2 additional pairs of multi-density inserts.
- 1 pair of custom-molded shoes and 2 additional pair of multi-density inserts.
Documentation Requirements
Medicare program carriers generally require the following before reimbursement will be made for shoes, inserts or modifications furnished to a program beneficiary.
- A certification of medical necessity from the physician who manages the patient's diabetes, which certifies that the patient (a) has diabetes mellitus, (b) has at least one of the qualifying conditions, (c) is being treated under a comprehensive plan of care for his or her diabetes, and (d) needs diabetic shoes. Medicare carriers recommend that suppliers use the Medicare approved "Statement of Certifying Physician for Therapeutic Shoes" form to fulfill this requirement.
- A prescription for a particular type of footwear (e.g., shoes, inserts, modifications) from a podiatrist or physician who is knowledgeable in the fitting of diabetic shoes and inserts. Suppliers are required to keep file copies of signed and dated physician prescriptions.
Furnishing The Footwear
The footwear must be fitted and furnished by a podiatrist or other qualified individual, such as a certified pedorthist, orthotist, or prosthetist. The certifying physician may not furnish the footwear unless he or she practices in a defined rural area or health professional shortage area. The prescribing physician may be the supplier.
Additional Requirements
Additional requirements may apply. You should consult a qualified expert or Medicare for more information.
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The information contained herein is a summary of select Medicare rules and policies, and is intended for information purposes only. For comprehensive or authoritative guidance, please consult Medicare program representatives and publications. |
