Why Did DPMs Miss The Boat On Therapeutic Diabetic Hosiery?

Doug Richie Jr. DPM FACFAS

While the incidence of diabetes and foot-related complications continues to spiral out of control in this country, medical professionals need to step back and evaluate their role in preventive medicine.

Most of my podiatric colleagues are unaware of the significant role that the Internet and direct-to-consumer businesses have in the care of the patient with diabetes. Today, millions of patients with diabetes turn to the Internet and commercial companies to provide information and products to prevent the complications of diabetes.

A clear example of this issue is the growth of the therapeutic hosiery industry, which provides products designed for the patient with diabetes. Companies sell the hosiery almost exclusively to the patient outside of the normal professional referral/delivery system.

Over 18 years ago, I published research and developed specialized hosiery for protection of the diabetic foot. I spent eight years teaching and persuading doctors to embrace hosiery as a preventive modality for the diabetic foot. However, my efforts and those of other noted authorities who tried to preach this new intervention had clearly failed. Soon after that, the Internet emerged as a major tool for medical education and provider of therapies and interventions, which patients accessed directly without the input of doctors.

Today, therapeutic hosiery is a $250 million industry, fueled solely by the patient who is interested in prevention of skin ulcerations and potential amputation. While doctors failed to see the potential of therapeutic hosiery, patients became their own advocates and sought this simple intervention as an effective preventive modality. Many other products are now available on the Internet with proposed preventive benefits for patients with diabetes.

When will doctors intervene and become the advocates for legitimate preventive treatments? When will we dispel other gimmicks that have no therapeutic merit?


Here in Oklahoma where patients won't pay for anything out of pocket, I strive to educate diabetic patients on the importance of investing in the proper socks. But most of them would rather hold on to their $15 than play a part in their foot health. It's frustrating to say the least. Peg Mitchel, C.Ped.
Doug Richie Jr. DPM FACFAS's picture

Peg, This is my point exactly. When we assume that our patients won't pay for anything out of pocket, we find out later that these patients willingly do so. Most of my colleagues had the same assumption in the mid 1990's that most patients would not pay any amount over $2.00 for "socks" and closed their minds to the option to recommend or sell properly designed hosiery products to patients with high risk feet. Ten years later, we find that these same patients are spending millions of dollars for so-called "diabetic socks" with many products having no merit whatsoever. Doctor recommended products fell by the wayside while the best internet marketeers succeeded. Many other sham footcare products are being sold to our diabetic patients on the internet. It is time for us to wake up and propose a position statement about this practice. Doug Richie D.P.M.

Dittos to Peg Mitchel's comment for Southern California, San Diego County. I have handed out to every patient I dispense diabetic shoes to since shortly after I started dispensing DM Shoes in 2003 the following. The handout consists of your article Diabetic Hosiery, BioMechanics December 1996, Excerpts from your lectures on dispensing AFOs, AAPSM handout Sports Medicine Sock Guidelines. I have seen socks marketed and labeled as "diabetic socks" dispensed from a podiatrist's office that were all cotton. I talked to him about it. He was simply unaware of the materials used in the socks and, not aware of the materials that should be used in diabetic socks. I have seen some less expensive diabetic socks ~$6 in Target. They were acyrlic blend and seemed of a quite adequate design and workmanship. Bruce T. Hutchinson, D.P.M.

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