Diabetic Foot Care - Types of Shoes

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Betty McTague
Presents
The L.E.A.P. Program

TYPES OF SHOES

DESCRIPTIONS

Comfort shoe: Shoe that promotes foot health and assists in prevention of foot problems. A comfort shoe may be of therapeutic value, and in such cases is usually fitted by a certified pedorthists (C. Ped.) or an experienced trained shoe fitter. At a minimum, a comfort shoe has the following features:

1. Deep broad toe box
2. Removable and flexible inlays
3. Last shape compatible with foot shape
4. Availability in an expanded range of sizes
5. Leather or material of equal quality
6. Impact, shock absorbing material(s).

Interim Shoe: medically indicated temporary shoe that permits ambulation and facilitates wound healing or post trauma recovery for the involved foot. An interim shoe has, at a minimum, the following features:

1. Appropriate adjustable closure
2. Construction suitable for community ambulation, defined as allowing independent ambulation.
3. Construction with lightweight materials that can be hygienically maintained.
4. Size of sufficient volume to appropriately accommodate patient’s condition.
5. Cushion inlay of appropriate thickness.

Medical-grade Shoe(does not include interim shoes, as defined above); medically-indicated shoe designed to accommodate a condition, pathology or to alter lower extremity biomechanical function. Medical-grade shoes are appropriate when the deformity or medical condition or pathology precludes accommodation by standard over the counter shoes. Medical-grade shoes are likely to be depth shoes, custom-molded shoes or manufactured over a modified last to address the needs or the individual. Medical-grade shoes are usually fit by a qualified health professional specially trained in fitting specialized footwear or a certified pedorthist. A medical-grade shoe must have at least the following features:

1. Blucher or lace to toe /surgical opening pattern with some form of shoe closure.
2. Leather upper, or a suitable upper material of equal quality
3. Sole attached by sewn or cement process
4. Adaptability of shoe upper and sole materials to accommodate modifications and modalities
5. Sole graded to the size and width of the upper, in accordance with the American standard last sizing schedule or its equivalent, unless the shoe is custom-made or custom-molded
6. Firm, extended medial heel counter unless the patient’s condition indicates otherwise. A firm extended medial heel counter reaches at least midway through the longitudinal arch.
7. Availability in full and half sizes and multiple widths, unless custom-made or custom-molded. Adult medical grade footwear must be available in a complete range of 13 or more full sizes and half sizes and at least four widths; children’s medical grade footwear must be available in two or more widths
8. Smooth, moisture/vapor absorbent protective lining
9. Last shape that accommodates forefoot contours and deformities
10. The differential between sole thickness and heel height does not exceed 1 ¼" with the exception of fixed or spastic equinus pathology
11. Capacity to address medical conditions of the foot that the standard ready made footwear cannot address

A medical-grade shoe may meet standards other than Medicare’s regulations for Therapeutic Shoes for Diabetics.

Standard Over-The -Counter Shoe: any ready-made shoe for the general populace. Shoes come in a variety of styles, including dress, casual, work and athletic. This type of shoe is not therapeutic and must never be fitted or dispensed as a therapeutic type of shoe.

Therapeutic Shoe: medically-indicated shoe that can be a medical-grade shoe, a depth shoe, or a custom shoe and is accommodative or functional. Therapeutic shoes are usually fit by a health professional specially trained in this type of fitting or by a certified pedorthists.

The following definitions have been taken directly from the United State’s Medicare’s Part B Medical Policy for Therapeutic shoes for Diabetics:

1. A depth shoe is one that:

has a full length, heel-to toe filler that when removed

provides a minimum of 3/16" of additional depth used to

accommodate custom-molded or customized inserts

is made from leather or other suitable material of equal quality

Has some form of closure(velcro, lace or zipper)

is available in full and half sizes with a minimum of three width so that the sole is graded to the size and width of the upper portions of the shoe according to the American standard last sizing schedule or its equivalent. ( The American last sizing schedule is the numerical shoe sizing system used for shoes in the United States.) This includes a shoe with or without a seamless toe.

2. A custom-molded shoe is one that:

is constructed over a positive model / mold of a patient’s foot

is made of leather or other suitable material of equal quality

has removable inserts which can be altered or replaced as the patient’s condition warrants

has some form of shoe closure (lace, velcro, zipper). This includes a shoe with or without an internally seamless shoe

For more information e-mail Betty

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