Cath Lab Digest

   One of the first patients I saw when I started practice many years ago was a diabetic patient who presented with medial ulcerations on both great toes. I aggressively treated the ulcerations and offloaded the toes. After the lesions had healed, I triumphantly told the patient she could go back to wearing her regular shoes.

   Two weeks later, she returned to the office with the ulcers back in full bloom. As I should have done earlier, I had a discussion with the patient about shoes and found out she was wearing the same shoes she had worn for many years and could not afford any other shoes. I have seen the same scenario repeated multiple times in my practice over the ensuing years.

   In 1998, Congress passed the Diabetic Therapeutic Shoe Bill, which made it possible to provide depth shoes and custom inserts, funded by Medicare, to patients with diabetes. This has been a tremendous help in the management of the diabetic foot. The question is: who should be the expert in this program? Should it be the shoe salesman on the corner, the pharmacist who has taken a weekend course, the physical therapist or the entrepreneur who takes a bus to nursing homes and assisted living centers to provide “diabetic shoes to all”?

Why DPMs Are Uniquely Positioned To Lead The Program

   I believe the podiatrist should be the expert and manager in the diabetic shoe arena as well as the other medical portions of diabetic foot care. Podiatrists provide a unique medical service to patients with diabetes when we manage their foot problems. We should be the very best at preventing diabetes-related problems in the lower extremity. When we do our job correctly, we can provide limb- and sometimes life-saving service to our patients with diabetes.

   It is generally recognized in the medical community that podiatrists are unsurpassed at providing lower extremity care for the diabetic population. Shoes play a very important role in the management of these patients. Even the very best wound care physician, surgeon or at-risk foot care manager in the world will not be effective if the patient is wearing a substandard shoe.

   As I have lectured across the country in the last several years on this and other subjects, I have found that many podiatrists do not participate in the Diabetic Therapeutic Shoe Program. When I ask them why they do not, some of the answers include:

   • It is too much of a hassle in the office.
   • I do not want to have an inventory of shoes.
   • I do not have a durable medical equipment (DME) provider number.
   • I do not know how to start.
   • I have heard the billing is a problem for the office.
   • I am not a shoe salesman.

   If we as podiatrists do not run the diabetic shoe program in our offices, then others will fill the vacuum. As with other programs, some have abused the shoe program. The best way to ensure this does not happen is to make our referring physicians and patients aware that we are the experts who control the program and provide the service.

Who Qualifies For The Shoe Program?

   Diabetic shoes, inserts and/or modification to the shoes are covered if the patient meets the following criteria:

1) the patient has diabetes mellitus (ICD-9 diagnosis codes 250.00-250.91); and
2) the patient has one or more of the following conditions: