The diabetic shoe bill provided through Medicare is a great program.  This bill provides diabetic patients on Medicare an opportunity to get one pair of shoes and three sets of inserts annually.  Like all Medicare programs, there are abuses of this coverage by providers, suppliers and patients but overall I find it rewarding to prevent future severe foot complications in situations where the shoes are needed.  Not all patients qualify for the shoe bill.  Diabetic patients who have diabetes with peripheral vascular disease, neuropathy, a history of amputation or many variances from these basic qualifiers are allowed to participate.  My blog today is not so much about the program’s operations but more about the shoes provided.

The primary purpose of the program is to provide shoes that reduce pressures on the foot and therefore reduce the risk of ulcerations that often times lead to infections and amputations.  In my book, this is a worthy goal.  However, if I am allowed to rant a bit today, I feel that too often diabetic shoes are made so soft and “squishy” (lol) that patients begin to have additional problems with their feet.  Particularly those patients who happen to have the qualifying conditions to get the shoes but are still very active.  It is almost like walking around on pillows all day or spending many hour walking the beach barefoot.

Our feet need some help.  Particularly when they have spent a lifetime in a supportive environment such a good leather lace-up shoe with an arch support or when arthritis has begun to show itself.  To take that foot, and then one day put it in a soft foam-like upper with a heat mold-able plastic insole (plastazote) gives the foot little help and leads to fatigue, contracture of the lesser toes trying to stabilize the foot and can ultimately increase pressure in some spots.

My request for each of you considering diabetic shoes is to make sure they are as supportive as possible considering your foot condition and as functional as possible considering your activity level.  If you are active it is very likely you will need additional arch support in your new shoes and not just cushions!  I’m talking about semi-rigid plastic, cork, felt and many other material options that will help you propel more efficiently and reduce stress and strain.

Be sure to find an expert in diabetic shoes and ask questions about the shoes that are being made for you because they should help your foot situation…not make it worse.

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