Will Medicare cover the cost of a diabetic shoe? 

Effective December 1, 2016.  Next Step Foot & Ankle Clinic will not be participating in any insurance carrier’s diabetic shoe program.  This includes the Medicare Therapeutic Shoe Program.  We will continue to offer Diabetic Shoes for those who wish to pay for the shoes and inserts on their own.       Diabetes can be dangerous to your feet. Even a small cut can have consequences. Diabetes may cause nerve damage that takes away the feeling to your feet, making it harder to heal an injury or resist infection. In 1993, Congress passed the Medicare Therapeutic Shoe Bill, which allows qualified persons to receive Medicare assistance for protective shoes and inserts. Diabetic shoes and prescription inserts are intended to help prevent more serious foot health complications that can arise as a result of diabetes.

Can you answer yes to any of these foot problems?

Poor CirculationFoot DeformitiesPre-ulcerative callus formulation or peripheral neuropathy with a history of callus formationHistory of previous foot ulcerationPrevious amputation of the foot or part of the foot

If you are a qualifying diabetic, Medicare and your supplemental insurance may reimburse for all or part of the cost of your Dr. Comfort shoes and prescription inserts. Medicare allows one pair of Diabetic shoes per calendar year for patients who are being treated by their Primary Care Physician for diabetes or other qualifying peripheral vascular disease. Medicare requires a few things of their patients who want their diabetic shoes to be covered:

Patient must be in a current treatment regimen by their Primary Care Physician for a qualifying condition such as diabetes or peripheral vascular disease.We must submit to Medicare clinical notes from your Primary Care Provider showing a face to face visit with your Medical Doctor (not a Physician’s Assistant or Nurse) within the previous 6 months. These notes must document treatment of diabetes or the qualifying condition and must be signed and dated by the MD who provided the clinical notes.In addition, your MD must sign and date a Certifying Physician Statement noting the condition that qualifies you for Diabetic Shoes under the Medicare program and at least one other condition, such as a deformity that requires accommodation, peripheral neuropathy with callus formation.

Next Step Foot & Ankle Clinic will provide you with a brochure you can take to your Primary Care Physician that is managing your diabetes to see if you qualify and get your paperwork started. This brochure explains the process for both you and your doctor and includes simple 1-2-3 instructions, along with the forms your doctor will need to complete. It also has some important facts about diabetes foot health.  As with all Medicare claims, Medicare pays 80% after the annual deductible is met, and the patient is responsible for their 20%. We will work with you to see if this is a covered benefit for you. We submit claims to Medicare for our patients electronically. Private insurance and cash patients may also obtain shoes from our office.   Please call us to begin your claim at 210.375.3318.   What foot conditions are associated with diabetes? 

People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications.

Neuropathy Although it can hurt, diabetic nerve damage can also lessen your ability to feel pain, heat, and cold. Loss of feeling often means you may not feel a foot injury. You could have a tack or stone in your shoe and walk on it all day without knowing. You could get a blister and not feel it. You might not notice a foot injury until the skin breaks down and becomes infected.

Skin Changes Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your foot no longer work.

Calluses Calluses occur more often and build up faster on the feet of people with diabetes. This is because there are high-pressure areas under the foot. Too much callus may mean that you will need therapeutic shoes and inserts.

Foot Ulcers Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb.

Poor Circulation Poor circulation (blood flow) can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. You can control some of the things that cause poor blood flow. Don’t smoke; smoking makes arteries harden faster. 

Amputation People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have peripheral arterial disease (PAD), which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footwear.

Dr. Darren Silvester and the staff at Next Step Foot & Ankle Clinic are dedicated to treating your diabetic feet and finding you the relief you need. Contact our office in Universal City, Texas today by calling 210-375-3318 or our Pleasanton, TX office at 830-569-3338 to start effectively managing your diabetes and foot health. What is the benefit of diabetic shoes? 

Shoes for people with diabetes have a higher, wider toe box, giving your toes extra wiggle room. Toes that rub against each other or against a shoe get hot spots and blisters. Those do not heal as fast as they did before diabetes. Nerve damage caused by diabetes can make your toes feel numb. If this is the case, they cannot warn you when they are rubbing and blistering. The extra room in diabetes shoes protects your toes while you stand and walk. Now that you have diabetes, you need shoes that support your arches, ankles, and heels. Going barefoot is out. Flip-flops are out. Some people may overpronate (roll the feet too far inward) or underpronate (not roll the feet inward enough) when walking, which can also cause hot spots that may develop into blisters and sores. So the soles of shoes for people with diabetes have special stabilizers to keep feet level. You will notice that the soles are thick and wide. Thicker soles cushion your feet from wear and tear, and that little bit of extra width helps your feet to avoid those hot spots. Shoes made for people with diabetes also tend to be deeper than other shoes to make room for orthotics — the inserts that correct an uneven stride, cushion the heel, or support arches. Many patients with Type 2 diabetes use these inserts, so we need the extra depth. We are pleased to offer DJO (formerly Dr. Comfort) and SafeStep Shoes. Fitting is done in our office by our trained medical assistants, and shoes typically arrive in two weeks. Dr. Silvester and Dr. Danial will provide any needed follow-up and can modify insoles to ensure a proper and safe fit.  Next Step Foot & Ankle Clinic offers Diabetic Shoes on a self-pay basis.  We do not participate in any insurance carrier’s diabetic shoe program.  This includes the Medicare Therapeutic Shoe Program.  

What are diabetic compression stockings? 

Compression Stockings are used not only to help decrease swelling in your legs, but to also help prevent the formation of blood clots in the lower legs, as well as aiding in the treatment of ulcers of the lower legs. The majority of venous ulcers heal with compression bandages, however ulcers frequently recur. Clinical guidelines therefore recommend that people continue to wear compression, usually in the form of hosiery (tights, stockings, socks) after their ulcer heals, to prevent recurrence.

Why do I need diabetic socks? 

Diabetes causes nerve damage and reduced circulation that can be hazardous to your feet. Deterioration of your peripheral nerves reduces sensation in your extremities, so you may not feel it when you hurt your feet.  Poor blood circulation can also make it difficult for foot injuries and infections to heal. That’s why even a small bump or cut can result in serious consequences if it goes without timely medical attention. If you have diabetes, the right socks can be one of your best protectors from painful foot problems, like those associated with diabetic neuropathy (nerve damage). Learn what to look for when you stock up on socks. Most diabetic socks are seam-free to prevent irritation on your toes, stretchy and non-binding to help promote circulation and cushioned to protect feet from shock and pressure. Is Charcot foot treatable? 

Charcot foot is treatable, though the extent of the therapy you need will depend on how much damage your foot sustained. Some Charcot foot treatment is conservative. Your foot will need to be immobilized in a cast or special boot. This helps reduce the swelling in your lower limbs, as well as keep the damaged bones in the proper place so that they heal correctly. You’ll need to avoid all weight-bearing on the affected foot for a time. Once the bones have healed enough, you will also need to wear special orthotic shoes to support your lower limbs and protect them from ulcers in the future. More severe deformities will need surgery to reconstruct the collapsed arch, remove bony prominences, and lengthen tightened tendons. After your foot is surgically repaired, it will be casted and allowed to heal. This whole process takes several months, but without it, your foot will be permanently deformed. If you have diabetic foot problems and are concerned about Charcot foot, let Dr. Darren Silvester at Next Step Foot & Ankle Clinic in Pleasanton, TX, know. Call (210) 375-3318 or use our website form to request an appointment. What is osteomyelitis? 

Osteomyelitis is an infection in bone tissue. It usually develops when bacteria travels through the blood stream or migrates from neighboring tissues. Your bones can also be infected directly if an injury exposes the bone tissue to pathogens. The bacteria can quickly destroy the bone and become deadly if it’s not treated promptly. Diabetic feet have a particularly high risk for this infection. Diabetes increases your chances for wounds that open up the foot to pathogens. The disease also impairs your immune system, so your body has a hard time fighting any bacteria. The pathogens are then able to migrate from the soft tissues in your lower limbs to your bones. Osteomyelitis is a dangerous infection that needs aggressive treatments. If you develop a deep, painful foot infection and fever, especially after an injury, contact Dr. Darren Silvester and our team at Next Step Foot & Ankle Clinic in Pleasanton, TX, promptly. Call (210) 375-3318 to make an appointment to take care of the problem.